Anti–Vascular Endothelial Growth Factor Therapy for Diabetic Retinopathy: Consequences of Inadvertent Treatment Interruptions - Wubben, T.J.; Johnson, M.W.; Sohn, E.H.; Peairs, J.J.; Kay, C.N.; Kim, S.J.; Gardner, T.W.; Paulus, Y.M.; Zacks, D.N.; Steinle, N.C.; Avery, R.L.; Berrocal, M.H. (American Journal of Ophthalmology, 2019)
Purpose: To illustrate that patients with diabetic retinopathy who are treated exclusively with anti–vascular endothelial growth factor (VEGF) therapy and have an interruption in treatment may experience marked progression of disease with potentially devastating visual consequences. Design: Retrospective, multicenter, case series. Methods: Retrospective review of patients treated exclusively with anti-VEGF therapy for proliferative diabetic retinopathy (PDR) or nonproliferative diabetic retinopathy (NPDR), with or without diabetic macular edema (DME), and temporarily lost to follow-up. Baseline disease characteristics, cause and duration of the treatment interruption, and resulting disease progression, complications, and outcomes were assessed. Results: Thirteen eyes of 12 patients with type 2 diabetes were identified. The mean age was 57 ± 10 years, and 50% were women. Anti-VEGF therapy was indicated for PDR with DME in 7 (54%) eyes, PDR without DME in 3 (23%) eyes, and moderate to severe NPDR with DME in 3 (23%) eyes. Eight eyes had visual acuity (VA) of 20/80 or better before treatment interruption. The median duration of treatment hiatus was 12 months. Reasons for treatment interruption included intercurrent illness (31%), noncompliance (31%), and financial issues (15%). Complications upon follow-up included vitreous hemorrhage (9 eyes), neovascular glaucoma (5 eyes), and traction retinal detachment (4 eyes). Despite treatment of these complications, 77% of eyes lost ≥3 lines of VA, with 46% of eyes having a final VA of hand motion or worse. Conclusions: Diabetic patients are subject to significant lapses in follow-up because of illness, financial hardship, or noncompliance. In patients with diabetic retinopathy, especially PDR, who are managed with anti-VEGF therapy alone, unintentional treatment interruptions can result in irreversible blindness.
Keywords: aflibercept; bevacizumab; ranibizumab; vasculotropin inhibitor; adult; aged; article; blindness; case study; clinical article; comorbidity; diabetic macular edema; disease course; disease severity; drug withdrawal; female; financial deficit; follow up; human; male; middle aged; neovascular glaucoma; nonproliferative diabetic retinopathy; patient compliance; priority journal; proliferative diabetic retinopathy; retina detachment; retrospective study; treatment duration; treatment outcome; visual acuity; vitreous hemorrhage

Awareness of ocular diagnosis, transportation means, and barriers to ophthalmology follow-up in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study - Hark, L.A.; Radakrishnan, A.; Madhava, M.; Anderson-Quiñones, C.; Fudemberg, S.; Robinson, D.; Myers, J.S.; Zhan, T.; Adeghate, J.; Hegarty, S.; Leite, S.; Leiby, B.E.; et al. (Social work in health care, 2019)
Purpose: The purpose of this study was to assess factors affecting follow-up eye care in participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study, such as awareness of ocular diagnosis, availability of transportation methods, and reasons for missing eye care appointments. Methods: The sample included 172 participants who were randomized to the intervention group and contacted by the social worker. Results: A total of 155 participants completed the assessment form, which was used as an instrument to assess factors affecting adherence to follow-up eye care. The main reasons for missing eye exam appointments were feeling ill (38.1%, n = 59) and forgetting the appointment (34.2%, n = 53). In addition, 45 (29.2%) participants were unaware of or did not comprehend the severity of their ocular diagnosis. Common methods of transportation included public transportation (31.6%, n = 49), driving (29.7%, n = 46), and being driven (27.7%, n = 43) to their appointment. Conclusion: These results suggest that individuals in need of eye care may benefit from additional assistance of a social worker regarding ongoing eye exam appointment reminders and in-depth explanation of their ocular diagnosis.
Keywords: adult; aftercare; age; aged; controlled study; female; glaucoma; health care delivery; hospital management; human; male; middle aged; ophthalmology; organization and management; patient compliance; Pennsylvania; randomized controlled trial; risk factor; severity of illness index; sex factor; social work; socioeconomics; telemedicine; very elderly

Primary Care Spending in the Fee-for-Service Medicare Population - Reid, R.; Damberg, C.; Friedberg, M.W. (JAMA Internal Medicine, 2019)
Keywords: acute heart infarction; aged; Alzheimer disease; anemia; asthma; atrial fibrillation; breast cancer; cataract; cerebrovascular accident; chronic kidney failure; chronic obstructive lung disease; colorectal cancer; congestive heart failure; dementia; depression; diabetes mellitus; endometrium cancer; female; glaucoma; health care personnel; health care utilization; health center; hip fracture; human; hyperlipidemia; hypertension; hypothyroidism; ischemic heart disease; letter; lung cancer; major clinical study; male; medicaid; medical fee; medicare; multiple chronic conditions; osteoarthritis; osteoporosis; patient counseling; pelvis fracture; prescription; primary medical care; priority journal; prostate cancer; prostate hypertrophy; rheumatoid arthritis; rural health care; transient ischemic attack; very elderly

Cost and Visit Duration of Same-Day Access at an Academic Ophthalmology Department vs Emergency Department - Singman, E.L.; Smith, K.; Mehta, R.; Boland, M.V.; Srikumaran, D.; Frick, K.; Young, L.; Locco, G.; Tian, J.; Kowalewski, C.; McDonnell, P. (JAMA Ophthalmology, 2019)
Importance: Convenient outpatient access for ophthalmology patients seeking urgent care could offer savings compared with an emergency department (ED) visit. Objective: To evaluate the costs and visit durations of same-day access (SDA) in an ophthalmology department at an academic medical center vs ED care. Design, Setting, and Participants: This single-center study was a retrospective quality improvement analysis of an institutional electronic medical record system at the Wilmer Eye Institute clinics and the Johns Hopkins Hospital ED. On June 1, 2015, the Wilmer Eye Institute and Johns Hopkins Hospital initiated an official policy of providing SDA to patients calling for appointments (ie, the same-day project). All ophthalmology clinic locations created same-day appointment slots for at least 1 practitioner. In recognition of seasonal variations in patient visit volumes, the 10 months before implementation (August 1, 2014, to May 31, 2015) were compared with complementary periods in 2015 to 2016 and 2016 to 2017. Main Outcomes and Measures: The study tabulated encounters, charges, and visit length for outpatients seen on the same day or by previously scheduled appointments. For the ED patients, volume, diagnoses, charges, and length of stay data were collected. The numbers of SDA patients who indicated urgency were tabulated. Results: The number of SDA patients increased from 22 781 to 26 579 for the first year after SDA implementation. The mean charge was $258 (95% CI, $250-$266; median, $184; interquartile range [IQR], $175-$320), and the mean clinic transit time was 1.55 hours (95% CI, 1.54-1.57 hours; median, 1.28 hours). For patients seeking eye care in the ED, the mean professional fee was $401 (95% CI, $390-$411; median, $360; IQR, $255-$500), the mean (SD) total hospital charge was $1040 ($999) (95% CI, $729-$1079; median, $1002; IQR, $334-$1429), and the mean length of stay was 7.30 hours (95% CI, 7.01-7.57 hours; median, 7.20 hours). The top 4 ophthalmic diagnoses for ED patients were conjunctivitis, cornea abrasion, iritis, and visual loss, which were unchanged after SDA implementation. In calendar year 2017, a total of 4062 SDA patients reported urgency; their estimated savings in charges compared with an ED visit were $580866 in professional fees and $3176484 in hospital charges. Conclusions and Relevance: Same-day access appears to be less expensive and to require less time in the health care system than a visit to the ED for an ophthalmic diagnosis. Substantial savings in time and money might be achieved if urgent eye care is delivered in the clinic rather than the ED.
Keywords: article; cellulitis; conjunctivitis; cornea ulcer; dry eye; electronic medical record system; emergency ward; eye care; eye pain; glaucoma; health care access; health care cost; health care policy; hordeolum; hospital charge; human; hyphema; intraocular foreign body; iritis; keratitis; length of stay; ophthalmology; optic nerve disease; optic neuritis; orbit fracture; priority journal; retina blood vessel occlusion; retina tear; retrospective study; seasonal variation; total quality management; visual impairment; vitreous body detachment; vitreous hemorrhage

Topical glucocorticoids and risk of type 2 diabetes mellitus - Johns, E.C.; Reynolds, R.M. (Nature Reviews Endocrinology, 2019)
A positive association between topical corticosteroid use and risk of type 2 diabetes mellitus has been reported in a large European population-based study. However, the increase in risk is small and should not influence the prescribing of topical corticosteroids when clinically indicated.
Keywords: antihypertensive agent; antilipemic agent; glucocorticoid; glucose; insulin; insulin receptor; adipose tissue; bacterial skin disease; Cushing syndrome; Danish citizen; Denmark; dermatitis; diagnostic error; disease association; disease severity; dose response; drug exposure; drug potency; drug use; eczema; ethnicity; follow up; glaucoma; gluconeogenesis; glucose blood level; glucose metabolism; health care; health care personnel; human; hyperglycemia; hypothalamus hypophysis adrenal system; incidence; insulin release; intraocular hypertension; juvenile osteoporosis; liver tissue; long term care; molecular weight; muscle tissue; mycosis; non insulin dependent diabetes mellitus; note; pancreas islet beta cell; pathogenesis; patient compliance; patient risk; prescription; priority journal; psoriasis; risk factor; Singapore; smoking; social status; treatment duration; United Kingdom

Clinical presentation, comorbidities and healthcare utilization of patients with dry eye and Meibomian gland dysfunction-a United States database analysis - Ruppenkamp, J.; Folly, E.; Holy, C.; Blackie, C.A. (Investigative Ophthalmology and Visual Science, 2019)
Purpose : Meibomian Gland Dysfunction (MGD) is a common condition leading to dry eye and general ocular surface compromise. Clinical trial data suggests a prevalence of nearly 50% in the elderly. Despite high disease state prevalence, there is an absence of published reports of patient pathways, diagnostics and treatments, and overall healthcare utilization (HCU), when diagnosed with MGD. Methods : The IBM MarketScan® Commercial and Medicare databases were queried. Patients with MGD and dry eye were identified. All patients had at least 12 months continuous medical and prescription drug enrollment pre-and 6 months post-index. Charlson and Elixhauser comorbidity indices as well as ocular conditions and presence of Sjögren's disease were analyzed for all patients. The HCU related to ocular conditions were analyzed and yearly payments for eye care were calculated and adjusted for inflation using 2017 consumer price-index. Results : 2,738 commercially-insured and 965 Medicare patients were included, 82.5% > 45 years, 69.3% female, 29% with Elixhauser index > 2. Comorbidities included hypertension (38.7%), hypothyroidism (18.1%), diabetes (13.4%), depression (14.6%) and chronic pulmonary disease (14.2%). Ocular conditions identified at index were: cataract: 19.2%, glaucoma: 9.6%, conjunctiva-related disorders (CRD): 13.2%, lachrymal system disorders (LSD): 74.0%. At 12 months post-index, CRD and LSD were still reported for 14.6% patients and 45.4% patients, respectively. In the 12-months post-index, only 49.3% patients had a subsequent eye exam (43.5% of commercially-insured and 65.2% Medicare patients), during which diagnostic procedures for tears analysis and dry eye were only performed on 12.7% patients (12.6% commercially-insured and 13.1% Medicare patients). From index to 12 months post, all eye-care related healthcare (excluding drugs) averaged US$ 288.73 (standard deviation (SD): $1,224.6) for commercially insured and US$ 639.07 (SD: $1,972.51) for Medicare patients. Conclusions : Patients diagnosed both dry eye and MGD were mostly older than 45, with multiple comorbidities. In stark contrast to the high disease prevalence reports in the peer reviewed literature, MGD and dry eye patients appear to receive a bare minimum of diagnostic testing and follow-up care.
Keywords: prescription drug; aged; cataract; chronic lung disease; conference abstract; conjunctiva; consumer; depression; diabetes mellitus; diagnosis; dry eye; Elixhauser comorbidity index; eye care; female; follow up; glaucoma; health care utilization; human; hypertension; hypothyroidism; lacrimal gland disease; major clinical study; male; medicare; meibomian gland dysfunction; prevalence; United States

Understanding barriers to glaucoma treatment adherence among patients in South India - Killeen, O.; Pillai, M.; Udayakumar, B.; Shroff, S.; Vimalanathan, M.; Cho, J.; Newman-Casey, P.A. (Investigative Ophthalmology and Visual Science, 2019)
Purpose: Data on barriers to glaucoma treatment adherence in South India is limited; improved knowledge of these barriers is needed to advance disease self-management programs. Patient counseling based on Self-Determination Theory (SDT) has been shown to improve treatment adherence. We aimed to use the theoretical framework of SDT to understand barriers to glaucoma treatment adherence in South India to inform future Methods: Glaucoma patients ≥ 18 years old taking ≥1 glaucoma medication were approached in the waiting rooms at the Aravind Eye Hospital (Madurai, India). Patients were screened with a validated medication adherence tool and those who were nonadherent or >3 months late for follow-up were invited to participate in semi-structured interviews on barriers to glaucoma treatment. Interviews were audio-recorded, transcribed, and translated into English. Two researchers identified themes and coded the transcripts. Results: 70/167 (42%) did not adhere to drops. The 45 interviewed were 62 ±12 years old and took 1.6 ± 0.7 drops. 42 (93%) were not adherent to glaucoma mediation and 21 (47%) were late for follow-up. Key barriers to medication adherence were difficulty obtaining drops (20, 44%), being busy (18, 40%), and expense (17, 38%). Key barriers to follow-up were distance to hospital (21, 47%), expense (20, 44%), and lack of escort (15, 33%). These barriers can be grouped into the three basic psychological needs of SDT modified for an Indian context: relatedness, competence, and autonomy of the family. Conclusions: Previously, only 6% of glaucoma patients surveyed in South India selfreported medication non-adherence; our finding of 42% non-adherence is more in line with glaucoma medication adherence rates around the world. Previous studies identified barriers to glaucoma treatment adherence in South India using surveys and questionnaires; to our knowledge, this is the first study to use semi-structured interviews to elicit rich qualitative data on treatment barriers in this population. We found that complex factors cause high rates of glaucoma treatment non-adherence in South India. In the past, counseling that provided intellectual information about glaucoma did not improve treatment adherence at Aravind. An approach based on SDT modified for an Indian context, in which counseling aims to support patients' and their families' motivation for behavior change, may be more impactful.
Keywords: adult; behavior change; conceptual framework; conference abstract; controlled study; counseling; follow up; genetic transcription; glaucoma; human; India; medication compliance; motivation; questionnaire; semi structured interview; theoretical study; waiting room

Predictors of non-adherence to follow-up after cataract surgery: Results from the PCIOL study - Moustafa, G.A.; Borkar, D.S.; Eton, E.A.; Koulisis, N.; Kloek, C.E. (Investigative Ophthalmology and Visual Science, 2019)
Purpose : Nonattendance of patient postoperative appointments is associated with risk for non-detection of disease, decreased clinical efficiency, underutilization of administrative and clinical resources, and revenue loss. We seek to identify factors that predict nonadherence to follow-up after cataract surgery. Methods : Medical records of patients who underwent cataract extraction with intraocular lens implantation by phacoemulsification at the Comprehensive Ophthalmology Service, Massachusetts Eye and Ear (MEE), between January 1, 2014 to December 31, 2014, were reviewed. Non-adult, second eye cases, and cases on days of heavy snowfall were excluded. The association of missed visits with variables, such as age, gender, race, smoking status, drinking status, insurance type, travel time to the hospital, ocular comorbidities, major medical comorbidities, major mental comorbidities, intraoperative complications, preoperative visual acuity, whether cataract surgery was combined with another ocular procedure (e.g. vitrectomy, glaucoma surgery), and whether a resident or an attending served as primary surgeon was investigated. Results : Of the 1099 cases identified, 133 (12.1%) had missed at least one postoperative follow-up visit. Three (0.3%), 29 (2.6%), and 113 (10.3%) cases did not attend their postoperative day 1, week 1, and month 1 appointment, respectively. Fourteen (1.3%) cases did not attend more than one appointment. Very old (≥90) and very young (<30) age (adjusted odds ratio [aOR]=8.85 and 47.62, 95% confidence interval [CI]=1.88-41.67 and 4.13-500, as opposed to middle-aged patients, respectively), smoking status (aOR=2.07, 95% CI 1.26-3.40, as opposed to non-smokers), public insurance (aOR=1.50, 95% CI 1.08- 2.08, as opposed to commercial insurance), longer travel time to the hospital (aOR=2.85, 95% CI 1.49-5.46, for more than two hours as opposed to less than an hour), absence of ocular comorbidities (aOR=1.68, 95% CI 1.23-2.30), and the presence of major mental comorbidities (aOR=2.56, 95% CI 1.89-3.45) were associated with non-adherence to followup in both the univariate and multivariate analysis. Conclusions : Certain patient-related factors are associated with higher risk of missing follow-up appointments after cataract surgery. Targeted interventions have the capacity to decrease the rate of missed visits in patients that are high-risk for non-adherence.
Keywords: adult; aftercataract; comorbidity; conference abstract; controlled study; ear; female; follow up; gender; glaucoma surgery; human; insurance; lens implantation; major clinical study; male; Massachusetts; medical record; middle aged; non-smoker; ophthalmology; people by drinking status; peroperative complication; phacoemulsification; preoperative evaluation; race; resident; travel; very elderly; visual acuity; vitrectomy

Follow-up Rates at a Free Ophthalmology Homeless Clinic - Hennein, L.; Spaulding, K.; Karlegan, V.; De Alba Campomanes, A. (Investigative Ophthalmology and Visual Science, 2019)
Purpose: To examine follow-up rates and barriers to care for patients referred from a free ophthalmology homeless clinic. Methods: This retrospective cohort included 68 patients who were evaluated at a free, monthly ophthalmology clinic from September 2017 to 2018 at a local homeless shelter. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a partnering nonprofit organization. Follow-up rates were calculated. Categorical variables were compared with chi-squared testing to determine their association with follow-up rates. Results: Of the 68 patients, 40 (59%) were referred to a partnering nonprofit organization for free eyeglasses and 17 (25%) were referred to a local county hospital for advanced ophthalmologic care. Of those referred, 7 patients (41%) presented to their county hospital appointment while 14 patients (35%) presented to the nonprofit organization for free eyeglasses. Fifty-two percent of patients with a pre-established primary care provider (PCP) presented to their referral appointment while only 20% of patients without a PCP presented to their appointment (p = 0.025). Nineteen of the 43 patients (44%) who completed at least a high school education presented to their referral appointment while all patients without a high school diploma failed to present to their appointment (p = 0.037). Vision-threatening conditions identified at the homeless clinic did not significantly affect follow-up rates: patients with diabetic and hypertensive retinopathy, afferent pupillary defects, glaucoma/glaucoma suspect, and visual field defects were not more likely to present to their referral appointment at the county hospital compared to those without vision-threatening conditions (p = 0.79). Conclusions: In the current literature, there is limited knowledge of follow-up rates for ophthalmologic diseases and refractive error among those without permanent housing. In our study, less than half of referred patients presented to their appointments. Barriers to presentation included no PCP and lower educational status. There was no improvement in follow-up rates among those being referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be beneficial, particularly in those not looped into the healthcare system and those of lower educational attainment.
Keywords: adult; afferent pupillary defect; attention; cohort analysis; conference abstract; controlled study; diabetic retinopathy; educational status; eye care; female; follow up; glaucoma; health care system; high school; housing; human; hypertension retinopathy; major clinical study; male; mental capacity; non profit organization; ophthalmology; patient referral; primary medical care; refraction error; retrospective study; spectacles; treatment failure; visual field defect

Glaucoma disease characteristics and outpatient visit adherence among prisoners - Tiwana, M.S.; Kanu, L.; Dikopf, M.; Edward, D. (Investigative Ophthalmology and Visual Science, 2019)
Purpose : Treatment and follow-up adherence are important factors in the successful management of glaucoma, and are currently understudied in the prisoner population. In this study, we sought to compare the differences in demographics, disease characteristics, and follow-up times between incarcerated and non-incarcerated patients with glaucoma. Methods : We performed a retrospective chart review of UIC glaucoma visits from January 2015 to December 2017. All prisoners presenting to the glaucoma clinic over the study period were included. Age, sex, and race matched controls were selected from nonincarcerated patients in the same clinic over the same period of time. Demographics, clinical findings, interventions, and follow-up information were recorded. Statistical analysis included student t-test, one-way analysis of variance, or chi-squared test, as appropriate. Results : 14 prisoners and 24 non-incarcerated patients (controls) were included in the study. All patients were male. Mean age was 54.2 +/- 10.6 for the prisoners and 56.8 +/- 9.7 for the controls (p=0.44). A majority of patients were black (87.5% in controls and 78.6% in prisoners). Disease distribution was similar in both populations; primary open angle glaucoma (POAG) was the most common diagnosis (44.0% in prisoners, 37.5% in controls), followed by POAG suspect (24.0% in prisoners, 16.7% in controls). Prisoners were seen 2.1 times over the study period, while controls were seen 4.2 times. Follow-up adherence was significantly worse for prisoners versus controls. Follow-up visits for controls occurred 11.7 +/- 5.8 days later than their recommended follow-up date, while prisoners were seen 177.8+/-34.2 days later (p<0.0001). A substantially higher proportion of prisoner follow-up visits were delayed by at least one month when compared to controls (66.7% vs 12.3%, respectively). Ultimately, 42.8% of prisoners were lost to follow-up, compared to 12.5% of controls. Conclusions : Despite being in a regimented institution where transportation, appointment attendance, and medication administration are controlled, adherence to follow-up visits remains a significant problem among the prisoner population. Various social, logistical, and communication issues may contribute to adherence issues, and warrant further study.
Keywords: adult; analysis of variance; clinical article; conference abstract; controlled study; female; follow up; human; male; medical record review; middle aged; open angle glaucoma; outpatient; prisoner; race; retrospective study

Identifying Predictors of Patient no-shows in Pediatric Ophthalmology - Goldstein, I.; Lin, W.-C.; Reznick, L.G.; Chiang, M.F.; Hribar, M. (Investigative Ophthalmology and Visual Science, 2019)
Purpose: Office visits that patients miss without warning cause loss of revenue, decreased productivity, and potential risks to quality of care. Predicting which visits will be “no-shows” is challenging given the different reasons that patients miss appointments. Identifying predictors of no-show status would allow schedulers to mitigate these negative effects by overbooking scheduled office visits with a higher likelihood of being a no-show. This study uses EHR data and machine learning to identify important predictors of the no show status of office visits in pediatric ophthalmology. Methods: We used data from five pediatric ophthalmologists from 2015 through 2018 at OHSU in Portland, Oregon, as well as publicly available data from the national weather service to train a gradient boosting machine (GBM) model to predict whether or not patients would attend their appointments. The variables included in the model were: the ICD-10 code of the patient's previous visit, the month, the patient's insurance type, the visit type, the difference between the visit date and the date the visit was scheduled, the visit hour, rainfall, snowfall, hottest temperature, coldest temperature, number of previous no-shows, visit provider, patient age, number of previous same day cancellations, day of the week, clinic location, zip code by region, active patient portal account, number of non-same day cancels, and patient sex. We then used this model to identify the four most predictive variables of patient no show status. Results: In our data set of 8,673 visits, 1,280 or 17.3% were no show visits. The GBM model had an area under the ROC curve of 0.714. The four most predictive variables were the ICD-10 code of the patient's previous visit, the month, the patient's insurance type, and the visit type. Of these four variables, the following specific factors had the highest frequency of no-shows: the previous visit ICD-10 code was congenital ptosis, the visit occurred in July, the patient had out of state Medicaid insurance, and the reason for visit was a followup for glaucoma. Conclusions: Our analysis suggests a combination of environmental, clinical, and patient factors can be used to help predict when a visit will be a no-show. This is helpful for informing overbooking strategies as well as targeting interventions to improve the no-show rate among at risk populations.
Keywords: rain; ambulatory care; child; clinical article; conference abstract; congenital blepharoptosis; female; follow up; glaucoma; human; ICD-10; machine learning; male; medicaid; medical record; ophthalmologist; ophthalmology; Oregon; receiver operating characteristic

Novel Drug Delivery Systems for the Treatment of Glaucoma - Capitena Young, C.E.; Kahook, M.Y.; Seibold, L.K. (Current Ophthalmology Reports, 2019)
Purpose of Review: In this article, we review new and emerging drug delivery methods used in the treatment of glaucoma. Recent Findings: Several methods for sustained delivery of glaucoma medications have shown promise recently. Drug-eluting punctal plugs, contact lenses, and fornix-based silicone rings as well as subconjunctival and intracameral injections or implants are either in development or clinical trials. Thus far, those studied have demonstrated significant intraocular pressure (IOP) lowering ability with favorable safety profiles. However, long-term clinical safety data and comparative trials with existing therapies have been limited. Summary: Patient adherence with medication regimens remains a major obstacle in preventing glaucoma progression. Emerging patient-independent platforms that can deliver IOP lowering therapeutics hold promise for enhancement of adherence to treatments while remaining safe and effective. Each of these systems has their own unique advantages and disadvantages. It is still unclear where each of these products will fit into individual patient and practitioner treatment algorithms.
Keywords: contact lens; intravitreal implant; punctal plug; atropine; bimatoprost; latanoprost; timolol; travoprost; disease exacerbation; drug delivery system; drug efficacy; drug manufacture; drug tolerance; feasibility study; glaucoma; human; intracameral drug administration; intraocular pressure; particle size; patient compliance; patient safety; priority journal; review; subconjunctival drug administration; visual acuity

Urban diabetic retinopathy teleophthalmology screening: results and impact at the service corridor - Boucher, M.C.; El Yamani, M.E.M. (Canadian Journal of Ophthalmology, 2019)
Objective: To assess real-world results and the impact on a hospital service corridor for screening for DR through an urban community teleophthalmology service. Methods: Retrospective analysis at the hospital service corridor of 148 diabetics referred to it following DR teleophthalmology screening of 1185 type II diabetics. Results: Of the screened diabetics, 87.4% (n = 1036) were exempted from face-to-face clinical examination (FFCE) in a traditional hospital eye care pathway and continued monitoring through teleophthalmology under a watch-and-wait attitude, while 12.5% (n = 148) were recommended for an FFCE. The FFCEs revealed that significant DR was present in 48.2% or in 5.6% of this screened diabetic population. Reasons for referral were findings of significant DR in 40.5%, of which diabetic macular edema (DME) represented 86.6%, other incidental significant sight-threatening findings represented 32.4% (4% of the screened diabetics), and insufficient image quality was obtained for the other 27.0%. Optical coherence tomography (OCT) imaging at FFCE confirmed DME in 26.4% and led to treatment. Patients referred for insufficient image quality showed significant pathology in 90.2%, of whom 63.4% underwent further monitoring or treatment. The readers requested the FFCEs for 148 patients within 1 month of the reading in 19.6%, 3 months in 26.3%, 4–12 months in 47.3%, and 12 months in 6.7% over the 34 months of the study. Compliance with FFCEs was 91.9%, absolute in 78.4% and relative in 21.5%. The availability of OCT at the imaging site would have impacted 4.5% of the screened diabetics by enabling teleophthalmology monitoring of 91.6%, identifying just-in-time interventions for DME treatments in 26.4% and reducing by 25% the need for referral of OCT-negative reader-identified DME. Conclusion: The FFCEs generated at the hospital service corridor by an urban community DR screening teleophthalmology project did not impact negatively on its services; moreover, the service corridor was exempted from providing FFCEs to 87.4% of the diabetic population it serves. This study may help provide cost-efficiency indications for a screening protocol that would include OCT availability at the imaging site and measure its positive effects. While DR of which DME was the main cause of referral for FFCE, incidental significant sight-threatening findings were significant and approached DR as a cause of referral; this supports the recommendation of continued human intervention in DR teleophthalmology screening at this time and for this population, until automatic computer-aided diagnosis systems can recognise biomarkers associated with other significant fundus diseases. As a secondary gain this project benefited individuals in need of care who were lost to the traditional eye care pathway. Good compliance with the follow-up FFCE further supports teleophthalmology in its effort to provide better access to DR screening.
Keywords: vasculotropin inhibitor; adult; age related macular degeneration; article; capsulotomy; cataract; clinical examination; diabetic macular edema; diabetic patient; diabetic retinopathy; epiretinal membrane; eye care; eye examination; glaucoma; hospital service; human; hypertension retinopathy; image enhancement; image quality; insulin dependent diabetes mellitus; iridotomy; macular degeneration; major clinical study; microaneurysm; non insulin dependent diabetes mellitus; nonproliferative diabetic retinopathy; ophthalmology; optical coherence tomography; population research; proliferative diabetic retinopathy; pseudophakia; retina maculopathy; retrospective study; screening test; telemedicine; urban population; visual acuity; young adult

Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: The LiGHT RCT - Gazzard, G.; Konstantakopoulou, E.; Garway-Heath, D.; Garg, A.; Vickerstaff, V.; Hunter, R.; Ambler, G.; Bunce, C.; Wormald, R.; Nathwani, N.; Barton, K.; Rubin, G.; et al. (Health Technology Assessment, 2019)
Background: Newly diagnosed open-angle glaucoma (OAG) and ocular hypertension (OHT) are habitually treated with intraocular pressure (IOP)-lowering eyedrops. Selective laser trabeculoplasty (SLT) is a safe alternative to drops and is rarely used as first-line treatment. Objectives: To compare health-related quality of life (HRQoL) in newly diagnosed, treatment-naive patients with OAG or OHT, treated with two treatment pathways: topical IOP-lowering medication from the outset (Medicine-1st) or primary SLT followed by topical medications as required (Laser-1st). We also compared the clinical effectiveness and cost-effectiveness of the two pathways. Design: A 36-month pragmatic, unmasked, multicentre randomised controlled trial. Settings: Six collaborating specialist glaucoma clinics across the UK. Participants: Newly diagnosed patients with OAG or OHT in one or both eyes who were aged ≥ 18 years and able to provide informed consent and read and understand English. Patients needed to qualify for treatment, be able to perform a reliable visual field (VF) test and have visual acuity of at least 6 out of 36 in the study eye. Patients with VF loss mean deviation worse than –12 dB in the better eye or –15 dB in the worse eye were excluded. Patients were also excluded if they had congenital, early childhood or secondary glaucoma or ocular comorbidities; if they had any previous ocular surgery except phacoemulsification, at least 1 year prior to recruitment or any active treatment for ophthalmic conditions; if they were pregnant; or if they were unable to use topical medical therapy or had contraindications to SLT. Interventions: SLT according to a predefined protocol compared with IOP-lowering eyedrops, as per national guidelines. Main outcome measures: The primary outcome was HRQoL at 3 years [as measured using the EuroQol-5 Dimensions, five-level version (EQ-5D-5L) questionnaire]. Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness and safety. Results: Of the 718 patients enrolled, 356 were randomised to Laser-1st (initial SLT followed by routine medical treatment) and 362 to Medicine-1st (routine medical treatment only). A total of 652 (91%) patients returned the primary outcome questionnaire at 36 months. The EQ-5D-5L score was not significantly different between the two arms [adjusted mean difference (Laser-1st – Medicine-1st) 0.01, 95% confidence interval (CI) –0.01 to 0.03; p = 0.23] at 36 months. Over 36 months, the proportion of visits at which IOP was within the target range was higher in the Laser-1st arm (93.0%, 95% CI 91.9% to 94.0%) than in the Medicine-1st arm (91.3%, 95% CI 89.9% to 92.5%), with IOP-lowering glaucoma surgery required in 0 and 11 patients, respectively. There was a 97% probability of Laser-1st being more cost-effective than Medicine-1st for the NHS, at a willingness to pay for a quality-adjusted life-year of £20,000, with a reduction in ophthalmology costs of £458 per patient (95% of bootstrap iterations between –£585 and –£345). Limitation: An unmasked design, although a limitation, was essential to capture any treatment effects on patients’ perception. The EQ-5D-5L questionnaire is a generic tool used in multiple settings and may not have been the most sensitive tool to investigate HRQoL. Conclusions: Compared with medication, SLT provided a stable, drop-free IOP control to 74.2% of patients for at least 3 years, with a reduced need for surgery, lower cost and comparable HRQoL. Based on the evidence, SLT seems to be the most cost-effective first-line treatment option for OAG and OHT, also providing better clinical outcomes. Future work: Longitudinal research into the clinical efficacy of SLT as a first-line treatment will specify the long-term differences of disease progression, treatment intensity and ocular surgery rates between the two pathways.
Keywords: ISRCTN32038223; laser; antiglaucoma agent; eye drops; adult; allergy; article; biomedical technology assessment; bleeding; blepharitis; blurred vision; branch retinal vein occlusion; cataract; central retina vein occlusion; cerebrovascular accident; clinical effectiveness; clinical outcome; conjunctiva disease; conjunctivitis; controlled study; cornea ulcer; cost effectiveness analysis; depression; diabetic macular edema; diabetic retinopathy; disease severity; dry eye; epiphora; European Quality of Life 5 Dimensions questionnaire; evidence based medicine; eye discomfort; eye disease; eye pain; fatigue; female; glaucoma; health care cost; health economics; human; hyperemia; impotence; inflammation; intermethod comparison; intraocular hypertension; iris disease; laser surgery; laser trabeculoplasty; major clinical study; male; malignant neoplasm; medical device complication; medical fee; middle aged; mortality; multicenter study; national health service; nightmare; open angle glaucoma; optic disc hemorrhage; pain; patient compliance; perimetry; phacoemulsification; photophobia; pragmatic trial; preoperative evaluation; pruritus; quality of life; randomized controlled trial; rash; refraction error; retina detachment; retina macula hemorrhage; sensitivity analysis; side effect; skin disease; somnolence; subconjunctival hemorrhage; therapy effect; trabeculoplasty; uveitis; visual acuity; visual impairment; vitreous floaters

Measles hospitalizations at a United States Children's Hospital 2011-2017 - Hester, G.; Nickel, A.; LeBlanc, J.; Carlson, R.; Spaulding, A.B.; Kalaskar, A.; Stinchfield, P. (Pediatric Infectious Disease Journal, 2019)
Background: There are no recent descriptions of measles hospitalizations and complications in US children despite outbreaks within the past decade- including 2 in Minnesota (2011 and 2017). The objective of our study was to describe complications, hospital management and resource utilization for children hospitalized for measles at a US children's hospital. Methods: Retrospective case series of children (0-18 years of age) hospitalized for measles (observation/inpatient diagnosis code for measles) at Children's Minnesota, January 1, 2011, to September 1, 2017. Descriptive statistics were performed. Results: Thirty-three patients were included (7 from 2011 and 21 from 2017 outbreaks). Median age was 27 months (range, 6-95 months), 94% were Black or African American (73% Somali ethnicity), 88% had medical assistance and 91% were unvaccinated to measles. Poor feeding was a primary reason for admission (97%); additional complications included otitis media (42%), pneumonia (30%), tracheitis (6%) and keratitis (3%). Additional testing was common [chest radiographs (70%), blood cultures (64%), nonmeasles viral testing (42%)]. Seventy-three percent received antibiotics, 30% required oxygen and 21% received Vitamin A. Median length of stay was 3.7 days (range, 1.1-26.2 days); 1 patient was readmitted. Median direct cost in 2017 was $5291 (interquartile range : $3907-$7519), and estimated total cost to the hospital for the 2017 outbreak was $1.3 million. Conclusions: Clinicians should be aware of measles complications and treatment. Public and private health efforts should continue to focus on immunization, given significant implications of measles infections for patients and healthcare systems. Future studies may assess complications of measles across the United States as individual outbreaks often occur in specific populations, making generalization of results challenging.
Keywords: antibiotic agent; immunoglobulin; measles vaccine; retinol; African American; article; asthma; blood culture; cellulitis; child; child hospitalization; child nutrition; clinical article; dehydration; health care utilization; hospital cost; hospital management; human; immunofluorescence; infant; keratitis; measles; medical care; medical record review; otitis; otitis media; oxygen therapy; pediatric hospital; pneumonia; polymerase chain reaction; priority journal; retrospective study; sepsis; streptococcal pharyngitis; systemic inflammatory response syndrome; thorax radiography; tracheitis; United States

In Support of Ophthalmology-Specific Patient-Reported Outcome Measures - Wallace, S.; Edmond, J. (Ophthalmology, 2019)
Keywords: air temperature; disease course; editorial; health survey; human; open angle glaucoma; ophthalmology; patient compliance; patient safety; patient satisfaction; patient-reported outcome; priority journal; Short Form 36; treatment outcome

Patient-reported nonadherence with glaucoma therapy - Wolfram, C.; Stahlberg, E.; Pfeiffer, N. (Journal of Ocular Pharmacology and Therapeutics, 2019)
Purpose: Effective glaucoma therapy relies to a great extent on the patients' ability to regularly self-administer eye drops. This study aimed to assess self-reported nonadherence and to identify potential barriers to adherence in glaucoma patients. Methods: Participants completed a 16-item questionnaire, designed to examine nonadherence rate and assess the therapy experience. Inclusion criteria stipulated treatment duration of at least 1 year. Nonadherence was defined as missing ≥5% of the prescribed pressure-lowering eye drops doses. Results: In total, 201 glaucoma patients aged 24-88 years were included. Mean treatment duration was 9.4 years. Nonadherence was reported by 30.3% of participants and 69.7% were reported to be adherent. Individuals who experienced side effects reported higher levels of nonadherence than those who did not (37.6% vs. 18.4%; P = 0.004). Eye drops with preservatives were used by 84.1% of participants, 11.9% were on combined preservative and preservative-free treatment, and 4.0% on preservative-free medication only. Self-reported nonadherence levels were 32.0%, 25.0%, and 12.5%, respectively, for each of these groups. Men reported higher rates of nonadherence than women (36.8% vs. 24.5%; P = 0.066). Age, social status, history of migration, severity of disease, and fear of blindness were not associated with significant differences in nonadherence levels. Conclusions: Nonadherence with glaucoma therapy is a significant barrier to therapeutic success for approximately one-third of patients. Nonadherence may be reduced if side effects are avoided. Preservative-free products may provide adherence benefits. The patient experience should be a key consideration when selecting appropriate treatments, to reduce nonadherence and optimize outcomes.
Keywords: antiglaucoma agent; adult; aged; article; blindness; blurred vision; clinical assessment; clinical evaluation; controlled study; disease duration; disease severity; dizziness; drug self administration; female; glaucoma; headache; human; major clinical study; male; migration; patient compliance; patient-reported outcome; social status; treatment duration; treatment refusal; vision; xerostomia

Micro/Nanoparticle Delivery Systems for Ocular Diseases - Halasz, K.; Kelly, S.J.; Iqbal, M.T.; Pathak, Y.; Sutariya, V. (Assay and Drug Development Technologies, 2019)
Micro-(MPs) and nanoparticles (NPs) have been recently studied for their application in ophthalmic drug delivery. These drug delivery systems are able to circumvent the ocular barriers that currently limit the efficacy of conventional treatments, as well as provide a more sustained release of drug, reducing the frequency of administration and increasing patient compliance. This review summarizes the recent trends in ophthalmic research from conventional treatment to the utilization of MPs and NPs as drug carriers.
Keywords: drug carrier; nanoparticle; age related macular degeneration; anatomy; biodegradation; cataract; diabetic retinopathy; drug delivery system; drug formulation; dry eye; eye disease; eye infection; eye inflammation; Fuchs endothelial dystrophy; glaucoma; human; intraocular drug administration; myopia; patient compliance; retina vein occlusion; review; subretinal neovascularization

Unveiling the efficacy, safety, and tolerability of anti-interleukin-1 treatment in monogenic and multifactorial autoinflammatory diseases - Bettiol, A.; Lopalco, G.; Emmi, G.; Cantarini, L.; Urban, M.L.; Vitale, A.; Denora, N.; Lopalco, A.; Cutrignelli, A.; Lopedota, A.; Venerito, V.; Fornaro, M.; et al. (International Journal of Molecular Sciences, 2019)
Autoinflammatory diseases (AIDs) are heterogeneous disorders characterized by dysregulation in the inflammasome, a large intracellular multiprotein platform, leading to overproduction of interleukin-1(IL-1)β that plays a predominant pathogenic role in such diseases. Appropriate treatment is crucial, also considering that AIDs may persist into adulthood with negative consequences on patients’ quality of life. IL-1β blockade results in a sustained reduction of disease severity in most AIDs. Agrowing experience with the human IL-1 receptor antagonist, Anakinra (ANA), and the monoclonal anti IL-1β antibody, Canakinumab (CANA), has also been engendered, highlighting their efficacy upon protean clinical manifestations of AIDs. Safety and tolerability have been confirmed by several clinical trials and observational studies on both large and small cohorts of AID patients. The same treatment has been proposed in refractory Kawasaki disease, an acute inflammatory vasculitis occurring in children before 5 years, which has been postulated to be autoinflammatory for its phenotypical and immunological similarity with systemic juvenile idiopathic arthritis. Nevertheless, minor concerns about IL-1 antagonists have been raised regarding their employment in children, and the development of novel pharmacological formulations is aimed at minimizing side effects that may affect adherence to treatment. The present review summarizes current findings on the efficacy, safety, and tolerability of ANA and CANA for treatment of AIDs and Kawasaki vasculitis with a specific focus on the pediatric setting.
Keywords: acetylsalicylic acid; anakinra; C reactive protein; canakinumab; colchicine; corticosteroid; cryopyrin; cyclooxygenase 2; immunoglobulin; inflammasome; interleukin 1 antibody; interleukin 1alpha; interleukin 1beta; interleukin 23; interleukin 6; methotrexate; mevalonic acid; multiprotein complex; nitric oxide; phospholipase A; procalcitonin; prostaglandin E2; ribavirin; thrombocyte activating factor; tocilizumab; toll like receptor adaptor molecule 1; tumor necrosis factor; unindexed drug; ustekinumab; abdominal abscess; abdominal pain; anemia; anxiety disorder; appendectomy; appendicitis; arthralgia; article; asthma; autoinflammatory disease; bacteremia; bronchitis; CINCA syndrome; computer assisted tomography; connective tissue disease; creatinine clearance; dehydration; diarrhea; disease activity; disease severity; drug efficacy; drug safety; drug tolerability; erythema; gastroenteritis; gastrointestinal disease; gastrointestinal hemorrhage; glaucoma; headache; heart sinoatrial block; hepatitis; hidradenitis; hospitalization; human; hyperkalemia; hypertriglyceridemia; immune response; immunophenotyping; influenza; injection site reaction; intestine obstruction; intracranial pressure; kidney transplantation; knee meniscus rupture; coinfection; monogenic disorder; mucocutaneous lymph node syndrome; multifactorial genetic disorder; nausea; nuclear magnetic resonance imaging; patient compliance; pericarditis; peritonitis; pharyngitis; phase 2 clinical trial (topic); phase 3 clinical trial (topic); pneumonia; pruritus; quality of life; rash; rhinitis; rhinopharyngitis; rhinorrhea; skin manifestation; Streptococcus infection; tonsillitis; tooth infection; unilateral blindness; upper respiratory tract infection; urinalysis; urinary tract infection

Patients’ and prescribers’ perception of contact lenses as a potential ocular drug delivery system - Ghazal, H.; Ahmadouk, J.; Dhanji, S.; El-bushra, A.; Kayyali, R.; ElShaer, A. (Contact Lens and Anterior Eye, 2019)
Contact lenses (CLs) designed to deliver medication gradually to the eye are being developed and investigated for the use in ocular drug delivery. The aim of the current research is to determine patients’ acceptance of the use of lenses for ocular drug delivery. In addition, the study aimed to seek the views and perceptions of healthcare professionals (HCPs) on CLs as a method of ocular drug delivery and whether it will be prescribed to treat ocular conditions. This was a cross-sectional survey targeted at patients and HCPs. Two separate questionnaires were created with open-closed ended and multiple response questions, gauging the perceptions and acceptance of CLs as drug delivery tool. The patients’ survey was distributed in John Radcliffe (JR), Oxford and Moorfields eye hospital (MEH), London, UK. The HCPs’ questionnaire was manually distributed and was also devised on Survey Monkey and sent by email to ophthalmologists, optometrists, opticians, GPs and hospital and community pharmacists. The data were analysed using SPSS statistical software and Excel. Over 60% (92/151) of patients would accept the use of CLs for their ocular treatment with the highest acceptance being reported by patients in the age group of 30–49 years old. The most frequently used conventional treatment formulation was eye drops as indicated by 87% (131/151) of the responses. More than half of eye drop users (57%, 75/131) indicated that they would accept using CLs expecting them to reduce the frequency of application of the medicine and be less time consuming. Interestingly, half of HCPs were not aware of CLs as an ocular drug delivery method; nevertheless, a total of 65 HCPs out of the 112 surveyed stated that they would prescribe/dispense CLs to treat ocular disease.
Keywords: contact lens; eye drops; eye ointment; adult; aged; article; blepharitis; blepharospasm; cataract; conjunctival hemorrhage; conjunctivitis; controlled study; cross-sectional study; disease duration; drug delivery system; drug efficacy; episcleritis; female; glaucoma; health care personnel; human; macular edema; major clinical study; male; medication compliance; patient attitude; patient compliance; patient preference; patient satisfaction; perception; personal experience; physician attitude; prescription; prevalence; priority journal; retinopathy; treatment duration; treatment response; Usher syndrome

A Comparison of Resource Use and Costs of Caring for Patients With Exfoliation Syndrome Glaucoma Versus Primary Open-Angle Glaucoma - Rathi, S.; Andrews, C.; Greenfield, D.S.; Stein, J.D. (American Journal of Ophthalmology, 2019)
Purpose: To characterize differences in resource utilization and cost of managing enrollees with exfoliation glaucoma (XFG) compared to primary open-angle glaucoma (POAG). Design: Retrospective utilization and cost comparison using Medicare claims data. Methods: We identified Medicare beneficiaries with XFG or POAG and ≥5 years of continuous enrollment from January 2008 to December 2014. We distinguished newly diagnosed cases from those with preexisting disease. We compared ophthalmic resource utilization and costs over 2 years of follow-up for persons with newly diagnosed and preexisting XFG vs those with POAG. Main outcome measures were number of clinic visits, diagnostic procedures, medication fills, laser and incisional surgery, and mean eye care costs per beneficiary. Results: Among 192 eligible enrollees (median age 77.6 years) with newly diagnosed XFG and 7339 enrollees (median age 77.3 years) with newly diagnosed POAG, those with XFG had more office visits (mean, 9.1 vs 7.9; P =.001), cataract surgery (34.9% vs 19.0%; P <.0001), and glaucoma surgery (28.7% vs 19.7%, P =.002). They also experienced 27% higher mean total eye care costs ($3260 vs $2562, P =.0001) over 2 years of follow-up. Among 2745 enrollees (median age 80.5 years) with preexisting XFG and 89 036 persons (median age 79.5) with preexisting POAG, persons with XFG had more office visits (mean 9.3 vs 7.3; P <.0001), perimetry (85.3% vs 79.8%; P <.0001), cataract surgery (23.4% vs 12.3%; P <.0001), laser trabeculoplasty (18.6% vs 9.6%; P <.0001), and trabeculectomy (8.1 vs 1.8%; P <.0001) and experienced 37% higher total mean eye care costs ($3764 vs $2739; P <.0001). Conclusions: Healthcare resource utilization and costs are substantially higher for managing patients with XFG compared to POAG.
Keywords: aged; article; cataract extraction; cost benefit analysis; disease severity; eye care; female; follow up; glaucoma surgery; health care cost; health care utilization; health insurance; health service; human; incidence; intermethod comparison; major clinical study; male; open angle glaucoma; outcome assessment; perimetry; priority journal; pseudoexfoliation; retrospective study; trabeculectomy; trabeculoplasty

Psychological and psychiatric aspects of face transplantation: Lessons learned from the long-term follow-up of six patients - Lemogne, C.; Bellivier, F.; Fakra, E.; Yon, L.; Limosin, F.; Consoli, S.M.; Lantieri, L.; Hivelin, M. (Journal of Psychosomatic Research, 2019)
Since 2005, at least 38 face transplantations have been performed worldwide. Available recommendations on psychological management are based on isolated cases or small case series, either not focused on mental health or with a short follow-up. We propose herein a clinical commentary on psychological and psychiatric outcomes from the follow-up of a prospective single-center cohort of six patients over a period of 3.5 to 9 years. Seven patients received a face transplant between January 2007 and April 2011: two patients with neurofibromatosis, four with self-inflicted ballistic trauma, one with self-immolation. One patient died at 63 days of cerebral sequelae from cardiac arrest in the setting of bacterial infection. The six other patients were routinely evaluated with unstructured psychological interviews up to May 2016 and with the Short Form 36-item health survey and the Mini-International Neuropsychiatric Interview at one year and at the end of the follow-up. Clinically meaningful observations were the following: a history of mental disorders before disfigurement was associated with poor physical and mental outcomes, including poor adherence and one suicide; untreated depression was associated with poor adherence; acceptance of the new face occurred rapidly and without significant distress in all of the patients; fear of transplant rejection was present to some degree in all of the patients and did not substantially differ from other transplantation settings; media exposure may be disturbing but may also have had positive psychological effects on some of the patients. Mental health issues related to chronic rejection and re-transplantation remain to be explored.
Keywords: feeding tube; benzodiazepine derivative; clomipramine; escitalopram; immunosuppressive agent; mirtazapine; paroxetine; sedative agent; steroid; venlafaxine; acute kidney failure; adolescent; alcohol consumption; alcoholism; anxiety; anxiety disorder; article; automutilation; bacterial infection; cannabis use; case report; chronic graft rejection; clinical article; comorbidity; cytomegalovirus infection; daily life activity; depression; drug substitution; erythema; face malformation; facial nerve; facial transplantation; family history; follow up; glaucoma; graft rejection; gunshot injury; heart arrest; hospitalization; human; hypertension; iatrogenic acute kidney failure; iatrogenic disease; impulsiveness; jejunostomy; kidney failure; long term care; major depression; male; medical history; medication compliance; mental disease; mental health; mental health care; mini international neuropsychiatric interview; muscle fatigue; neurofibromatosis; optic nerve; parttime employment; patient compliance; postoperative delirium; prospective study; psychiatry; psychologic assessment; psychological aspect; quality of life; remission; risk factor; Short Form 36; skin biopsy; social interaction; suicidal ideation; suicide; suicide attempt; surgical risk; symptom; tobacco consumption; tracheostomy; visual impairment

Discovery, characterization and clinical utility of prostaglandin agonists for the treatment of glaucoma - Klimko, P.G.; Sharif, N.A. (British Journal of Pharmacology, 2019)
Topical ophthalmic formulations of analogues of the endogenous arachidonic acid cyclooxygenase metabolite, PGF2α, are the standard of care treatment for the blinding disease glaucoma. These are the most potent and efficacious medical therapies for lowering intraocular pressure (IOP), the most important risk factor identified for disease progression. They have few side effects and offer the convenience of once-a-day dosing. It was initially believed that endogenous PGs raised IOP and caused substantial ocular surface adverse effects. However, carefully designed experiments demonstrated that esterification of the carboxylic acid afforded potent and efficacious topical ocular hypotensive activity. The final hurdle to be overcome was improvement of the side effect profile. A hypothesis was advanced that the IOP-lowering effect of PGF2α isopropyl ester was due to activation of its cognate PG-FP receptor, while side effects were largely due to promiscuous interaction with other PG receptors. This hypothesis was validated by modification of the ω chain (carbons 13–20) to a phenyl group. This provided the first marketed FP-class PG agonist analogue (FP-PGA) ocular hypotensive agent, latanoprost. Since the introduction of latanoprost into clinical medicine to lower and control IOP, a number of additional FP-PGAs have been discovered, characterized and marketed, including travoprost, tafluprost, unoprostone isopropyl ester and bimatoprost (an amide). Linked Articles: This article is part of a themed section on Eicosanoids 35 years from the 1982 Nobel: where are we now? To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.8/issuetoc.
Keywords: NCT00767494; NCT01180062; NCT01481077; NCT01789736; NCT01863953; NCT01896180; NCT02129673; NCT02358369; NCT02371746; NCT02754596; NCT02914509; NCT03216902; ophthalmological implant; punctal plug; alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; bimatoprost plus timolol; carbonate dehydratase inhibitor; latanoprost; latanoprost plus timolol; latanoprostene bunod; muscarinic agent; ono 9054; prodrug; prostaglandin derivative; prostaglandin receptor stimulating agent; sepetaprost; tafluprost; tafluprost plus timolol; tapcom; timolol; timolol plus travoprost; travoprost; unoprostone isopropyl ester; aqueous humor; blood eye barrier; chemical modification; conjunctival hyperemia; drug dose escalation; drug efficacy; drug penetration; drug potency; drug screening; eye irritation; glaucoma; human; intraocular foreign body; intraocular hypertension; intraocular pressure; medication compliance; monotherapy; nonhuman; open angle glaucoma; patient compliance; pharmacophore; priority journal; review; sustained drug release; trabecular meshwork; duotrav; ganfort; ono 9054; tapcom; taptiqom; vyzulta; xalacom; xalatan; xalcom

Short-term Optic Disc Cupping Reversal in a Patient with Mild Juvenile Open-angle Glaucoma Due to Early Idiopathic Intracranial Hypertension - Umfress, A.C.; Mawn, L.A.; Joos, K.M. (Journal of Glaucoma, 2019)
Purpose: The purpose of this study was to report a case of optic disc cupping reversal in an adult without significant intraocular pressure-lowering treatment. Patient: A 20-year-old female with a history of mild juvenile open-angle glaucoma who developed subjective blurred vision and a decrease in cupping of her optic discs. Results: Dilated examination demonstrated decreased cup-to-disc ratios in both eyes with a slight blurring of the disc margin in the right eye. The appearance of both optic discs returned to baseline after weight loss therapy. Conclusions: An unexplained reduction of optic nerve cup-to-disc ratio should prompt a workup for other etiologies, such as increased intracranial pressure. Baseline photographs not subjected to computerized scan obsolescence are extremely useful in monitoring the long-term appearance of asymmetric optic discs as an adjunct to the clinical examination.
Keywords: Cirrus; Goldmann applanation tonometer; optical coherence tomography device; acetazolamide; bimatoprost; adult; article; blurred vision; body mass; body weight gain; body weight loss; case report; clinical article; clinical evaluation; corneal pachymetry; differential diagnosis; disease course; family history; female; fluoroscopy; gonioscopy; human; idiopathic intracranial hypertension; intracranial pressure; intraocular pressure; laser surgery; lumbar puncture; mild juvenile open angle glaucoma; nuclear magnetic resonance imaging; onset age; open angle glaucoma; optic disk anomaly; optic disk cup; optic nerve; optic nerve cup to disk ratio; optic nerve cupping; optical coherence tomography; papilledema; patient compliance; priority journal; sedentary lifestyle; short course therapy; trabeculoplasty; traffic accident; treatment duration; visual field; visual system parameters; young adult; Cirrus

Leveraging Electronic Health Records to Identify and Characterize Patients with Low Vision - Swenor, B.K.; Guo, X.; Boland, M.V.; Goldstein, J.E. (Ophthalmic Epidemiology, 2019)
Purpose: To use electronic health record (EHR) data to estimate the prevalence and characteristics of low-vision (LV) patients. Methods: EHR data were obtained for all patients at the nine clinical locations of the Wilmer Eye Institute in 2014. LV status at each visit was defined as visual acuity (VA) worse than 20/40 in the better-seeing eye. Prevalence and incidence estimates were determined over a 12-month period. Demographic and clinical data were used to compare the characteristics of patients with and without LV. Logistic regression analyses were used to determine prevalence and incidence estimates adjusted for age, sex, race, and ethnicity. Results: A total of 100,755 patients were included in the analysis. There were 7752 (7.7%) prevalent and 1962 (2.1%) incident cases of LV. Among patients with LV, 55% had VA between 20/40 and 20/60. Outside of LV clinics, retina and glaucoma clinics had the highest prevalence (18% and 14%, respectively) and incidence (5% and 4%, respectively) of LV. The urban hospital center had twice the prevalence of LV than suburban clinics (11.5% vs. 5.6%). The odds of prevalent LV was greatest among patients 80 years and older (odds ratio = 6.18; 95% confidence interval: 5.62–6.80) as compared to those 20–39 years old. Conclusions: EHR can be used to estimate the prevalence and describe the characteristics of patients with LV seeking ophthalmic care. The highest prevalence rates of LV are observed in the urban setting and among patients obtaining retina and glaucoma care.
Keywords: adult; aged; article; cataract; clinical study; controlled study; electronic health record; female; glaucoma; groups by age; health care utilization; hospital; human; incidence; logistic regression analysis; low vision; major clinical study; male; prevalence; priority journal; urban area; visual acuity

Follow-up and adherence to glaucoma care by newly diagnosed glaucoma patients in enugu, nigeria - Kizor-Akaraiwe, N.N. (Ophthalmic Epidemiology, 2019)
Purpose: To determine uptake, adherence and influencing factors to follow-up care by newly diagnosed glaucoma patients from free eye screening exercise. Methods: The study was a cross-sectional survey of newly diagnosed glaucoma patients during free eye screenings carried out in March and October, 2016 in Enugu, Nigeria. Data on participants were analyzed after a minimum of 6 months from the screening for uptake and adherence to follow-up care. Qualifying patients had questionnaires administered to them by phone interview. Information requested regards awareness, knowledge on diagnosis as well as reasons for non-uptake and non-adherence. Results: 182 newly diagnosed glaucoma patients were included of which 121 (66.5%) were males, with median age of 50years.About 164 (90.1%) had at least a primary education. There were more self- employed persons 59 (32.4%) compared to other occupations. Uptake of follow up care was 17.6% (32/182). Adherence rate was 25% (8/32). Major reasons for non-uptake were lack of funds 54.9% (n = 50/91), distance 11% (n = 10/91) and receiving care from other facilities 11.0% (n = 10/91). Others include discourteous staff behavior and lack of information on diagnosis. Similarly, major reasons for non-adherence were lack of funds 44.4% (n = 8/18) and distance 22.2% (n = 4/18). Knowledge and prior awareness of glaucoma were found to be significantly associated with uptake of follow up care (p = 0.020). Conclusion: Uptake and adherence to follow-up was found to be low in this study population mainly attributed to cost, distance and poor knowledge of glaucoma natural history. Reviewing cost/out of pocket expenditure, providing care closer to patients, adequate education of staff and patients may significantly improve uptake of care after initial diagnosis.
Keywords: adult; article; awareness; clinical evaluation; comparative study; controlled study; cross-sectional study; educational status; employment; eye examination; female; follow up; glaucoma; health survey; human; major clinical study; male; medical care; medical information; medication compliance; Nigeria; priority journal; screening test; treatment duration; visual acuity

Factors Affecting Adherence to Topical Glaucoma Therapy: A Quantitative and Qualitative Pilot Study Analysis in Sydney, Australia - Spencer, S.K.R.; Shulruf, B.; McPherson, Z.E.; Zhang, H.; Lee, M.B.; Francis, I.C.; Bank, A.; Coroneo, M.T.; Agar, A. (Ophthalmology Glaucoma, 2019)
Purpose: To assess which factors in the lives and disease of patients with glaucoma affect their adherence to topical glaucoma therapy and the quantitative significance of this effect. To assess qualitatively the most influential barriers to adherence from the perspective of the patient. Design: Multicenter, prospective, cross-sectional pilot study. Participants: A total of 145 patients, attending outpatient metropolitan glaucoma clinics in Sydney, Australia, who were prescribed topical glaucoma medications. Methods: A structured interview-based questionnaire was conducted with 145 individuals using glaucoma eye drops that had been prescribed at least 2 weeks previously. The questionnaire involved 2 novel questions on adherence, 29 questions on factors identified or postulated in the literature as affecting adherence for quantitative analysis, and 1 open-response question on patient-identified causes of nonadherence for qualitative analysis. This questionnaire represents the broadest coverage of factors hypothesized to affect adherence in a single study in the glaucoma medication adherence literature to date. Main Outcome Measures: Adherence rate, risk factors for poor adherence, and patient-identified barriers to adherence. Results: In response to the question “How many days have you missed a drop in the last 2 weeks,” 69.7% of patients reported total adherence. Four factors were significantly related to an increased likelihood of reporting having missed drops in the last 2 weeks. These were difficulty applying drops (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.02–5.44; P < 0.05), a past or current diagnosis of depression (OR, 3.61; 95% CI, 1.53–8.52; P < 0.01), patient self-rating of own memory ≤ 7 of 10 (OR, 3.15; 95% CI, 1.36–7.30; P < 0.01), and self-reported motivation score ≤ 6 of 10 (OR, 10.94; 95% CI, 3.00–39.81; P < 0.01). Patient understanding of glaucoma, ethnicity, and socioeconomic status were among the 25 factors found not to have a statistically significant correlation with adherence. Conclusions: There is a significant proportion of patients taking their topical glaucoma medications less often than prescribed. Adherence to topical glaucoma therapies is negatively correlated to several factors: difficulty applying drops, a past or current diagnosis of depression, poor self-rating of own memory, and poor self-rating of own motivation. These may prove useful in designing interventions to improve adherence in these patients.
Keywords: antiglaucoma agent; eye drops; article; Australia; cross-sectional study; depression; ethnicity; factor analysis; feasibility study; glaucoma; human; motivation; outpatient department; patient compliance; pilot study; prescription; priority journal; prospective study; qualitative analysis; qualitative research; quantitative analysis; quantitative study; questionnaire; risk assessment; risk factor; scoring system; self concept; self report; social status; structured interview; systematic review

Effectiveness of quinacrine (mepacrine) in photosensitive autoimmune diseases, lupus erythematosus, and dermatomyositis: Report on 38 cases and literature review - Rios-Fernández, R.; Callejas-Rubio, J.-L.; Ortego-Centeno, N. (Archives of Rheumatology, 2019)
Objectives: This study aims to report our experience with photosensitive autoimmune diseases including lupus erythematosus and dermatomyositis (DM) treated with quinacrine (Qn) as either monotherapy or combination with other antimalarials, steroids, and immunosuppressive therapy in an add-on regimen in light of a review of the relevant literature. Patients and methods: The study included 38 patients (6 males, 32 females; mean age 45±8 years; range, 23 to 72 years) with systemic lupus erythematosus (SLE), cutaneous lupus or DM who had been treated with Qn. The following data were obtained from the records of each patient: sex, age, diagnosis, duration of the disease, duration of treatment, smoking behavior, antimalarial treatment, concomitant treatment, and clinical indications, as well as Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) activity before initiation, at the last visit, or when Qn treatment was completed. We carried out a MEDLINE search for previously reported cases that, together with our patients, served as the basis of this report. Results: Of the 38 patients, 34 were suffering from SLE or cutaneous lupus and four from DM. Qn was dosed at 50 or 100 mg in most of the patients. Twenty-seven patients received Qn as an add-on regimen therapy. Clinical response was analyzed in patients with SLE or cutaneous lupus. Of the patients, 25 responded (68.4%), 13 (52%) had improved CLASI activity and 12 (48%) had improved SLEDAI score. Fifty percent of the patients with DM responded. A total of 188 cases were identified from the literature. The most frequent diagnosis was cutaneous lupus (68.6%), followed by SLE (32.6%). Only 7.4% of the patients had DM. The majority of the patients received concomitant immunosuppressive medications. Treatment response was 73% in patients with SLE and/or cutaneous lupus and 35.7% in patients with DM. Side effects were scarce and the most frequent was yellow skin discoloration. Conclusion: Quinacrine may be an alternative for patients with poor response or those who are intolerant to other antimalarials. Thus, Qn may aid in controlling the activity of photosensitive autoimmune diseases.
Keywords: azathioprine; belimumab; chloroquine; corticosteroid; cyclosporine; efalizumab; hydroxychloroquine; mepacrine; methotrexate; mycophenolate mofetil; rituximab; tacrolimus; thalidomide; adult; aged; article; autoimmune disease; cerebrovascular accident; clinical article; clinical feature; dermatitis; dermatomyositis; discoid lupus erythematosus; disease activity; disease duration; drug eruption; drug hypersensitivity; epigastric pain; fatigue; female; glaucoma; hepatitis; human; human tissue; male; nausea; optic neuritis; patient compliance; photosensitivity; pruritus; psoriasis; rash; retinopathy; retrospective study; skin discoloration; skin lupus erythematosus; SLEDAI; systemic lupus erythematosus; treatment duration; treatment response

Hyperlipidemia, blood lipid level, and the risk of glaucoma: A meta-analysis - Wang, S.; Bao, X. (Investigative Ophthalmology and Visual Science, 2019)
PURPOSE. Previous studies reported that hyperlipidemia and blood lipid levels were associated with glaucoma, ocular hypertension (OHT), and intraocular pressure (IOP). However, studies aimed at investigating this association have yielded conflicting results. Therefore, to shed light on these inconclusive findings, we performed multiple distinct meta-analyses to clarify the association of hyperlipidemia and blood lipid levels with glaucoma, OHT, and IOP. METHODS. A systematic literature search from Embase, Web of Science, and PubMed was performed to identify relevant studies. To assess the association between hyperlipidemia and glaucoma, we used the pooled odds ratio (OR) with 95% confidence interval (CI). When we assessed the association between blood lipid levels and IOP levels, the pooled mean difference in IOP associated with a 10 mg/dL increase in the blood lipid level was estimated. The pooled difference in IOP was also estimated between patients with and without hyperlipidemia. All the papers that assessed the correlation between hyperlipidemia and glaucoma, between blood lipid levels and IOP levels, and between hyperlipidemia and IOP were included in this meta-analysis. RESULTS. We detected a marked association between hyperlipidemia and glaucoma (OR = 1.37; 95% CI = 1.16–1.61), with significant heterogeneity among studies. However, hyperlipidemia was not significantly associated with glaucoma in our analysis of only crosssectional studies, studies that reported only on hypercholesterolemia patients, studies that were conducted only in North America and Europe, or studies in which normal-tension glaucoma (NTG) patients were included only in the subgroup analyses. The pooled results showed that an increase of 10 mg/dL in blood triglyceride levels would increase the IOP by 0.016 mm Hg (95% CI = 0.009–0.024), with evident heterogeneity between studies (P < 0.001; I2 = 92.0%). The pooled results showed that the blood total cholesterol and lowdensity lipoprotein-cholesterol (LDL-c) level both had a significant association with IOP. When compared to the patients with nonhyperlipidemia, those with hyperlipidemia had a significantly higher IOP of 0.51 mm Hg (95% CI = 0.18–0.83) (P = 0.001 for heterogeneity; I2 = 81.6%). CONCLUSIONS. The evidence suggests that hyperlipidemia is significantly associated with an increased risk of glaucoma and that hyperlipidemia and the increased blood lipid levels are associated with increased IOP.
Keywords: non contact tonometer; antiglaucoma agent; high density lipoprotein cholesterol; low density lipoprotein cholesterol; triacylglycerol; ambulatory care; article; body mass; clinical outcome; coronary artery disease; diabetes mellitus; human; hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; ICD-9; ICD-9-CM; intraocular hypertension; intraocular pressure; lipid blood level; meta analysis; open angle glaucoma; optic disc appearance; optic disk cup; optic nerve; priority journal; quality control; retina degeneration; risk factor; visual field; visual field defect; visual system parameters

The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland - Sii, S.; Nasser, A.; Loo, C.Y.; Croghan, C.; Rotchford, A.; Agarwal, P.K. (British Journal of Ophthalmology, 2019)
Background Since the introduction of National Institute for Health and Care Excellence glaucoma guidelines 2009, the number of referrals from community optometrists to hospital eye services has increased across the UK, resulting in increase in first visit discharge rates (FVDRs). Aim To assess the impact of Scottish Intercollegiate Guidelines Network (SIGN) 144 on quality of referrals from community optometrists. Methodology A retrospective study of patient records who attended as new adult glaucoma referrals to clinics in Princess Alexandra Eye Pavilion, Edinburgh, and in Greater Glasgow and Clyde, was carried out across October-November 2014 (group 1) and September-October 2016 (group 2), before and after the introduction of SIGN 144. The primary outcome of this study is FVDRs. A secondary outcome is the extent of compliance to referral recommendations by SIGN guidelines. Results Three hundred and twelve and 325 patients were included in groups 1 and 2, respectively. There was a significant decline in FVDRs between these two periods from 29.2% to 19.2%. (p=0.004) (OR 0.58 (95%CI 0.40 to 0.84)). Post-SIGN guidelines, 87% of referrals were compliant to SIGN referral criteria while 13% remained non-compliant. The main reasons for non-compliance were no repeatable visual field defects (42.0%) and referrals due to high intraocular pressure were either not repeated or not interpreted in the context of age and central corneal thickness (36.8%). Conclusion Patients referred after the introduction of SIGN guidelines were 33.5% less likely to be discharged at the first visit. Although compliance to most recommendations in SIGN guidelines has improved, there is still a need to improve adherence to referral criteria.
Keywords: adult; aged; article; cornea thickness; false positive result; female; glaucoma; health care quality; health impact assessment; hospital discharge; human; intraocular pressure; major clinical study; male; optometrist; patient referral; practice guideline; priority journal; retrospective study; Scotland; treatment outcome; treatment refusal; visual field defect

Adherence to topical glaucoma medications and associated factors in Gondar University Hospital Tertiary Eye Care Center, northwest Ethiopia - Anbesse, D.H.; Yibekal, B.T.; Assefa, N.L. (European Journal of Ophthalmology, 2019)
Purpose: The purpose of the study was to determine proportion of adherence to topical glaucoma medications and associated factors among glaucoma patients in Gondar University Hospital Tertiary Eye Care and Training Center, northwest Ethiopia. Methods: This cross-sectional design study was conducted on 360 participants from April–May 2017. Structured questionnaire was completed and adherence was assessed by patients’ self-report survey. The data were analyzed by SPSS version 20. Multivariate logistic regression was used to identify the determinant factors. The significance was considered at p value less than 0.05. Result: More than half, 221 (61.4%) (95% confidence interval: 56.1–66.7), of the study participants were found to adhere well to glaucoma medications. Male sex (adjusted odds ratio = 1.86 (95% confidence interval: 1.13–3.06)), urban residence (adjusted odds ratio = 2.33 (95% confidence interval: 1.46–3.72)), normal visual acuity (adjusted odds ratio = 2.23 (95% confidence interval: 1.13–4.42)), low visual acuity (adjusted odds ratio = 1.74 (95% confidence interval: 1.05–2.88)), and self-sponsor for medications (adjusted odds ratio = 0.21 (95% confidence interval: 0.12–0.38)) were significantly associated with good adherence Conclusion: The level of medication adherence to topical glaucoma medications is not good enough as compared to other studies done in Ethiopia. Male sex, urban residence, normal, and low visual acuity were positive predictors, whereas self-sponsored for medications was negative predictors for good adherence to glaucoma medications.
Keywords: antiglaucoma agent; adult; article; blindness; cross-sectional study; female; follow up; glaucoma; human; major clinical study; male; middle aged; open angle glaucoma; optic nerve lesion; patient compliance; prevalence; priority journal; refraction error; self report; structured questionnaire; visual acuity; visual stimulation

Topical cyclosporine-A versus prednisolone for herpetic stromal keratitis: a randomized controlled trial - Peyman, A.; Nayebzadeh, M.; Peyman, M.; Afshari, N.A.; Pourazizi, M. (Acta Ophthalmologica, 2019)
Purpose: To compare topical cyclosporine-A 2% eye drop (Cs-A) with prednisolone acetate 1% eye drop for treatment of herpetic stromal keratitis (HSK). Methods: In this randomized clinical trial, 38 eyes of 33 patients with HSK were randomly assigned to receive either 2% Cs-A or 1% prednisolone acetate eye drops. All subjects received oral acyclovir 400 mg twice a day. Slit-lamp examination, Scheimpflug tomography corneal optical densitometry (Pentacam®, Oculus Inc., Wetzlar, Germany), best-corrected visual acuity (BCVA), and intra-ocular pressure (IOP) were evaluated at the first visit, and 14 and 30 days after the treatment. Results: Within-group analysis revealed significant improvement of total cornea optical density after 30 days of treatment in both groups (30.3 ± 10.5 to 28.3 ± 9.8, p < 0.001 for prednisolone group, and 30.5 ± 8.8 to 28.8 ± 8.3 p < 0.001 for Cs-A group, mean ± SD). We were not able to disclose any significant difference between the two groups regarding the improvement of cornea optical density (p = 0.66). Best-corrected visual acuity (BCVA) logMAR significantly improved in both groups after 30 days of treatment (0.20 ± 0.52, p = 0.002 in prednisolone group, and 0.24 ± 0.31, p < 0.001 in Cs-A group, mean ± SD). Analysis between groups did not show a significant difference of BCVA improvement (p = 0.45). We did not observe any severe side effect attributable to drugs. Conclusions: Cs-A 2% and prednisolone acetate 1% topical eye drops are effective for treatment of HSK.
Keywords: 2015052112724N; ophthalmic camera; aciclovir; cyclosporine; eye drops; precord; prednisolone acetate; adolescent; adult; aged; article; best corrected visual acuity; burning sensation; clinical article; clinical assessment; controlled study; densitometry; drug efficacy; drug safety; eye redness; female; follow up; herpetic stromal keratitis; human; intraocular pressure; keratitis; male; medication compliance; optical density; outcome assessment; patient compliance; priority journal; randomized controlled trial; slit lamp microscopy; treatment duration; precord; Pentacam

The Relationship of Self-Report and Medication Possession with Glaucoma Medication Administration Success - Hein, A.M.; Rosdahl, J.A.; Bosworth, H.B.; Woolson, S.L.; Olsen, M.K.; Kirshner, M.A.; Muir, K.W. (Journal of Glaucoma, 2019)
Purpose: Many glaucoma eye drop users cannot successfully self-Administer drops, and observing patients' drop technique can be time-consuming. We sought to examine the association of patient self-reported efficacy of eye drop technique and medication possession data as potential surrogate measures for actual drop administration success. Patients and Methods: In total, 137 adults with medically treated glaucoma were enrolled from a University eye clinic (n=54) or a Veteran Affairs (VA) eye clinic (n=83). All participants were asked, "How confident are you that you can get the medication into your eye?" Medication possession ratio (MPR), defined as the amount of eye drop available divided by the amount prescribed, was calculated for VA study site participants for 6 months. The main outcome was the correct eye drop technique, defined as the ability to get drops into the eye and to put only 1 drop into the eye at a time. Results: Among 117 participants who were "very confident" they could administer eye drops correctly, 95 participants (81%) displayed the correct drop technique. Of those who reported being less than "very confident" (n=18), 11 participants (61%) displayed correct drop technique (the Fisher exact test, P=0.07). For the VA sample, 20 participants with MPR<1.2, 20 participants with MPR=1.2 to 1.8, and 23 participants with MPR>1.8 displayed correct eye drop technique (the Fisher exact test, P=0.18). Conclusions: Self-reported administration success and MPR are not strongly associated with successful eye drop administration. Thus, direct observation of patients' drop instillation may be the most effective means of determining patient efficacy.
Keywords: eye drops; adult; aged; article; cohort analysis; drug efficacy; female; glaucoma; human; major clinical study; male; patient compliance; prospective study; secondary analysis; self report; treatment outcome; university hospital

Preliminary Steps to Address Glaucoma Medication Adherence: Beginning to Tackle the Elephant in the Room - Newman-Casey, P.A.; Myers, J.S. (JAMA Ophthalmology, 2019)
Keywords: antiglaucoma agent; glaucoma; human; medication compliance; note; patient compliance; priority journal; reminder system; risk reduction; visual impairment

Current management of glaucoma - Lusthaus, J.; Goldberg, I. (Medical Journal of Australia, 2019)
Glaucoma is an irreversible progressive optic neuropathy, for which the major proven treatment is to lower the intraocular pressure (IOP). Five groups of IOP-lowering eye drops have varying mechanisms of action. Some drops, such as β-blockers and α-2 agonists, have potentially serious systemic side effects. Acetazolamide is the only available oral agent; it is effective at lowering IOP, but significant side effects relegate its use usually to refractory glaucoma. Two new eye drops, netarsudil and latanoprostene bunod, have recently been approved by the United States Food and Drug Administration. Both have novel IOP-lowering mechanisms and target the conventional aqueous outflow system. Selective laser trabeculoplasty is a gentle treatment that enhances conventional aqueous outflow. It may be used as an initial treatment, as a substitute for eye drops, or to delay glaucoma drainage surgery. Recent advancements in glaucoma surgery have seen an influx of minimally invasive glaucoma surgery devices, which are being used more frequently and earlier on in the treatment paradigm. As limited long term data are available, trabeculectomy remains the gold standard IOP-lowering procedure. Improvements in drug delivery are on the horizon. Drug-eluting devices and implants are able to deliver the drug closer to the receptors for an extended period of time. This will improve treatment adherence and efficacy, which are major limitations with current medical therapy.
Keywords: glaucoma drainage implant; microcatheter; nonvalved ophthalmic drainage device; acetazolamide; alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; bimatoprost plus timolol; brimonidine; brinzolamide; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; dorzolamide; latanoprost; latanoprostene bunod; muscarinic agent; netarsudil; nitric oxide; pilocarpine; prostaglandin derivative; tafluprost; timolol; travoprost; allergy; anorexia; blepharoconjunctivitis; blurred vision; bradycardia; bronchoconstriction; bronchospasm; closed angle glaucoma; conjunctival hyperemia; diarrhea; drowsiness; drug delivery system; drug effect; drug efficacy; drug mechanism; drug safety; drug tolerability; drug withdrawal; dysgeusia; electrolyte disturbance; eye irritation; glaucoma; glaucoma surgery; human; hyperemia; hypertrichosis; hypotension; intraocular hypotension; intraocular pressure; kidney failure; low level laser therapy; medication compliance; metabolic acidosis; miosis; myopia; nausea; nephrolithiasis; nonhuman; open angle glaucoma; orbit disease; patient compliance; polyuria; prevalence; retina detachment; retina tear; review; side effect; skin pigmentation; skin tingling; Stevens Johnson syndrome; tachycardia; topical treatment; trabeculectomy; trabeculoplasty; vitreous floaters; vomiting; weakness; xerostomia; CyPass Micro-Stent; iStent; iStent inject; iTrack; XEN Gel Stent

Influence of new treatment modalities on adherence in glaucoma - Meier-Gibbons, F.; Berlin, M.S.; Töteberg-Harms, M. (Current Opinion in Ophthalmology, 2019)
Purpose of reviewIt is well known that glaucoma patients are not adherent to their therapeutic regimens. The issue of nonadherence is multifactorial and includes inadequate communication between doctors and patients, resulting in significant costs associated with enhanced disease progression. Therapeutic regimens are risk factors which often influences adherence rates. Thus, alternative treatment modalities, especially those risk factors that do not rely on patients' cooperation, may enable improvements in long-term outcomes of glaucoma in patient.Recent findingsThe studies selected for this review were divided into new medications, especially advancements in pharmaceutical approaches to treat glaucoma and new ways of delivering the medication, new surgical methods, especially minimally invasive surgery methods for glaucoma, and new studies about adherence in glaucoma.SummarySurprisingly, a very few studies on glaucoma medication or surgery addressed the concept of adherence. However, adherence is discussed in studies which consider psychological aspects of patients or communication issues between doctors and patients. Although these studies were performed in clinical settings, the issue of adherence is not addressed; despite it has significant effect on long-term outpatient care. A combination of both aspects, adherence and miscommunication, should be considered in studies.
Keywords: trabeculotome; butanediol; fasudil; latanoprost; latanoprostene bunod; netarsudil; norephedrine; ripasudil; aqueous humor formation; aqueous humor outflow; glaucoma; glaucoma surgery; gonioscopy; human; minimally invasive surgery; patient compliance; priority journal; review; risk factor; surgical approach; trabecular meshwork; trabeculotomy; ultrasound

A nationwide survey of factors influencing adherence to ocular hypotensive eyedrops in Japan - Tsumura, T.; Kashiwagi, K.; Suzuki, Y.; Yoshikawa, K.; Suzumura, H.; Maeda, T.; Takeda, R.; Saito, H.; Araie, M. (International Ophthalmology, 2019)
Introduction: Few reports have investigated the status of adherence in Japan on a large scale. We aimed to investigate the status of adherence to topical glaucoma treatment and its associated factors. Methods: A nationwide survey was conducted as a prospective fashion. Participants in this survey were subjects with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension or pseudoexfoliation glaucoma who had been prescribed anti-glaucoma ophthalmic eyedrops and whose ophthalmologist considered prescribing any fixed combination of ocular hypotensive eyedrops for the first time between 2011 and 2012. Subjects and their attending ophthalmologists independently completed a questionnaire by utilizing a fixed combination of ocular hypotensive eyedrops. Results: A total of 1358 ophthalmologists from 1071 medical institutions participated in this survey. We registered 4430 subjects (2049 males and 2381 females). In total, data from 3853 subjects (87.6%) were analyzed after inclusion of subjects based on inclusion and exclusion criteria. Good adherence was defined as not forgetting instillation during the past week. Rates of good adherence reported by subjects and ophthalmologists were 72.4 and 78.5%, respectively (P < 0.0001). The consistency of adherence evaluation between subjects and ophthalmologists was moderate [kappa score 0.5025 (95% confidence interval 0.4740–0.5309)]. Significant factors associated with adherence were size of clinic, age, gender, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma. Conclusion: Adherence to ocular hypotensive eyedrops among Japanese subjects was relatively good. Concordance of adherence between subjects’ reports and ophthalmologists’ responses was moderate. Size of clinic, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma were associated with adherence among Japanese glaucoma subjects.
Keywords: eye drops; aged; article; attitude to health; female; gender; groups by age; health survey; human; intraocular hypertension; Japan; major clinical study; male; open angle glaucoma; ophthalmologist; patient compliance; patient preference; prescription; pseudoexfoliation; questionnaire; register

Visual impairment and blindness in institutionalized elderly in Germany - Larsen, P.P.; Thiele, S.; Krohne, T.U.; Ziemssen, F.; Krummenauer, F.; Holz, F.G.; Finger, R.P. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2019)
Purpose: To determine the prevalence of and identify factors associated with visual impairment and blindness in institutionalized elderly in Germany. Methods: In this prospective multicenter cross-sectional study, ophthalmic health care need and provision were investigated in institutionalized elderly in 32 nursing homes in Germany. All participants underwent a standardized examination including medical and ocular history, refraction, visual acuity testing, tonometry, biomicroscopy, and dilated funduscopy. A standardized questionnaire was used to identify factors associated with eye healthcare utilization, visual impairment and/or blindness. Results: Visual acuity of 566 (94.3%; 413 women and 153 men) of a total of 600 institutionalized elderly was determined. Mean age of the included patients was 82.9 years (± 9.8). Of all participants, 30 (5.3%; 95% CI 3.4–7.2%) were blind and 106 (18.7%; 95% CI 15.5–21.9%) were moderately or severely visually impaired according to the World Health Organization definition. The 136 blind and moderately or severely visually impaired participants were older (OR, Odds Ratio = 1.1, 95% CI 1.0–1.1; p < 0.001), and more likely to have reduced mobility (OR = 12.6, 95% CI 2.8–57.6; p = 0.001). Conclusion: A high proportion of blindness and visual impairment was found amongst nursing home residents. Age and reduced mobility were factors associated with an increased likelihood of blindness and visual impairment. Any surveys of blindness and visual impairment excluding nursing homes may considerably underestimate the prevalence of visual impairment and blindness.
Keywords: adult; aged; article; biomicroscopy; blindness; cataract; cornea opacity; cross-sectional study; diabetic retinopathy; disease association; disease severity; eye examination; eye refraction; female; Germany; glaucoma; health care need; health care planning; health care utilization; human; institutionalized elderly; major clinical study; male; medical history; middle aged; multicenter study; nursing home; nursing home patient; ophthalmoscopy; physical mobility; prevalence; priority journal; prospective study; questionnaire; refraction error; retina injury; tonometry; very elderly; visual acuity; visual impairment

IMI – Clinical myopia control trials and instrumentation report - Wolffsohn, J.S.; Kollbaum, P.S.; Berntsen, D.A.; Atchison, D.A.; Benavente, A.; Bradley, A.; Buckhurst, H.; Collins, M.; Fujikado, T.; Hiraoka, T.; Hirota, M.; Jones, D.; et al. (Investigative Ophthalmology and Visual Science, 2019)
The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/ lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.
Keywords: contact lens; medical device; orthokeratology lens; single vision spectacles; accommodation paralysis; anisometropia; article; astigmatism; best corrected visual acuity; comet assay; cornea; evidence based practice; eye axis length; eye movement; eye refraction; glaucoma; human; intraocular pressure; masking; myopia; patient compliance; patient-reported outcome; priority journal; pupil; randomization; refraction error; sclera; stratification; ultrasound; visual acuity; visual impairment

Medical use of cannabis for glaucoma - Rafuse, P.; Buys, Y.M. (Canadian Journal of Ophthalmology, 2019)
Keywords: cannabis; editorial; glaucoma; health care access; health care policy; human; intraocular pressure; traffic accident; treatment duration

21st century glaucoma care - Quigley, H.A. (Eye (Basingstoke), 2019)
Glaucoma care has evolved dramatically over the past generation, with changes that have incorporated new technology and improved understanding of the disease process. A major need is to construct a useful definition of glaucomatous optic neuropathy that can be used to compare data across clinical research studies. The treatment of glaucoma should now be based on achievement of a goal target for intraocular pressure, unique to each patient. Adherence with eye drop treatment is far from ideal and can be improved using reminder systems. Sustained delivery of glaucoma medication is on the horizon. New surgical approaches to glaucoma are being actively studied but have not as yet found their place in its care, with rigorous testing against present treatments needed.
Keywords: antiglaucoma agent; eye drops; cell phone use; diagnostic accuracy; drug delivery system; glaucoma; glaucoma surgery; human; intraocular pressure; iridotomy; nerve injury; nonhuman; optical coherence tomography; patient compliance; review; tonometry; trabeculoplasty; visual field; visual system examination

Healthcare resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma - Voorham, J.; Xu, X.; Price, D.B.; Golam, S.; Davis, J.; Zhi Jie Ling, J.; Kerkhof, M.; Ow, M.; Tran, T.N. (Allergy: European Journal of Allergy and Clinical Immunology, 2019)
Background: Although systemic corticosteroid (SCS) treatment, irrespective of duration or dosage, is associated with adverse outcomes for patients with asthma, the longitudinal effects of this treatment on adverse outcomes, healthcare resource utilization (HCRU), and healthcare costs are unknown. Methods: We identified patients initiating intermittent or long-term SCS who were diagnosed with active asthma from UK general practice with linked secondary care data. Control (non-SCS) patients were matched by sex and index date with those initiating SCS. Minimum baseline period was 1 year prior to index date; minimum follow-up duration was 2 years post–index date. Cumulative incidence of SCS-associated adverse outcomes and associated HCRU and costs were compared between SCS and non-SCS patient groups and among average SCS daily exposure categories. Associations between exposure and annualized HCRU and costs were assessed, adjusted for confounders. Results: Analyses included 9413 matched pairs. Median (interquartile range) follow up was as follows: SCS group: 7.1 (4.1-11.8) years; control group: 6.4 (3.8-10.0) years. Greater SCS dosages were correlated with greater cumulative incidence. For example, patients with type 2 diabetes receiving an average daily dosage of ≥7.5 mg had a 15-year cumulative incidence (37.5%) that was 1.5-5 times greater than those receiving lower dosages. HCRU and costs increased annually for SCS patients but not for non-SCS patients. Increases in all-cause adverse outcome (excluding asthma)–associated HCRU and costs were dose-dependent. Conclusions: Over the long term, adverse outcomes associated with SCS initiation were relatively frequent and costly, with a positive dosage–response relationship with SCS exposure.
Keywords: corticosteroid; accident; adult; adverse outcome; aged; article; asthma; cardiovascular disease; cataract; cerebrovascular accident; cerebrovascular disease; comparative study; concentration response; controlled study; corticosteroid therapy; drug megadose; emergency care; female; general practitioner; glaucoma; health care cost; health care utilization; heart failure; heart infarction; hospitalization; human; incidence; long term exposure; low drug dose; maintenance drug dose; male; medical specialist; middle aged; non insulin dependent diabetes mellitus; osteoporosis; pneumonia; prescription; priority journal; secondary health care; systemic therapy; very elderly; young adult

Novel Dexamethasone Sodium Phosphate Treatment (DSP-Visulex) for Noninfectious Anterior Uveitis: A Randomized Phase I/II Clinical Trial - Papangkorn, K.; Truett, K.R.; Vitale, A.T.; Jhaveri, C.; Scales, D.K.; Foster, C.S.; Montieth, A.; Higuchi, J.W.; Brar, B.; Higuchi, W.I. (Current Eye Research, 2019)
Purpose: Frequent steroid drops represent a challenge in patient compliance. This study evaluated the safety and efficacy of 5 minute topical dexamethasone sodium phosphate-Visulex (DSP-Visulex) treatment regimen (two applications on the first week then weekly after) compared to daily prednisolone acetate 1% (PA) for noninfectious anterior uveitis. Materials and Methods: Forty-four patients were randomized to 8% DSP-Visulex with placebo eye drops (8% group, n = 14), 15% DSP-Visulex with placebo eye drops (15% group, n = 15), or Vehicle-Visulex with PA eye drops (PA group, n = 15). Patients received daily eye drops and Visulex treatments on days 1, 3, 8, and 15 with an optional treatment on day 22. Efficacy measures were change in anterior chamber cell (ACC) count from baseline and proportion of patients with zero ACC count at days 8, 15, and 29. Safety measures were adverse events (AEs), visual acuity, ocular symptoms, and intraocular pressure (IOP). Results: ACC resolution over time was similar among the three groups. The percentage of patients with clear ACC was 18%, 22%, and 15% on day 8; 27%, 56%, and 54% on day 15; and 90%, 88%, and 77% on day 29 for the 8%, 15%, and PA groups, respectively. The numbers of reported AEs were 10, 36, and 12 for the 8%, 15%, and PA groups, respectively. Ten patients among all groups experienced treatment-related AEs, which included headache, eye pain, corneal abrasion, conjunctival/corneal staining, conjunctivitis, visual acuity reduction, and keratitis all of which were resolved during the timeframe of patients’ participation in the study. IOP elevation was noted in the PA group throughout the study, whereas IOP elevation in the DSP-Visulex groups was observed at day 3 but not thereafter. Conclusions: The efficacy of the DSP-Visulex applications was comparable to the daily PA drops in the treatment of noninfectious anterior uveitis. Both 8% and 15% DSP-Visulex treatments were safe and well tolerated.
Keywords: NCT02309385; ophthalmic drug delivery device; dexamethasone sodium phosphate; placebo; abrasion; adult; anterior eye chamber; article; best corrected visual acuity; chemosis; clinical article; conjunctival hemorrhage; conjunctivitis; controlled study; dermatitis; diabetic ketoacidosis; drug dose reduction; drug efficacy; drug safety; drug tolerability; eye pain; eyelid pain; female; glaucoma; headache; human; hyperemia; intraocular pressure; iridocyclitis; keratitis; male; multicenter study; patient compliance; phase 1 clinical trial; phase 2 clinical trial; priority journal; randomized controlled trial; retina detachment; retina hemorrhage; slit lamp microscopy; surgical patient; treatment duration; uveitis; viral conjunctivitis; visual acuity; visual analog scale; Visulex

DALK repair of corneal melt secondary to rheumatoid arthritis - Greenan, E.; Murphy, C. (Irish Journal of Medical Science, 2019)
Corneal melt is a rare ocular condition, with an estimated incidence of 3 per million annually (1). The majority of presentations are related to collagen vascular disease, of which longstanding rheumatoid arthritis (RA) is the most commonly attributing co-pathology (2-4). Herein, we describe the case of a 58-year-old patient with a background history of seropositive RA who was referred to the Royal Victoria Eye and Ear Hospital for the emergency treatment of corneal melt. His ocular history to that point was significant for blepharitis, dry eye disease (DED), and marginal keratitis. On exam a bow-shaped area of ulceration was found on the inferior quadrant of his right cornea, stretching 3mm in length, with a central Siedel's positive perforation. As the length of the aperture was too great to be glued, the cornea was surgically repaired with a crescentic deep anterior lamellar keratoplasty (DALK). Post operatively, the patient's recovery was fragmented, complicated by a minor blunt force trauma that required surgical re-suturing of the graft, as well as missed review appointments due to pneumonia. Despite such disruption, nine months after his initial presentation the patient had successfully regained visual acuity of 6/6 in his right eye. At final review before transfer back to his local ophthalmic unit, the patient's DALK patch showed thin vascularisation, overlaid with a few scattered superficial punctate epithelial erosions, and most importantly, remained clear. This case highlights the importance of relating ocular pathology to systemic disease. In relation to the health of the eye, corneal melt can result in loss of vision due to corneal scarring, as well as threaten the survival of the globe if perforation occurs and structural integrity is not reinstated. Furthermore, the presence of corneal melt may indicate uncontrolled systemic disease, most critically, vasculitis (5, 6). Studies have shown that systemic vasculitis has a high rate of potential mortality (7) if not treated and it is recommended that early and aggressive immunosuppression is commenced (8). In such a clinical scenario it is important to take into consideration comorbid ocular surface disease. This patient had a background ocular history of DED, blepharitis and recurrent marginal keratitis (9-11). These conditions play into a vicious cycle (12) that can potentiate a destructive cascade led by dysregulation proteases (13), leading to rapid stromal thinning and even corneal perforation, as was the case here. Finally, this report nicely illustrates the benefits of DALK versus traditional penetrating keratoplasty (PK). As well as having similar postoperative visual outcomes (14), in sparing the native endothelium and Descemet's membrane, DALK has a lower rate of graft rejection. And, although could not be predicted in this case, quite luckily DALK has a markedly reduced rate of the risk of graft loss following blunt trauma when compared to PK grafts (15).
Keywords: proteinase; adult; blepharitis; blindness; blunt trauma; case report; clinical article; complication; conference abstract; cornea perforation; Descemet membrane; dry eye; ear; emergency treatment; endothelium; erosion; graft failure; graft rejection; human; immunosuppressive treatment; keratitis; male; middle aged; mortality; ocular surface disease; penetrating keratoplasty; pneumonia; remission; rheumatoid arthritis; scar formation; surgery; systemic disease; systemic vasculitis; ulcer; vascularization; visual acuity

Medical interventions for traumatic hyphema - Gharaibeh, A.; Savage, H.I.; Scherer, R.W.; Goldberg, M.F.; Lindsley, K. (Cochrane Database of Systematic Reviews, 2019)
Background: Traumatic hyphema is the entry of blood into the anterior chamber (the space between the cornea and iris) subsequent to a blow or a projectile striking the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g. corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications can lead to permanent impairment of vision. People with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure. If rebleeding occurs, the rates and severity of complications increase. Objectives: To assess the effectiveness of various medical interventions in the management of traumatic hyphema. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 6); MEDLINE Ovid; Embase.com; PubMed (1948 to June 2018); the ISRCTN registry; ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The date of the search was 28 June 2018. Selection criteria: Two review authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. In this review, we included randomized and quasi-randomized trials that compared various medical (non-surgical) interventions versus other medical intervention or control groups for the treatment of traumatic hyphema following closed-globe trauma. We applied no restrictions regarding age, gender, severity of the closed-globe trauma, or level of visual acuity at the time of enrollment. Data collection and analysis: Two review authors independently extracted the data for the primary outcomes, visual acuity and time to resolution of primary hemorrhage, and secondary outcomes including: secondary hemorrhage and time to rebleed; risk of corneal blood staining, glaucoma or elevated intraocular pressure, optic atrophy, or peripheral anterior synechiae; adverse events; and duration of hospitalization. We entered and analyzed data using Review Manager 5. We performed meta-analyses using a fixed-effect model and reported dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean differences (MD). Main results: We included 20 randomized and seven quasi-randomized studies with a total of 2643 participants. Interventions included antifibrinolytic agents (systemic and topical aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest. We found no evidence of an effect on visual acuity for any intervention, whether measured within two weeks (short term) or for longer periods. In a meta-analysis of two trials, we found no evidence of an effect of aminocaproic acid on long-term visual acuity (RR 1.03, 95% confidence interval (CI) 0.82 to 1.29) or final visual acuity measured up to three years after the hyphema (RR 1.05, 95% CI 0.93 to 1.18). Eight trials evaluated the effects of various interventions on short-term visual acuity; none of these interventions was measured in more than one trial. No intervention showed a statistically significant effect (RRs ranged from 0.75 to 1.10). Similarly, visual acuity measured for longer periods in four trials evaluating different interventions was also not statistically significant (RRs ranged from 0.82 to 1.02). The evidence supporting these findings was of low or very low certainty. Systemic aminocaproic acid reduced the rate of recurrent hemorrhage (RR 0.28, 95% CI 0.13 to 0.60) as assessed in six trials with 330 participants. A sensitivity analysis omitting two studies not using an intention-to-treat analysis reduced the strength of the evidence (RR 0.43, 95% CI 0.17 to 1.08). We obtained similar results for topical aminocaproic acid (RR 0.48, 95% CI 0.20 to 1.10) in two studies with 121 participants. We assessed the certainty of these findings as low and very low, respectively. Systemic tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage (RR 0.31, 95% CI 0.17 to 0.55) in five trials with 578 participants, as did aminomethylbenzoic acid as reported in one study (RR 0.10, 95% CI 0.02 to 0.41). The evidence to support an associated reduction in the risk of complications from secondary hemorrhage (i.e. corneal blood staining, peripheral anterior synechiae, elevated intraocular pressure, and development of optic atrophy) by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compared with placebo. We found no evidence of an effect in the number of adverse events with the use of systemic versus topical aminocaproic acid or with standard versus lower drug dose.  The number of days for the primary hyphema to resolve appeared to be longer with the use of systemic aminocaproic acid compared with no use, but this outcome was not altered by any other intervention. The available evidence on usage of systemic or topical corticosteroids, cycloplegics, or aspirin in traumatic hyphema was limited due to the small numbers of participants and events in the trials. We found no evidence of an effect between a single versus binocular patch or ambulation versus complete bed rest on the risk of secondary hemorrhage or time to rebleed. Authors' conclusions: We found no evidence of an effect on visual acuity by any of the interventions evaluated in this review. Although evidence was limited, it appears that people with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhaging. However, hyphema took longer clear in people treated with systemic aminocaproic acid. There is no good evidence to support the use of antifibrinolytic agents in the management of traumatic hyphema other than possibly to reduce the rate of secondary hemorrhage. Similarly, there is no evidence to support the use of corticosteroids, cycloplegics, or non-drug interventions (such as binocular patching, bed rest, or head elevation) in the management of traumatic hyphema. As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value.
Keywords: eye patch; 4 aminomethylbenzoic acid; acetylsalicylic acid; agents acting on the eye; aminocaproic acid; Chinese drug; chloramphenicol; conjugated estrogen; corticosteroid derivative; cycloplegic agent; eye drops; hydrocortisone; miotic agent; placebo; prednisone; tranexamic acid; unclassified drug; yunnan baiyao; abnormal sensation; ambulatory care; bed rest; bleeding; Chinese medicine; confidence interval; conservative treatment; cornea disease; data analysis; data base; data synthesis; diarrhea; dizziness; drug administration route; drug dose comparison; drug efficacy; drug eruption; dry nose; economic aspect; eye disease; follow up; glaucoma; head position; hospitalization; human; hyphema; hypotension; information processing; intraocular foreign body; intraocular hypertension; muscle cramp; nausea; nausea and vomiting; optic nerve atrophy; peripheral anterior synechiae; physical activity; priority journal; pruritus; punctate corneal staining; quality of life; randomized controlled trial (topic); review; risk assessment; sensitivity analysis; systematic review; treatment outcome; visual acuity; vomiting; xerostomia

Latanoprost, a balanced prostaglandin - Martinez-de-la-Casa, J.M.; Donde, S.; Wierzbowska, J. (Expert Review of Ophthalmology, 2019)
Introduction: Glaucoma is a leading cause of blindness and represents a significant global health and economic concern. Prostaglandin analogs such as latanoprost–which act to reduce intraocular pressure by enhancing uveoscleral flow and slow the development and progression of glaucoma–are recommended as a first-line monotherapy. Areas covered: We review recent efficacy and safety data for latanoprost, both alone and in combination therapy, and vs. other prostaglandin analogs, focusing on the tolerability and adherence to the drug and the subsequent impact on patient-perceived quality of life. Relevant studies were identified by an electronic literature search using MEDLINE PubMed, and current global glaucoma guidelines were reviewed. Expert commentary: Prostaglandin analogs represent the cornerstone in glaucoma therapy. Individual studies demonstrate differences in efficacy between prostaglandin analogs, but within-class differences are generally small–and, on balance, latanoprost presents a good efficacy-safety profile. Low adverse event rates result in greater persistence and improved quality of life for patients. Further, a latanoprost/β-blocker combination represents an efficacious therapeutic alternative where monotherapy does not sufficiently reduce intraocular pressure. However, high-quality randomized controlled trials are required to provide further information regarding fixed-dose combination vs. unfixed combination treatment regimens.
Keywords: latanoprost; angina pectoris; asthma; backache; blurred vision; conjunctival hyperemia; disease exacerbation; drug efficacy; drug safety; drug tolerability; dyspnea; eye burning; eye irritation; eye pain; glaucoma; human; injection site stinging; intraocular foreign body; intraocular pressure; iris disease; lens capsule rupture; myalgia; ocular pruritus; outcome assessment; patient compliance; perfusion pressure; periorbital edema; pigment disorder; quality of life; retina macula cystoid edema; review; thorax pain

Trends in and Predictors of Depression Among Participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS) - Musch, D.C.; Niziol, L.M.; Janz, N.K.; Gillespie, B.W. (American Journal of Ophthalmology, 2019)
Purpose: To characterize longitudinal trends and factors predictive of depressive symptoms following glaucoma diagnosis in Collaborative Initial Glaucoma Treatment Study (CIGTS) participants. Design: Cohort study using follow-up data from a clinical trial. Methods: A total of 607 participants with newly diagnosed open-angle glaucoma were enrolled at 14 clinical centers in the United States from October 1993 through April 1997, randomized to treatment with medication or surgery, and followed every 6 months through 2004. The 8-item Center for Epidemiologic Studies Depression Scale (CES-D) was administered at baseline and follow-up visits. Three outcome measures were investigated: overall CES-D depression score, presence of mild or worse depression (CES-D score ≥ 7), and number of depressive symptoms endorsed. Results: The average baseline CES-D score was 2.4 (SD = 3.8), 12.5% of subjects reported symptoms associated with mild or worse depression, and 55.3% reported at least 1 depressive symptom. By 1 year posttreatment, depression measures decreased (1.5, 6.7%, and 38.4%, respectively), with modest decreases thereafter. Baseline factors predictive of mild or worse depression included worse vision-related quality of life (VRQOL) (odds ratio [OR] = 2.41), female sex (OR = 1.42), younger age (OR per 10 years younger = 1.24), and less than high school education (OR = 2.93); other outcomes showed similar results. Conclusions: Depressive symptoms decreased considerably during the first year after treatment initiation, but were elevated in those with impaired VRQOL. Given the potential of depression to reduce treatment adherence and thus increase the risk of glaucoma progression, eye care providers should ask patients about depressive symptoms, provide reassurance when appropriate, and make referrals as necessary.
Keywords: adult; age; article; Center for Epidemiologic Studies Depression Scale; cohort analysis; controlled study; depression; depression assessment; disease association; disease exacerbation; disease severity; educational status; eye care professional; female; follow up; human; longitudinal study; major clinical study; male; middle aged; open angle glaucoma; outcome assessment; patient compliance; patient-reported outcome; predictor variable; priority journal; quality of life; reassurance; risk factor; sex difference; therapy effect; treatment duration; trend study; United States

Effects of dietary and lifestyle recommendations on patients with glaucoma: A randomized controlled pilot trial - Hecht, I.; Achiron, A.; Bartov, E.; Maharshak, I.; Mendel, L.; Pe'er, L.; Bar, A.; Burgansky-Eliash, Z. (European Journal of Integrative Medicine, 2019)
Introduction: Several studies have shown intra-ocular pressure (IOP) reductions following lifestyle and behavior changes in primary open-angled glaucoma (POAG) in the short term. Our aim in this study was to examine the potential of such interventions as an adjunct treatment and assess their cumulative short-term effect on IOP and illness perception in patients with POAG. Methods: In this randomized, parallel-arm, single blind controlled trial, POAG patients were randomized in a 1:1 ratio to either a treatment group which received instructions on dietary and lifestyle changes in addition to their standard therapy or to a control group which continued their standard therapy. Recommendations were selected to include those previously reported to reduce IOP; including: Saffron spice supplementation, high fiber diet, avoidance of caffeine, aerobic exercise, head elevation during sleep and others. Illness perception was assessed using the Brief IPQ questionnaire. Results: 22 participants were enrolled, 3 were lost to follow-up and 19 entered analysis. Mean age was 69 ± 12 and 12 (63%) were female. Concerns about the illness, symptoms, and feelings of control were significantly improved in the treatment group compared with controls (all P < 0.05). Mean IOP reduced in the treatment group by 1.0 ± 3.1 mmHg (17.5 ± 4.3–16.5 ± 4.7) and by 0.7 ± 4.1 mmHg in the controls (16.8 ± 4.7–16.1 ± 6.2) with no significant difference between them (P = 0.866). Conclusions: Dietary and lifestyle changes may improve illness perception and patient well-being, however they do not appear to affect IOP in the short term among patients with POAG.
Keywords: aerobic exercise; aged; article; attitude to illness; blindness; clinical article; clinical outcome; controlled study; female; glaucoma; high fiber diet; human; intraocular pressure; lifestyle modification; male; outcome assessment; patient compliance; pilot study; priority journal; prospective study; randomized controlled trial; sleep pattern; spice; supplementation; wellbeing

Comparing the long-term impact on health care resources utilization and costs due to various single-piece acrylic monofocal intraocular lens implantation during cataract surgery: A cost-consequence analysis for the United Kingdom, Italy, and Denmark - Dhariwal, M.; Bouchet, C.; Jawla, S. (Clinical Ophthalmology, 2019)
Purpose: The objective of this study was to estimate the cost impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy and its complications due to single-piece acrylic monofocal intraocular lenses (IOLs) in the healthcare setting of United Kingdom, Italy, and Denmark. Materials and methods: A hypothetical cost-consequence model was developed to estimate economic burden of Nd:YAG laser capsulotomy due to different single-piece acrylic monofocal IOLs. Cumulative incidence of Nd:YAG laser capsulotomy at 3 years after cataract surgery with five single-piece monofocal acrylic IOLs was sourced from retrospective data analysis of electronic medical records of cataract patients in the United Kingdom. Risk probability of post-Nd:YAG laser complications, ie, retinal detachment, glaucoma, and cystoid macular edema at 3 years was derived using published literature. Unit costs were taken from publicly available sources with all costs converted to euro (€). Number of cataract procedures per year for each country was sourced from Eurostat statistics. Results: For the estimated cataract procedures carried out nationally every year, single-piece monofocal hydrophobic AcrySof IOL was associated with substantially lower cases of Nd:YAG laser capsulotomy procedures and subsequent complications in 3 years after cataract surgery when compared to other single-piece monofocal acrylic IOLs. The total cost savings with the use of AcrySof over other IOLs in countries assessed ranged from €0.5 to €4.7 million (vs AMO Tecnis) and €2.1 to €17.9 million (vs Rayner C-/Super-flex). Conclusion: Incidence of Nd:YAG capsulotomy due to the choice of IOL could significantly affect healthcare budgets in the post-cataract surgery period. Our analysis indicates that single-piece monofocal AcrySof IOLs is the most cost-saving treatment option for health care systems when compared to other acrylic single-piece IOLs.
Keywords: AMO Tecnis; B and L Akreos; lens implant; Lenstec Softec; neodymium YAG laser; Rayner C; punctal plug; acrylic acid; article; capsulotomy; cataract extraction; comparative study; controlled study; cost effectiveness analysis; Denmark; economic aspect; equipment design; glaucoma; health care cost; health care utilization; human; incidence; Italy; lens implantation; major clinical study; retina detachment; retina macula cystoid edema; retrospective study; sensitivity analysis; United Kingdom; AcrySof; AMO Tecnis; B and L Akreos; Lenstec Softec; Rayner C; Super-flex

Corticosteroids in moderate-to-severe graves’ ophthalmopathy: Oral or intravenous therapy? - Penta, L.; Muzi, G.; Cofini, M.; Leonardi, A.; Lanciotti, L.; Esposito, S. (International Journal of Environmental Research and Public Health, 2019)
Background: Ophthalmopathy is a rare extra-thyroid manifestation of Graves’ disease, in paediatrics. Intravenous corticosteroids are the main treatment of moderate-to-severe Graves’ orbitopathy. In this paper, we describe a moderate-to-severe active Graves’ ophthalmopathy in a child and the response to oral therapy with prednisone. Case presentation: A nine-year-old male child suffering for a few months, from palpitations, tremors, and paresthesia was hospitalized in our Pediatric Clinic. At admission, the thyroid function laboratory tests showed hyperthyroidism with elevated free thyroxine (FT4) and free triiodothyronine (FT3) levels and suppressed thyroid-stimulating hormone (TSH) levels. These findings, combined with the clinical conditions—an ophthalmologic evaluation (that showed the presence of exophthalmos without lagophthalmos and visual acuity deficiency), thyroid ultrasound, and TSH receptor antibody positivity—led to a diagnosis of Graves’ disease. Therefore, methimazole was administered at a dose of 0.4|mg/kg/day. After 4 months, thyroid function was clearly improved, with normal FT3 and FT4 values and increasing TSH values, without adverse effects. Nevertheless, an eye examination showed ophthalmopathy with signs of activity, an increase in the exophthalmos of the right eye with palpebral retraction, soft tissue involvement (succulent and oedematous eyelids, caruncle and conjunctival hyperaemia and oedema) and keratopathy, resulting from exposure. We began steroid therapy with oral administration of prednisone (1 mg/kg/day) for four weeks, followed by gradual tapering. After one week of therapy with prednisone, an eye assessment showed reduced retraction of the upper eyelid of the right eye, improvement of right eye exophthalmometry and reduction of conjunctival hyperaemia. After four weeks of therapy with prednisone, an eye assessment showed reduction of the right palpebral retraction without conjunctival hyperaemia and no other signs of inflammation of the anterior segment; after twelve weeks, an eye assessment showed a notable decrease in the right palpebral retraction and the absence of keratitis, despite persisting moderate conjunctival hyperaemia. No adverse event associated with steroid use was observed during the treatment period and no problem in compliance was reported. Conclusion: Prednisone seems a better choice than intravenous corticosteroids, for treating moderate-to-severe and active Graves’ ophthalmopathy, keeping in mind the importance of quality of life in pediatric patients.
Keywords: liothyronine; prednisone; thiamazole; thyroglobulin antibody; thyroid peroxidase antibody; thyrotropin; thyrotropin receptor antibody; thyroxine; anterior eye segment; antibody detection; article; case report; child; clinical article; conjunctival hyperemia; corticosteroid therapy; disease duration; disease severity; drug choice; drug dose reduction; drug efficacy; drug safety; dry skin; echography; electrocardiography; endocrine ophthalmopathy; exophthalmos; eye examination; eye movement disorder; eyelid edema; eyelid retraction; follow up; free liothyronine index; free thyroxine index; Graves disease; heart palpitation; human; hyperthyroidism; keratopathy; male; paresthesia; patient compliance; quality of life; school child; sinus tachycardia; thyroid function; thyroid function test; thyroid weight; thyrotropin blood level; treatment duration; treatment response; tremor; visual acuity; vital sign

A theory-driven qualitative study exploring issues relating to adherence to topical glaucoma medications - McDonald, S.; Ferguson, E.; Hagger, M.S.; Foss, A.J.E.; King, A.J. (Patient Preference and Adherence, 2019)
Purpose: Investigating patients’ perceptions of their illness can provide important insights into the experience and management of the illness and associated treatment, and enhance understanding of variations in adherence to prescribed medication. The Common-Sense Model of Self-Regulation (CSM) provides a theoretical framework for the study of illness cognitions, health behavior, and adherence to health recommendations. The aim of this study was to use the CSM to investigate the experience of glaucoma and its treatment from the patients’ perspective, and to apply these insights to classify and clarify issues related to nonadherence with treatment. Patients and methods: A qualitative investigation using semi-structured interviews took place in two outpatient glaucoma clinics. Thirty-three patients with primary open-angle glaucoma using hypotensive eye drops participated in the study. Deductive content analysis was used to analyze the interview data. Results: Issues relating to nonadherence with hypotensive eye drops and patients’ experience with their glaucoma and treatment were identified. Treatment schedule and patient factors were classified as common barriers to adherence. Further themes include experienced symptoms of glaucoma, illness coherence, and the emotional and practical consequences of the illness. Conclusion: Findings provide important insights into the emotional and practical outcomes of glaucoma for patients, perceived symptoms of the illness, and insights into patient memory and cognition. These findings provide supporting evidence for the importance of conducting theoretically driven qualitative investigations of patients’ experience with glaucoma and their treatment, and provide suggestions on key issues that need to be addressed in future multidimensional interventions aimed at improving adherence and patient quality of life.
Keywords: antiglaucoma agent; adult; aged; article; attitude to illness; clinical article; emotion; female; human; male; open angle glaucoma; patient attitude; patient compliance; qualitative research; self regulation model; symptom; treatment refusal; very elderly

Real world use of loteprednol etabonate ophthalmic gel 0.5% in cases representative of comorbid pathologies responding to minimally invasive glaucoma surgery - Sheppard, J.D.; Singh, I.P. (Clinical Ophthalmology, 2019)
Purpose: With the increasing use of minimally invasive surgical techniques for intraocular pressure (IOP) lowering in glaucoma patients, there is a need to examine best practices regarding the postoperative management of these patients. Corticosteroids, though effective in controlling postoperative ocular pain and inflammation, present distinct challenges in glaucoma surgery patients, as their use can be associated with IOP elevation. Loteprednol etabonate (LE) is an ocular corticosteroid designed to have an improved safety profile relative to other corticosteroids. Methods: We report here a representative selection of cases in which patients were successfully treated with LE ophthalmic gel 0.5% (LE gel) following a variety of minimally invasive glaucoma surgery (MIGS) procedures. Cases included patients undergoing various procedures including a Trabectome combined with cataract surgery; micro-stent surgery (iStent) combined with cataract surgery; supraciliary CyPass Micro-Stent placement combined with cataract surgery; Kahook Dual Blade goniotomy; and ab interno canaloplasty using the iTrack catheter. Observations: In all cases, use of LE gel during the postoperative period appeared effective and safe in reducing inflammation and controlling pain. No adverse events or IOP elevations were noted, even in those patients continuing use of LE gel past the postoperative period for longer than six months with documented follow-up. In two cases, patients with elevated IOP using either prednisolone or difluprednate postoperatively were switched to LE gel, with a subsequent reduction in IOP. Conclusions: This selection of cases involving patients undergoing MIGS suggests that LE gel may be an effective and safe option for treating postoperative inflammation and pain following such procedures with minimal to no effect on IOP or other negative sequalae.
Keywords: glaucoma drainage implant; goniotomy; lens implant; microcatheter; nonvalved ophthalmic drainage device; ophthalmological surgical equipment; trabeculotome; besifloxacin; bimatoprost; brimonidine; brimonidine plus brinzolamide; brinzolamide plus timolol; bromfenac; difluprednate; dorzolamide plus timolol; latanoprost; levobunolol; loteprednol etabonate; moxifloxacin; mycophenolic acid; prednisolone; prednisolone acetate; prednisone; timolol; triamcinolone; ab interno canaloplasty; adult; aged; article; bedtime dosage; case report; cataract; cataract extraction; clinical article; comorbidity; drug dose reduction; drug efficacy; drug safety; drug withdrawal; evening dosage; eye inflammation; eye pain; female; follow up; glaucoma; glaucoma surgery; human; intraocular hypertension; male; middle aged; minimally invasive surgery; patient compliance; postoperative inflammation; postoperative pain; postoperative period; treatment duration; uveitis; CyPass; iStent; iTrack; Kahook Dual Blade

Evaluation of automatic monitoring of instillation adherence using eye dropper bottle sensor and deep learning in patients with glaucoma - Nishimura, K.; Tabuchi, H.; Nakakura, S.; Nakatani, Y.; Yorihiro, A.; Hasegawa, S.; Tanabe, H.; Noguchi, A.; Aoki, R.; Kiuchi, Y. (Translational Vision Science and Technology, 2019)
Purpose: We developed and evaluated an eye dropper bottle sensor system comprising motion sensor with automatic motion waveform analysis using deep learning (DL) to accurately measure adherence of patients with antiglaucoma ophthalmic solution therapy. Methods: We enrolled 20 patients with open-angle glaucoma who were treated with either latanoprost ophthalmic solution 0.005% or latanoprost-timolol maleate fixed combination ophthalmic solution in both eyes. An eye dropper bottle sensor was installed at patients’ homes, and they were asked to instill the medication and manually record each instillation time for 3 days. Waveform data were automatically collected from the eye dropper bottle sensor and judged as a complete instillation by the DL instillation assessment model. We compared the instillation times captured on the waveform data with those on each patient’s record form. In addition, we also calculated instillation movement duration from Waveform data. Results: The developed eye bottle sensor detected all 60 instillation events (100%). Mean difference between patient and eye bottle sensor recorded time was 1 ± 1.22 (range, 0-3) minutes. Additionally, mean instillation movement duration was 16.1 ± 14.4 (range, 4-43) seconds. Two-way ANOVA revealed a significant difference in instillation movement duration among patients (P < 0.001) and across days (P < 0.001). Conclusion: The eye dropper bottle sensor system developed by us can be used for automatic monitoring of instillation adherence in patients with glaucoma. Translational Relevance: We believe that our eye dropper bottle sensor system will accurately measure adherence of all glaucoma patients as well as help glaucoma treatment.
Keywords: electric battery; eye drop delivery aid; light emitting diode; eye drops; latanoprost plus timolol; acceleration; adult; article; clinical article; drug instillation; female; glaucoma; human; learning; machine learning; male; middle aged; monitoring; open angle glaucoma; patient compliance; perimetry; prevalence; questionnaire; sensory system; visual field

Management of glaucoma in developing countries: Challenges and opportunities for improvement - Delgado, M.F.; Abdelrahman, A.M.; Terahi, M.; Woll, J.J.M.Q.; Gil-Carrasco, F.; Cook, C.; Benharbit, M.; Boisseau, S.; Chung, E.; Hadjiat, Y.; Gomes, J.A.P. (ClinicoEconomics and Outcomes Research, 2019)
Glaucoma is the leading cause of blindness in the developed and developing world. Not only is the clinical impact of this disease considerable, but associated economic and humanistic burdens - affecting patients, caregivers, and society - are substantial. Since glaucoma is an age-related disorder and populations in many developing countries are aging at a faster pace than in the developed world, increasing attention is being focused on ways to ameliorate the burdens of illness. In this paper, we examine the burdens of glaucoma with particular focus on developing countries, discuss some of the challenges that exist in delivering optimal glaucoma management within budget constraints, and bring into perspective how we could improve current healthcare systems, leverage technology, and strike an appropriate balance between cost and quality of care, thereby offering considerations to payors and policymakers in these countries that may result in longer-term cost savings, while concurrently striving to achieve the WHO Vision on the prevention of blindness and visual impairment.
Keywords: antiglaucoma agent; article; blindness; budget; cost control; developing country; disease burden; drug cost; dry eye; glaucoma; health care access; health care cost; health care policy; health care quality; human; incidence; ocular surface disease; primary medical care; primary prevention; quality of life; systematic review; telemedicine; visual impairment

Managing side effects on ocular surface caused by Glaucoma eye drops - Ferreras, A.; Iester, M.; Figus, M.; Fogagnolo, P.; Frezzotti, P. (Current Medicinal Chemistry, 2019)
Keywords: antiglaucoma agent; artificial tear; benzalkonium chloride; eye drops; dry eye; editorial; glaucoma; human; ocular surface disease; patient compliance; quality of life; tear film; tear osmolarity

Advanced hydrogels based drug delivery systems for ophthalmic delivery - Gorantla, S.; Waghule, T.; Rapalli, V.K.; Singh, P.P.; Dubey, S.K.; Saha, R.N.; Singhvi, G. (Recent Patents on Drug Delivery and Formulation, 2019)
Hydrogels are aqueous gels composed of cross-linked networks of hydrophilic polymers. Stimuli-responsive based hydrogels have gained focus over the past 20 years for treating ophthalmic diseases. Different stimuli-responsive mechanisms are involved in forming polymer hydrogel networks, including change in temperature, pH, ions, and others including light, thrombin, pressure, antigen, and glucose-responsive. Incorporation of nanocarriers with these smart stimuli-responsive drug delivery systems that can extend the duration of action by increasing ocular bioavailability and reducing the dosing frequency. This review will focus on the hydrogel drug delivery systems highlighting the gelling mechanisms and emerging stimuli-responsive hydrogels from preformed gels, nanogels, and the role of advanced 3D printed hydrogels in vision-threatening diseases like age-related macular degeneration and retinitis pigmentosa. It also provides insight into the limitations of hydrogels along with the safety and biocompatibility of the hydrogel drug delivery systems.
Keywords: bevacizumab; cellulose derivative; curcumin; dexamethasone acetate; diclofenac; drug carrier; hyaluronic acid; hydrocortisone butyrate; hydrogel; liposome; muscone; nanocarrier; nanogel; nanoparticle; norfloxacin; pilocarpine; poloxamer; poly(n isopropylacrylamide); polyacrylic acid; polymer; ranibizumab; stimuli responsive polymer; timolol maleate; age related macular degeneration; biocompatibility; cataract; cross linking; drug bioavailability; drug delivery system; drug formulation; drug release; drug safety; drug solubility; drug stability; dry eye; endophthalmitis; eye infection; eye inflammation; flow kinetics; glaucoma; human; intracameral drug administration; intraocular drug administration; intraocular pressure; intrastromal drug administration; intravitreal drug administration; opthalmic delivery; patient compliance; pH measurement; priority journal; retention time; retinitis pigmentosa; review; shear stress; subconjunctival drug administration; subretinal drug administration; temperature measurement; three dimensional printing

XEN Gel Stent to Treat Intraocular Hypertension After Dexamethasone-Implant Intravitreal Injections: 5 Cases - Rezkallah, A.; Mathis, T.; Denis, P.; Kodjikian, L. (Journal of Glaucoma, 2019)
Introduction: Intravitreal injections (IVI) of slow-release dexamethasone (DEX) are generally well tolerated. Ocular hypertension (OHT) and cataracts are the most common adverse effects of DEX-implant (DEX-I). Material and Methods: The cases reported concern 5 eyes in four DEX-I IVI high-responder patients whose intraocular pressure (IOP) returned to normal after administration of a XEN gel stent with mitomycin subconjunctival injection, thus allowing the continued use of DEX-I which was the only therapeutic option for these patients. All patients were pure steroid responders with normal optic nerves. Results: No hypertension was observed in any of the eyes after DEX-implant intravitreal reinjection following XEN-surgery. All patients were successfully treated with XEN surgery and were retreated with DEX-implant with no further increase in IOP. The mean duration of follow-up after the MIGS procedure was 5 months (min-max, 2-12). None of the patients required needling. Conclusions: XEN gel stent would seem to represent a safe and effective solution for treating steroid-induced hypertension. It allows for the medium and long-term use of DEX-I in high responders. It could be of clinical interest to study this combination in a prospective trial with a large number of patients and long-term follow-up.
Keywords: nonvalved ophthalmic drainage device; ophthalmological implant; suture; acetazolamide; aflibercept; bevacizumab; bimatoprost plus timolol; brimonidine plus brinzolamide; dexamethasone; dorzolamide plus timolol; hemoglobin A1c; mitomycin; vasculotropin antibody; adult; aged; article; asthenia; best corrected visual acuity; case report; cataract; clinical article; clinical effectiveness; device safety; diabetic macular edema; drug efficacy; drug tolerability; dyslexia; endophthalmitis; female; follow up; glaucoma surgery; human; intraocular hypertension; intraocular pressure; laser coagulation; macular edema; macular thickness; male; medication compliance; metamorphopsia; middle aged; minimally invasive surgery; off label drug use; paresthesia; patient compliance; phacoemulsification; priority journal; recurrent disease; retinal telangiectasia; treatment refusal; XEN Gel Stent

Significant hyperopic shift in a patient with extreme myopia following severe hypotonia caused by glaucoma filtering surgery - Costa, J.C.; Alió, J. (European Journal of Ophthalmology, 2019)
Introduction: To report the case of a high hyperopic refractive shift associated with significant shortening of the ocular axial length following glaucoma filtering surgery. Methods: Case report. Patient’s records were consulted retrospectively. Results: A 57-year-old woman, highly myopic, with a history of bilateral intraocular refractive surgery in 1998 (phakic lens ZB5M) and bilensectomy in 2011 (phakic intraocular lens extraction plus cataract surgery with pseudophakic intraocular lens implantation), presented with consistently high intraocular pressure. Despite the treatment with different topical antiglaucomatous medications and good compliance, her intraocular pressure values remained consistently above 20 mmHg. In 2016, the patient was submitted for glaucoma filtering surgery and the mini shunt Ex-Press was implanted in both the eyes (3 months between surgeries). On the first postoperative day, the eyes were hypotonic (intraocular pressure of 5 mmHg) and bilateral macular edema was observed. Three days later, the intraocular pressure in both the eyes reached values higher than 6 mmHg (between 6 and 14 mmHg). Five months after the surgery the macular edema resolved and a significant shortening of the axial length and an important hyperopic refractive shift was observed. When comparing the preoperative and postoperative (18 months) measurements, the variation of the axial length was 2.49 mm in the right eye and 2.19 mm in the left eye; the patient refraction (spherical equivalent) shifted 2.50 diopters in the right eye and 1.75 diopters in the left eye. Conclusion: To the best of our knowledge, we report herein the first documented case of an axial length change of this magnitude after glaucoma filtering surgery.
Keywords: Acrysof MA60MA; applanation tonometer; nonvalved ophthalmic drainage device; ophthalmological implant; phakic intraocular lens; antiglaucoma agent; corticosteroid; latanoprost plus timolol; mitomycin; nepafenac; adult; article; best corrected visual acuity; case report; cataract extraction; clinical article; eye axis length; eye refraction; female; glaucoma surgery; high myopia; human; hypermetropia; interferometry; intraocular hypertension; intraocular hypotension; intraocular pressure; keratometry; lens implantation; macular edema; middle aged; ophthalmoscopy; optometry; patient compliance; priority journal; refractive surgery; retina degeneration; retinal pigment epithelium; retrospective study; subretinal neovascularization; tonometry; visual impairment; Acrysof MA60MA; Ex-Press

Synonyms: Triple A syndrome, 4 A Syndrome, Achalasia-Addisonianism-Alacrima syndrome - Dhar, M.; Arun, B.G.; Tebaibia, A. (Anasthesiologie und Intensivmedizin, 2019)
Disease summary: Allgrove Syndrome (AS) is rare autosomal recessive disorder characterised by achalasia cardia, alacrimia and adrenal insufficiency, which is generally adrenocorticotropic hormone (ACTH) resistant, and neurological abnormalities. Mutations have been identified in the AAAS gene, located on chromosome 12q13 (type-2 keratin gene), that codes for the ALADIN protein. IVS14 and EVS9 are the most common mutations. Alacrimia is an early and pathognomic symptom, but achalasia (50-100 %) and adrenal insufficiency (20-54%) are the more common presenting features. Autonomic disturbances and other neurological symptoms (10-23%) are rare. Patients may develop a variable combination of sensory-motor polyneuropathy amyotrophy, dysarthria, hyperreflexia, muscle weakness, dementia, abnormal autonomic function, erectile dysfunction (adult) and intellectual impairment. Diagnosis is generally made in the first decade of life when they present with dysphagia, vomiting and failure to thrive due to achalasia, hyperpigmentation of skin, shock due to adrenal insufficiency or seizures and coma due to severe hypoglycaemia. Typical dysmorphic faces including long thin face, long philthrum, narrow upper lip, down-turned mouth and sparse eyelashes may also be seen. Keratitis punctata is the most common complication of alacrimia. Patients with adrenal insufficiency are generally on a maintenance dose of a glucocorticoid like hydrocortisone. Most patients with achalasia require frequent pneumatic dilatations or surgical interventions like Heller’s myotomy.
Keywords: endotracheal tube; anesthetic agent; corticotropin; glucocorticoid; hydrocortisone; Allgrove syndrome; ambulatory care; anesthesia; anticoagulant therapy; article; blood transfusion; cardioesophagomyotomy; chromosome 12q; diagnostic procedure; differential diagnosis; esophagus dilatation; gene mutation; general anesthesia; human; long term care; mobilization; obstetric anesthesia; patient monitoring; patient positioning; patient transport; postoperative care; postoperative complication; preoperative evaluation; respiration control

Temporary Filtering Bleb Failure Induced by Anterior Chamber Sulfur Hexafluoride Gas: A Complication after Descemet Membrane Endothelial Keratoplasty - Enders, P.; Avgitidou, G.; Heindl, L.M.; Dietlein, T.S.; Cursiefen, C. (Case Reports in Ophthalmology, 2019)
Herein, we report two clinical cases with acute temporary filtering bleb obstruction by gas tamponade after Descemet membrane endothelial keratoplasty (DMEK) surgery and postoperative intraocular pressure (IOP) peaks. Both patients underwent uncomplicated DMEK surgery with 20% sulfur hexafluoride (SF 6) anterior chamber tamponade and had previous trabeculectomy for glaucoma. Prior to surgery, both patients showed patent bleb function with low to normal IOP without antiglaucomatous medication. After uneventful DMEK surgery, both patients showed postoperative IOP peaks of up to 50 mm Hg despite patent inferior iridotomy and no sign of a pupillary block. In both cases, SF 6 gas bubbles could be visualized obstructing the bleb. Both patients were treated with IOP-lowering agents topically as well as systemically. In addition, anterior chamber paracenteses were performed to reduce the SF 6 volume within the anterior chamber. Under this treatment, IOP normalized within the first 18 h after surgery. We hypothesize that the SF 6 gas tamponade from the anterior chamber migrates into the ostium and below the bleb, leading to an acute temporary insufficiency of bleb function and to a consecutive IOP peak after surgery. In contrast to a pupillary block, this mechanism cannot be antagonized by preoperative iridotomy and needs to be taken into account for every glaucoma patient with functional bleb undergoing DMEK surgery.
Keywords: acetazolamide; pilocarpine; sulfur hexafluoride; acute temporary filtering bleb obstruction; aged; ambulatory care; anterior eye chamber; aqueous humor formation; article; best corrected visual acuity; case report; clinical article; cornea edema; cornea transplantation; Descemet membrane endothelial keratoplasty; female; Fuchs endothelial dystrophy; hospital admission; hospital discharge; hospitalization; human; intraocular pressure; iridotomy; obstruction; open angle glaucoma; optical coherence tomography; paracentesis; postoperative complication; postoperative period; priority journal; pseudoexfoliation; slit lamp microscopy; trabeculectomy; very elderly

Validation of the general medication adherence scale in Saudi patients with chronic diseases - Naqvi, A.A.; AlShayban, D.M.; Ghori, S.A.; Mahmoud, M.A.; Haseeb, A.; Faidah, H.S.; Hassali, M.A. (Frontiers in Pharmacology, 2019)
Objective: The aim was to validate the General Medication Adherence Scale (GMAS) (English version) in Saudi patients with chronic disease. Methods: A month-long study was conducted in the out-patient department of tertiary care hospitals in three cities of Saudi Arabia that collected data from a randomized sample of Saudi patients with chronic disease. The study aimed to achieve an item-to-subject ratio greater than 1:10. Factor analyses were conducted and fit indices calculated. Convergent, discriminant, known group, and concurrent validities were analysed. Internal consistency was determined using test–retest reliability using Cronbach’s alpha (α), McDonald’s coefficient omega (ωt), and Pearson’s correlation coefficient (ρ). Sensitivity analysis was conducted. Data were analysed through Statistical Package for Social Sciences (SPSS) version 23. The study was ethically approved (i.e., IRB-129-26/6/1439). Results: The survey gathered responses from 171 patients with a response rate of 85.5%. An item-to-subject ratio of 1:15 was achieved. Factor analysis revealed a three-factor structure with acceptable fit indices (i.e., normed fit index (NFI) = 0.93, Tucker–Lewis index (TLI) = 0.99, and comparative fit index (CFI) = 0.99), i.e., greater than 0.9. The value of root mean square error of approximation (RMSEA) was 0.01, i.e., less than 0.08. The tool established construct validity, i.e., convergent and discriminant validities. Known group and concurrent validities were also established. An α value of 0.74 and ωt value of 0.92 were reported. Test–retest reliability ρ = 0.82, p < 0.001. The tool had high sensitivity (>75%) and specificity (>80%). Conclusion: The GMAS-English was successfully validated in Saudi patients with chronic disease.
Keywords: antianemic agent; antiangina pectoris agent; antiasthmatic agent; anticoagulant agent; anticonvulsive agent; antidiabetic agent; antiglaucoma agent; antigout agent; antihypertensive agent; antilipemic agent; antiparkinson agent; antirheumatic agent; cardiovascular agent; central nervous system agents; dermatological agent; gastrointestinal agent; hormones and agents acting on the endocrine system; respiratory tract agent; urinary tract agent; adult; analytical parameters; angina pectoris; article; asthma; attention deficit disorder; chronic disease; chronic obstructive lung disease; comparative fit index; concurrent validity; construct validity; controlled study; convergent validity; Crohn disease; deep vein thrombosis; diabetes mellitus; discriminant validity; dyslipidemia; epilepsy; factor analysis; female; gastroesophageal reflux; gastrointestinal disease; General Medication Adherence Scale; glaucoma; gout; health survey; human; hypertension; hyperthyroidism; hypothyroidism; internal consistency; irritable colon; ischemic heart disease; kidney failure; major clinical study; male; normed fit index; osteoarthritis; outpatient department; Parkinson disease; patient compliance; rating scale; rheumatoid arthritis; root mean square error of approximation; Saudi; Saudi Arabia; sensitivity analysis; sensitivity and specificity; sickle cell anemia; skin disease; statistical parameters; tertiary care center; test retest reliability; Tucker Lewis index; ulcerative colitis; urban area; validation study; varicosis

Investigation of medication adherence and reasons for poor adherence in patients on long-term glaucoma treatment regimes - McClelland, J.F.; Bodle, L.; Little, J.-A. (Patient Preference and Adherence, 2019)
Purpose: Long-term treatment adherence for a chronic asymptomatic condition is a demanding task for many patients. Treating progressive glaucoma can also be confounding for physicians, particularly when management relies on assumption of adherence. This study investigated associations between self-reported adherence and frequency of medication changes due to glaucoma progression. Methods: A total of 128 participants with primary open angle glaucoma were recruited from glaucoma clinics in Flinders Eye Center, South Australia, and completed confidential questionnaires. Information was obtained regarding beliefs about glaucoma and their treatment. Adherence was assessed using the four-item Morisky, Green and Levine Medication Adherence Questionnaire (MGL). Medical records were analyzed for the number of medication changes, due to glaucoma progression. Results: Adherence to topical glaucoma medication was categorized as ‘high’ in 41.4% (Morisky, Green and Levine (MGL). Data were analyzed for behaviors affecting adherence, history of adherence, and reasons for changed adherence. Chi-squared test demonstrated that there was no significant association noted between adherence and changes in medication regime (χ2 (2,128)=0.968, P=0.915); however, a significantly lower adherence was detected if participants had difficulties with their drop regime (χ2 (2,128)=7.24, P=0.027) or had help with drop insertion (χ2 (1,128)=9.77, P=0.008). Conclusion: This study revealed a higher rate of non-adherence than has previously been demonstrated in other studies. This may be attributed to the unique design of the confidential questionnaire and the independent and sympathetic questioning techniques used. Further work to develop a specific glaucoma medication adherence questionnaire would be valuable to enhance glaucoma management.
Keywords: antiglaucoma agent; eye drops; adult; aged; article; attitude to health; Australia; controlled study; disease course; employment; family history; female; human; long term care; major clinical study; male; medication compliance; Morisky Medication Adherence Scale; open angle glaucoma; optical coherence tomography; patient attitude; patient compliance; patient satisfaction; self report

Awareness and adherence in young and older glaucoma patients who live in European side of Istanbul - Tarakçioğlu, H.N.; Yildiz, A.M.; Sonbahar, O.; Yiğit, U.; Özkaya, A. (Medical Journal of Bakirkoy, 2019)
Objective: We aimed to compare the demographics, awareness about glaucoma, and adherence to the treatment between the young and old population of primary open angle glaucoma (POAG) patients. Methods: The POAG patients who were under follow-up in Bakırköy Training and Research Hospital Ophthalmology Clinic and were using medication since at least one year and volunteered for our survey were included this cross-sectional study between April and May 2018. Two surveys which included 13 questions and were used in previous studies were enriched with 6 additional questions and applied to the patients. The patients were divided into two groups according to the World Health Organization's classification in regard to age as ≤65 years (young patients) and >65 years (old patients) and compared in regards to the survey questions. Results: There was not statistically significant between the two groups in regards to gender, general awareness about glaucoma, regular followup, regular drug use, family history of glaucoma, disability in hand and arm movements, duration of glaucoma (p>0.05 for all). There was a statistical difference between the two groups in regards to the education level (the patients ≤65 years were more educated, p=0.03), awareness of blindness secondary to the disease (more frequent in the patients ≤65 years old, p=0.02), awareness of drug's brand (more frequent in the patients ≤65 years old, p=0.003), requiring assistance while using the drugs (more frequent in the group of patients >65 years-old, p=0.01), monthly number of forgetting the drug doses (more frequent in the group of patients >65 years-old, p=0.006), living alone (more frequent in the group of patients >65 years-old, p=0.02), and the number of used drugs (more frequent in the group of patients >65 years-old, p=0.03). Conclusion: It is obvious that the patients who are >65 years old will be less adherent to glaucoma treatment as they more frequently require assistance for drug use and live alone.
Keywords: antiglaucoma agent; aged; arm movement; article; attitude to health; blindness; cross-sectional study; demography; disease duration; drug dose; drug use; educational status; family history; follow up; hand movement; human; independent living; medication compliance; open angle glaucoma; patient compliance; Turkey (republic); World Health Organization

Influence of treatment adherence on the progression of primary open-angle glaucoma in clinical setting - Neroev, V.V.; Zolotarev, A.V.; Karlova, E.V.; Kiseleva, O.A.; Shishkin, M.M.; Germanova, V.N. (Vestnik oftalmologii, 2019)
Keywords: antihypertensive agent; preservative; human; intraocular pressure; open angle glaucoma; patient compliance; prospective study

The effect of a reminder short message service on the uptake of glaucoma screening by first-degree relatives of glaucoma patients: A randomized controlled trial - Salihu, D.; Adenuga, O.; Wade, P. (Middle East African Journal of Ophthalmology, 2019)
The purpose of this study was to determine the role of a reminder short message service (SMS) on the uptake of glaucoma screening by first-degree relatives (FDRs) of patients with primary open-angle glaucoma (POAG) in North-central Nigeria following a telephone invitation for screening. MATERIALS AND METHODS: A randomized controlled trial was conducted in the eye clinic of a tertiary hospital in Jos, North-central Nigeria. Two hundred FDRs of patients with POAG were invited through phone for free glaucoma screening and randomly allocated into two groups. The intervention group received a reminder SMS, whereas the control group did not receive a reminder. Those who failed to turn up for screening were contacted through phone to determine the reasons for their nonattendance. Chi-square test and bivariate analysis were used to compare attendance rate between the two groups. RESULTS: Sending a reminder SMS following a telephone invitation had no effect on the uptake of glaucoma screening. The response rate was lower in the phone call plus reminder SMS group (43.0% vs. 53.0%) though the difference was not statistically significant (P = 0.157). Competing needs such as work and lack of transport fare were the most common reasons given for not attending the screening. CONCLUSION: A reminder text message is not an effective tool for increasing the uptake of glaucoma screening in at-risk individuals in North-central Nigeria. Existing barriers to health care in the country need to be addressed before mobile phone technology can be effectively used in increasing the utilization of any free eye screening service.
Keywords: adult; aged; article; cell phone use; controlled study; fear; female; first-degree relative; human; major clinical study; male; mass screening; money; Nigeria; open angle glaucoma; patient attendance; priority journal; randomized controlled trial; short message service; tertiary care center; text messaging; time; travel; work

Use of and disparities in access to adaptive devices among U.S. adults with age-related eye diseases - Gibson, D.M. (Preventive Medicine Reports, 2018)
This paper examines adaptive device use among two samples of U.S. adults aged 40 years and older with age-related macular degeneration, diabetic retinopathy, glaucoma or cataracts from the 2008 and 2016 waves of the nationally-representative cross-sectional National Health Interview Survey (n = 2875 and n = 6233 respectively). Individuals who replied affirmatively to the question, “do you use any adaptive devices such as telescopic or other prescriptive lenses, magnifiers, large print or talking materials, CCTV, white cane or guide dogs?” were defined as adaptive device users. Descriptive statistics and logistic regression models of adaptive device use were estimated. The main regression models used 2008 data and included explanatory variables for vision-related limitations, other functional limitations, sociodemographic characteristics and the local availability of ophthalmologists and optometrists. 6.1% of the 2008 sample and 4.2% of the 2016 sample used adaptive devices, these percentages were significantly different. 31.4% of the 2008 sample and 24.0% of 2016 sample with multiple vision-related limitations used adaptive devices, these percentages were not significantly different. Based on previous research, adaptive device use among the subgroups with multiple vision-related limitations would be expected to improve functional ability. In the regression models, the likelihood of adaptive device use increased significantly with the number of vision-related limitations, family income and local ophthalmologist availability. The regression results provide evidence of socioeconomic and geographic disparities in adaptive device use in the U.S. Together the descriptive statistics and regression results suggest that public health strategies to increase access to adaptive devices are needed.
Keywords: adaptive device; device material; lens (optics); ophthalmological general equipment; telescope; white cane; adult; age related macular degeneration; aged; article; cataract; diabetic retinopathy; female; glaucoma; health care access; health care disparity; health care utilization; human; lens; major clinical study; male; priority journal; service dog; United States; very elderly

Congenital ectropion uveae with glaucoma: a case report - Kumari, R.; Saha, B.C. (International Ophthalmology, 2018)
Congenital ectropion uveae (CEU) is a rare anomaly characterized by ectropion uveae, iris hypoplasia, iridotrabecular dysgenesis and glaucoma. The apparent ectropion uveae results from the spread of iris pigment epithelium beyond the iris ruff and onto the anterior surface of the iris. Conclusion Open-angle glaucoma results due to angle dysgenesis, so patients should be carefully examined periodically for its early detection.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; eye drops; mitomycin; amblyopia; anisocoria; anterior eye chamber depth; article; case report; child; clinical article; congenital ectropion uveae; congenital glaucoma; disease association; disease duration; disease exacerbation; ectropion; eye refraction; female; follow up; glaucoma; gonioscopy; human; iris atrophy; iris prolapse; ophthalmoscopy; optic disk; optic nerve atrophy; patient compliance; patient counseling; photophobia; prognosis; ptosis (eyelid); risk factor; school child; slit lamp microscopy; trabeculectomy; visual acuity; visual impairment

Adherence and challenges in administering eye medications among glaucoma patients in a Malaysian public tertiary care centre - Suet Yee, K.C.; Jing Wen, L.; Chee Tao, C.; Fun Wee, H.; Siew Huang, L.; Chan, H.-K. (Journal of Pharmaceutical Health Services Research, 2018)
Objectives: To assess the adherence to and identify the challenges in administering eye medications among patients with glaucoma in Malaysia. Methods: This was a 1-year cross-sectional study conducted at the Outpatient Pharmacy Department of the Raja Permaisuri Bainun Hospital, a public tertiary care centre. Patients with glaucoma, who self-administered eye drops, were selected using the convenience sampling method and interviewed using the Brief Medication Questionnaire. The adherence of each patient was determined based on the total adherence score (0–1: good; 2–5 poor), while their responses to nine items describing the possible challenges in administering eye drops were dichotomized into ‘yes’ and ‘no’. Key findings: One hundred patients with a mean age of 67.6 ± 10.4 years were interviewed. The majority of them were Chinese (69%) and male (56%). Approximately half of them received two types of eye medications for glaucoma. The overall adherence rate was found to be 75%, and the median adherence score was 1.00 (interquartile ranges: 1.00). However, no significant associations were found between the patient adherence and their sociodemographic characteristics. The most frequently reported challenges included ‘eye drops falling on the cheeks’ (45%), ‘too many drops coming out of the eye drop bottles each time’ (42%) and ‘having difficulty in getting the eye medications refilled at the pharmacy on time’ (25%). It is also found that experiences with side effects of medications were inversely associated with adherence (odds ratio (OR): 0.12; 95% confidence interval (CI): 0.02–0.76; P = 0.024), while inconvenient administration times led to a higher risk of nonadherence (OR: 14.17; 95% CI: 3.49–57.63; P < 0.001). Conclusions: Nonadherence to eye medications was shown to be a major challenge in glaucoma treatment in Malaysia. Interventions to strengthen the patients’ commitment to the long-term treatment, as well as their knowledge of the medications, are therefore warranted.
Keywords: eye drops; aged; article; Brief Medication Questionnaire; Chinese; cross-sectional study; demography; drug dose regimen; drug labeling; drug packaging; drug self administration; female; glaucoma; high risk patient; human; knowledge; long term care; major clinical study; Malaysian; male; medication compliance; odds ratio; patient compliance; priority journal; questionnaire; self medication; tertiary care center; unspecified side effect

Compliance with primary open-angle glaucoma and primary open-angle glaucoma suspect preferred practice patterns in a retail-based eye clinic - Stanley, J.; Huisingh, C.E.; Swain, T.A.; McGwin, G.; Owsley, C.; Girkin, C.A.; Rhodes, L.A. (Journal of Glaucoma, 2018)
Purpose: To determine the level of adherence to the American Academy of Ophthalmology preferred practice pattern (PPP) guidelines for quality primary open-angle glaucoma (POAG) and POAG suspect (POAGS) care among retail-based optometrists. Methods: Patients with a diagnosis of POAG or POAGS who participated in a telemedicine pilot project were included. Patients' charts were evaluated for 15 elements of PPP guidelines for glaucoma care. Results were further stratified by number of follow-up visits and diagnosis. Results: Of 360 identified patients, 10 elements were documented in over 98%. Documentation of the remaining 5 components was as follows: dilated fundus examination 91.1%, central corneal thickness (CCT) 88.6%, visual field 78.9%, gonioscopy 47.5%, and target intraocular pressure (IOP) 15.6%. in total, 32.8% of patients were seen once, whereas the remaining 67.2% had multiple visits. In patients with multiple visits, providers were more likely to document systemic history (100.0% vs. 97.5%; P=0.0346), review of systems (100.0% vs. 97.5%; P=0.0346), gonioscopy (60.0% vs. 22.0%; P<0.001), CCT (94.2% vs. 77.1%; P<0.001), visual field (97.5% vs. 40.7%; P<0.001), and target IOP (22.4% vs. 1.7%; P<0.001) compared with single visit patients. In stratifying results by diagnosis, POAG patients more often received visual field testing (92.7% vs. 68.9%; P<0.001) and had an established target IOP (35.1% vs. 1.4%; P<0.001) compared with POAGS patients. Conclusions: Compliance with PPP guidelines for glaucoma care was very high for most elements but lower for performing dilated fundus examination, CCT, visual field, gonioscopy, and target IOP. This study highlights deficiencies in care likely to hamper the detection of glaucoma progression.
Keywords: African American; article; central corneal thickness; clinical practice; controlled study; eye fundus; female; follow up; gonioscopy; human; intraocular pressure; major clinical study; male; medical documentation; open angle glaucoma; optometrist; patient compliance; perimetry; pilot study; practice guideline; priority journal; telemedicine; visual field

Brinzolamide/Brimonidine Fixed Combination: Simplifying Glaucoma Treatment Regimens - Moosavi, R.; Ansari, E. (Ophthalmology and Therapy, 2018)
Introduction: To simplify the medical treatment of glaucoma for patients on multiple drops by introducing brinzolamide/brimonidine tartrate fixed combination (BBFC) ophthalmic suspension 1%/0.2% (SIMBRINZA®; Alcon Laboratories, Inc., Fort Worth, TX, USA) to the drop regimen and to establish its efficacy. To demonstrate that fixed combination (FC) therapies are associated with improvements in treatment adherence and persistence with reduced exposure to preservative-related ocular surface problems. Methods: Retrospective study: 76 patients were identified as taking BBFC following a switch in treatment regimen. Intraocular pressure (IOP) prior to and 2–17.5 months (average 5.4 months) after the introduction of BBFC was measured. The change in the average number of bottles used per eye was recorded. The rate of adverse effects (AEs) of BBFC was recorded. A two-tailed paired sample t test was used to compare IOP prior to and after the introduction of BBFC for each eye. Results: Mean change in IOP after BBFC introduction BBFC: − 2.76 mmHg (p < 0.0001). BBFC intolerance: 13%. On average there was a 0.24 reduction in the number of bottles of IOP-lowering medication used per eye (p < 0.0064). Conclusion: A switch to BBFC in the drop regimen is associated with a significant drop in IOP with reduced drop burden. Instead of a third IOP-lowering medication and bottle, a practitioner should consider using BBFC + prostaglandin analogue/FC drop for effective IOP control, reduced drop burden, reduced preservative load and increased likelihood of adherence. This study promotes the concept that any treatment should principally be assessed from the patients’ perspective and quality of life.
Keywords: Goldmann applanation tonometer; brimonidine plus brinzolamide; adult; aged; article; drug efficacy; drug tolerability; electronic patient record; follow up; human; intraocular hypertension; intraocular pressure; major clinical study; open angle glaucoma; outcome assessment; patient compliance; patient identification; priority journal; pseudoexfoliation; quality of life; retrospective study; very elderly; simbrinza

Traumatic hemorrhagic chemosis - Sternberg, M.L.; Lasecki, C.H. (Consultant, 2018)
Keywords: dorzolamide plus timolol; erythromycin; methazolamide; adult; agitation; autism; case report; cataract extraction; chemosis; clinical article; computer assisted tomography; conjunctival hemorrhage; conscious sedation; ecchymosis; eye injury; glaucoma; human; intraocular hypertension; male; ocular fibrosis; patient compliance; priority journal; short survey; traumatic hemorrhagic chemosis

Healthcare Utilization by Glaucoma Patients in a Team Care Model - Damento, G.M.; Winkler, N.S.; Hodge, D.O.; Khanna, S.S.; Khanna, C.L. (Seminars in Ophthalmology, 2018)
Purpose: To determine the effect of a glaucoma team care model on resource utilization and efficiency in glaucoma management. Methods: Retrospective cohort study of 358 patients diagnosed and treated for glaucoma. Analysis included number of patient visits, diagnostic tests, and glaucoma procedures performed before (2005–2007) and after (2008–2010) implementation of a team care model in 2008. Patients not involved in the model served as controls. Results: Number of patient visits did not change significantly after model implementation (p > .05). Diagnostic tests significantly increased in comprehensive ophthalmologist and glaucoma subspecialist groups 25 months after diagnosis (p = .03 and p = .001). Procedures increased for glaucoma subspecialists but was not statistically significant (p = .06). Optometrists used billing codes with significantly lower reimbursement than other providers (p < .001). Conclusions: Team care model had neutral effect on patient visits and increased testing. Continued evaluation of this model is required to determine its effect on disease progression and outcomes.
Keywords: article; cataract extraction; cohort analysis; collaborative care team; controlled study; Current Procedural Terminology; diagnostic test; glaucoma; gonioscopy; health care cost; health care utilization; human; major clinical study; ophthalmologist; ophthalmoscopy; optical coherence tomography; optometrist; pachymetry; patient care; priority journal; reimbursement; retrospective study; tonometry; trabeculectomy; trabeculoplasty; trabeculotomy

Anti-VEGF Neovascular Age-Related Macular Degeneration Treatment Adherence Requires Attention and Action - Musch, D.C. (JAMA Ophthalmology, 2018)
Keywords: agents acting on the eye; vasculotropin inhibitor; electronic medical record; follow up; glaucoma; health behavior; human; medical decision making; medication compliance; motivational interviewing; note; patient compliance; pharmaceutical care; priority journal; quality of life; self care; treatment outcome; wet macular degeneration

Affordability of Glaucoma Treatment Around the Globe: An Initial Step Toward Improving Universal Access to Glaucoma Treatment - Blumberg, D.M. (JAMA Ophthalmology, 2018)
Keywords: glaucoma; health care access; human; low income country; middle income country; note; priority journal; World Health Organization

Review of economic evaluations of teleophthalmology as a screening strategy for chronic eye disease in adults - Sharafeldin, N.; Kawaguchi, A.; Sundaram, A.; Campbell, S.; Rudnisky, C.; Weis, E.; Tennant, M.T.S.; Damji, K.F. (British Journal of Ophthalmology, 2018)
Background/aims Teleophthalmology is well positioned to play a key role in screening of major chronic eye diseases. Economic evaluation of cost-effectiveness of teleophthalmology, however, is lacking. This study provides a systematic review of economic studies of teleophthalmology screening for diabetic retinopathy (DR), glaucoma and macular degeneration. Methods Structured search of electronic databases and full article review yielded 20 cost-related articles. Sixteen articles fulfilled the inclusion criteria and were retained for a narrative review: 12 on DR, 2 on glaucoma and 2 on chronic eye disease. Results Teleophthalmology for DR yielded the most cost savings when compared with traditional clinic examination. The study settings varied among urban, rural and remote settings, community, hospital and health mobile units. The most important determinant of cost-effectiveness of teleophthalmology was the prevalence of DR among patients screened, indicating an increase of cost savings with the increase of screening rates. The required patient pool size to be screened varied from 110 to 3500 patients. Other factors potentially influencing cost-effectiveness of teleophthalmology were older patient age, regular screening and full utilisation of the equipment. Teleophthalmology for glaucoma was more cost-effective compared with in-person examination. Similarly, increasing number of glaucoma patients targeted for screening yielded more cost savings. Conclusions This economic review provides supportive evidence of cost-effectiveness of teleophthalmology for DR and glaucoma screening potentially increasing screening accessibility especially for rural and remote populations. Special selection of the targeted screening population will optimise the cost-effectiveness of teleophthalmology.
Keywords: age; article; clinical examination; cost control; cost effectiveness analysis; diabetic retinopathy; eye care; glaucoma; health care utilization; human; intermethod comparison; macular degeneration; prevalence; priority journal; rural area; screening; systematic review; telemedicine; teleophthalmology; urban area

Implementing collaborative care for glaucoma patients and suspects in Australia - Huang, J.; Hennessy, M.P.; Kalloniatis, M.; Zangerl, B. (Clinical and Experimental Ophthalmology, 2018)
Keywords: adult; Australia; collaborative care team; controlled study; eye photography; glaucoma; gonioscopy; health care access; health care facility; human; intraocular pressure; letter; major clinical study; middle aged; ophthalmologist; ophthalmoscopy; optical coherence tomography; optometrist; patient referral; practice guideline; pressure measurement; prospective study; slit lamp microscopy; visual acuity; visual field; visual system examination

Sjögren syndrome: Clinical manifestations, diagnosis, and management - Jadeed, M.; Nuhaily, S. (Consultant, 2018)
Sjögren syndrome (SS) is a systemic autoimmune disease characterized mainly by the presence of keratoconjunctivitis sicca and xerostomia. Patients also may experience inflammation of the joints, muscles, nerves, lungs, gastrointestinal tract, thyroid, lymph nodes, or any other organ of the body, as well as fatigue, disturbed sleep, and memory problems. The etiology and pathophysiology of SS are not well understood, and diagnosis presents a challenge. Although there is no cure, management includes pharmacologic and nonpharmacologic interventions with the goal of improving quality of life by treating the sicca and fatigue symptoms.
Keywords: cevimeline; cyclosporine; diclofenac; fluoride; fluorometholone; hyaluronic acid; hydroxychloroquine; indometacin; methylprednisolone; pilocarpine; rituximab; arthralgia; arthritis; article; body temperature disorder; cornea perforation; cornea ulcer; dental caries; disease activity; dry eye; dysphagia; fatigue; headache; hot flush; human; keratitis; mouth hygiene; nausea; nonhodgkin lymphoma; pathophysiology; patient compliance; patient education; priority journal; quality of life; Sjoegren syndrome; skin defect; urogenital tract disease; xerostomia

The 2016 American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) Database: Characteristics and Methods - Chiang, M.F.; Sommer, A.; Rich, W.L.; Lum, F.; Parke, D.W. (Ophthalmology, 2018)
Purpose: To describe the characteristics of the patient population included in the 2016 IRIS® Registry (Intelligent Research in Sight) database for analytic aims. Design: Description of a clinical data registry. Participants: The 2016 IRIS Registry database consists of 17 363 018 unique patients from 7200 United States–based ophthalmologists in the United States. Methods: Electronic health record (EHR) data were extracted from the participating practices and placed into a clinical database. The approach can be used across dozens of EHR systems. Main Outcome Measures: Demographic characteristics. Results: The 2016 IRIS Registry database includes data about patient demographics, top-coded disease conditions, and visit rates. Conclusions: The IRIS Registry is a unique, large, real-world data set that is available for analytics to provide perspectives and to learn about current ophthalmic care and treatment outcomes. The IRIS Registry can be used to answer questions about practice patterns, use, disease prevalence, clinical outcomes, and the comparative effectiveness of different treatments. Limitations of the data are the same limitations associated with EHR data in terms of documentation errors or missing data and the lack of images. Currently, open access to the database is not available, but there are opportunities for researchers to submit proposals for analyses, for example through a Research to Prevent Blindness and American Academy of Ophthalmology Award for IRIS Registry Research.
Keywords: adult; age distribution; age related macular degeneration; article; clinical outcome; comparative effectiveness; data base; demography; diabetic retinopathy; disease registry; dry eye; electronic health record; female; glaucoma; health care quality; health care utilization; human; Intelligent Research in Sight; major clinical study; male; middle aged; patient care; prevalence; priority journal; treatment outcome; United States

Eye care utilisation in Newfoundland and Labrador: access barriers and vision health outcomes - Lee, E.Y.; Cui, K.; Trope, G.E.; Buys, Y.M.; Chan, C.H.; Thavorn, K.; Jin, Y.-P. (Canadian Journal of Ophthalmology, 2018)
Objective: Our prior study revealed significantly lower use of eye care providers in Newfoundland and Labrador (NFLD). This study reports factors associated with this low use and related vision health outcomes. Design: Cross-sectional survey. Participants: A total of 14 925 Caucasian respondents to the Canadian Community Health Survey − Healthy Aging 2008/2009 aged ≥65 years. Methods: Univariate and multivariate analyses were performed using self-reported survey data. Results: NFLD, along with 3 other provinces, does not insure seniors for routine eye examinations. Among seniors without self-reported glaucoma, cataracts, and diabetes, the use of eye care providers in NFLD (36.3%) is the lowest compared with provinces with (50.7%, p < 0.05) and without (42.2%, p > 0.05) government-insured eye examinations. Among seniors with known eye disease insured for eye care in all provinces, eye care utilisation in NFLD (63.1%) is still the lowest across all provinces (69.4%−71.3%, p > 0.05). Compared with the national average, NFLD seniors have significantly higher proportions of low income (61.7% vs 47.4%), no postsecondary education (53.6% vs 42.2%), and rural residency (40.6% vs 18.9%). These factors are all associated with low levels of eye care utilisation. Compared with insured provinces, NFLD has a significantly lower prevalence of self-reported cataracts (16.7% vs 23.1) and glaucoma (3.8% vs 7.0%), and a slightly higher prevalence of presenting visual impairment (4.0% vs 3.5%). Conclusions: Lack of government insurance, low socioeconomic status, and living in nonurbanised areas all contribute to the underutilisation of eye care providers in NFLD. This underutilisation appears to be associated with reduced detection of eye diseases.
Keywords: adult; aged; article; cataract; Caucasian; cross-sectional study; diabetes mellitus; eye care; eye examination; glaucoma; health care access; health care utilization; health insurance; health literacy; healthy aging; human; lowest income group; Newfoundland and Labrador; outcome assessment; rural area; social status

Exploring the frequency and location of prescribing errors in the use of topical glaucoma medications - Lakhani, B.K.; King, A.J. (Clinical and Experimental Ophthalmology, 2018)
Importance: Very little is known about health-care professional related prescribing errors within the glaucoma setting. Background: This study aims to quantify these errors and to explore where they occur along the prescribing pathway. Design: Cross-sectional study of patients attending a specialty glaucoma clinic over a 5-month period. Participants: Data was collected for 109 patients. Methods: We compared glaucoma drop regimes from four different sources: As documented in the hospital notes for the last appointment, the letter sent to the General Practitioner (GP), patient's self-reporting and bottles/prescriptions brought to the clinic appointment. Main Outcome Measures: Discrepancies were identified and errors were grouped into one of four categories depending on where in the prescribing pathway they occurred: Incorrect prescribing of the drops by the clinician, incorrect prescribing of the drops by the GP/failure to provide a repeat prescription, incorrect dispensing of the drops by the pharmacist and possible non-adherence by the patient. Results: There was a total of 217 individual prescription items involving 266 active ingredients. Seventy-one prescription items out of 217 (33%) had an error, of this 53 (75%) were due to possible patient non-adherence and 18 (25%) were process related errors made by health-care professionals. Conclusions and Relevance: An error was identified in 33% of prescriptions. About 8.3% of prescriptions had a health-care professional related process error. These errors are preventable and recognition of these is important to maximize drop adherence and minimize disease progression, requiring increased consultations and interventions with quality of life and health economic consequences.
Keywords: adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; miotic agent; prostaglandin derivative; adult; aged; article; consultation; controlled study; cross-sectional study; disease course; female; general practitioner; glaucoma; health care personnel; health economics; human; major clinical study; male; medical error; medical record review; middle aged; patient compliance; patient-reported outcome; pharmacist; prescription; quality of life; very elderly

Therapy for open-angle glaucoma - Marshall, L.L.; Hayslett, R.L.; Stevens, G.A. (Consultant Pharmacist, 2018)
OBJECTIVE: Review the clinical manifestations and treatment of primary open-angle glaucoma (POAG). DATA SOURCES: Articles indexed in PubMed, Scopus, and Cochrane Library in the last 10 years using the key words “glaucoma,” “open-angle glaucoma,” and “‘open-angle glaucoma’ AND ‘treatment.’” Primary sources were used to locate additional resources. ClinicalTrials.gov was used to locate unpublished studies. STUDY SELECTION AND DATA EXTRACTION: Eighty-one publications were reviewed and criteria supporting the primary objective were used to identify useful resources. DATA SYNTHESIS: The literature included practice guidelines, review articles, original research articles, and product prescribing information for POAG. CONCLUSION: The POAG optic neuropathies result in optic disk damage and visual field loss. Ophthalmic medication therapy retards glaucoma progression, but many older patients require multiple medications to preserve vision and quality of life. An agent from the ophthalmic prostaglandin analog class is used as initial therapy in current practice because of the convenience of once-a-day administration and lower incidence of systemic side effects and slightly increased efficacy compared with other available ophthalmic medication classes. The other ophthalmic medication classes used in clinical practice include the beta-adrenergic blocking agents, the alpha-2 adrenergic agonists, and the carbonic anhydrase inhibitors. Proper ophthalmic eye-drop administration and medication adherence are imperative for preserving vision in POAG. Selective laser trabeculoplasty is a viable alternative to ophthalmic medications either initially or if a patient experiences ocular or systemic side effects from medication therapy. A modified prostaglandin analog was approved by the Food and Drug Administration in November 2017; its role in clinical practice is still evolving.
Keywords: adenosine receptor stimulating agent; alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; latanoprostene bunod; prostaglandin derivative; Rho kinase inhibitor; clinical feature; clinical practice; glaucoma; human; intraocular pressure; medication compliance; nonhuman; open angle glaucoma; optic disk; pathophysiology; patient compliance; practice guideline; primary glaucoma; quality of life; review; visual field

Old and new drug classes expanding to include glaucoma treatments - Kish, T. (P and T, 2018)
Keywords: acetazolamide; apraclonidine; betaxolol; bimatoprost; bimatoprost sr; brimonidine; dorzolamide; latanoprost; latanoprostene bunod; levobunolol; methazolamide; netarsudil; omidenepag isopropyl; otx tp; pilocarpine; latanoprost plus netarsudil; tafluprost; timolol; timolol maleate; travoprost; blurred vision; canaliculitis; conjunctival hemorrhage; conjunctival hyperemia; drug delivery system; eye pain; eyelid edema; glaucoma; human; intraocular pressure; monotherapy; note; patient compliance; patient safety; phase 1 clinical trial (topic); phase 2 clinical trial (topic); phase 3 clinical trial (topic); randomized controlled trial (topic); trabeculoplasty; alphagan; betagan; betoptic; bimatoprost sr; de 117; diamox; iopidine; lumigan; neptazane; otx tp; pilopine; rhopressa; roclatan; timoptic; travatan z; trusopt; vyzulta; xalatan; zioptan

The African American Eye Disease Study: Design and Methods - McKean-Cowdin, R.; Fairbrother-Crisp, A.; Torres, M.; Lastra, C.; Choudhury, F.; Jiang, X.; Burkemper, B.; Varma, R. (Ophthalmic Epidemiology, 2018)
Purpose: To describe the study design, operational and recruitment strategies, procedures, and baseline characteristics of the African American Eye Disease Study (AFEDS), a population-based assement of the prevalence of visual impairment, ocular disease, visual function, and health-related quality of life in African Americans. Methods: This population-based, cross-sectional study included over 6000 African Americans 40 years and older residing in and around Inglewood, California. A detailed interview and eye examination was performed on each eligible participant. The interview included an assessment of demographic, behavioral, and ocular risk factors and health-related and vision-related quality of life. The eye examination included measurements of visual acuity, intraocular pressure, visual fields; fundus and optic disc photography; a detailed anterior and posterior segment examination; and measurements of blood pressure, glycosylated hemoglobin levels, and blood glucose levels. Results: The AFEDS cohort includes more than 6000 participants that have completed a home questionnaire and a comprehensive eye examination. The majority of participants were female (63%), the average (± standard deviation) overall age was 60.9 (±11.3). Participants are mostly working (40%) or retired (41%), non-smoking (57%), partial drinking (54%), and with at least some college education (38%). A trust-development recruitment strategy was refined in order to overcome challenges in study participation. Conclusion: The AFEDS is the largest epidemiologic eye study among African Americans to date. The AFEDS cohort will provide information about the prevalence and risk factors of ocular disease in the largest ophthalmologic study population of African Americans in the United States.
Keywords: glucose; hemoglobin A1c; adult; African American; age related macular degeneration; article; blindness; cataract; cataract extraction; clinical examination; cohort analysis; comparative study; cross-sectional study; diabetic retinopathy; disease association; eye disease; eye examination; female; follow up; glaucoma; glucose blood level; health care utilization; health status; health survey; human; intraocular pressure; major clinical study; male; National Eye Institute Visual Function Questionnaire; outcome assessment; prevalence; priority journal; quality control; quality of life; risk factor; Short Form 12; visual acuity; visual field; World Health Organization

Surgical management of severe ocular surface injury due to Roman candle explosion accidents - Cheung, A.Y.; Genereux, B.M.; Dautremont, B.; Govil, A.; Holland, E.J. (Ocular Surface, 2018)
Purpose: To report the clinical features, management, and outcomes of patients with ocular surface damage secondary to Roman candle explosion accidents. Methods: Retrospective, noncomparative, interventional case series of 11 patients with Roman candle explosion-related ocular surface injuries referred to the Cincinnati Eye Institute between 2007 and 2016. Results: Eleven patients (10 male, 1 female, mean age 22.4 years) sustained unilateral ocular surface injuries with presenting visual acuity ranging from count fingers to light perception. All patients had severe limbal stem cell deficiency with total ocular surface failure. Eight eyes received a conjunctival-limbal autograft (CLAU) with a keratolimbal allograft (KLAL), 1 eye received a living related-conjunctival limbal allograft (lr-CLAL) with a KLAL, and 2 eyes received a CLAU with lr-CLAL. Nine eyes underwent subsequent penetrating keratoplasty, and 7 eyes had reconstructive eyelid surgery. Nine eyes demonstrated improved visual acuity at last follow-up; seven eyes demonstrated a stable ocular surface at last follow-up. Nonadherence was noted in 7 patients, either with poor adherence with post-operative treatment or poor follow-up; this portended a worse visual result. Conclusions: Roman candle-related accidents can lead to severe ocular surface injury. Despite total ocular surface failure, these eyes can achieve good postoperative visual results following limbal stem cell transplantation and subsequent keratoplasty with appropriate compliance.
Keywords: general device; keratoprosthesis; Roman candle; corticosteroid; hydroxymethylglutaryl coenzyme A reductase inhibitor; immunosuppressive agent; adolescent; adult; amnion; ankyloblepharon; article; autograft; child; clinical article; conjunctival limbal autograft; deep anterior lamellar keratoplasty; explosion; eye injury; eye surgery; eyelid reconstruction; female; glaucoma; graft failure; graft rejection; human; immunosuppressive treatment; intraocular hypertension; keratectomy; keratitis; keratolimbal allograft; keratoplasty; living related conjunctival limbal allograft; male; middle aged; neutropenia; ocular surface disease; reconstructive surgery; retrospective study; school child; side effect; stem cell transplantation; symblepharon; tarsorrhaphy; tissue transplantation; young adult

Glaucoma Adherence—From Theriac to the Future - Kinast, R.M.; Mansberger, S.L. (American Journal of Ophthalmology, 2018)
Keywords: antiglaucoma agent; eye drops; drug approval; drug cost; drug delivery system; editorial; Food and Drug Administration; glaucoma; health behavior; history of medicine; human; medical decision making; oral drug administration; patient attitude; patient compliance; patient monitoring; physician; priority journal

The Management of Inflammatory Bowel Disease in Elderly: Current Evidence and Future Perspectives - Arnott, I.; Rogler, G.; Halfvarson, J. (Inflammatory Intestinal Diseases, 2018)
Data on the elderly population with inflammatory bowel disease (IBD) are scarce, as this population is normally excluded from clinical trials. With an ageing population and an overall increasing prevalence of IBD; the incidence of IBD in elderly is rising. Comorbidities, wide differential diagnosis and polypharmacy make the diagnosis and management of the disease in elderly more challenging compared to that in younger adults. The knowledge of specific requirements for the management and treatment of IBD in advanced age may help in the framing of the definition of the appropriate care of this patient group. This manuscript reviews the most recent knowledge in the epidemiology, diagnosis and management of IBD in this population.
Keywords: acetylsalicylic acid; allopurinol; anticonvulsive agent; antidiabetic agent; azathioprine; C reactive protein; calcium channel blocking agent; calgranulin; clotrimazole; corticosteroid; digoxin; dipeptidyl carboxypeptidase inhibitor; diuretic agent; hydralazine; loop diuretic agent; mercaptopurine; mesalazine; methotrexate; nonsteroid antiinflammatory agent; penicillin derivative; tetracycline derivative; tuberculostatic agent; tumor necrosis factor inhibitor; warfarin; aged; bone marrow toxicity; cataract; colitis; comorbidity; Crohn disease; differential diagnosis; disease exacerbation; drug antagonism; drug blood level; drug dose reduction; drug potentiation; fatigue; gastrointestinal hemorrhage; glaucoma; hospital admission; human; hypokalemia; ileal pouch-anal anastomosis; incidence; infection; inflammatory bowel disease; infusion related reaction; leukopenia; lymphoma; malabsorption; malnutrition; mycosis; nausea; neurologic disease; nonhodgkin lymphoma; patient compliance; patient-reported outcome; polypharmacy; prevalence; priority journal; proctocolectomy; rash; remission; review; rheumatic disease; skin manifestation; stomatitis; surgical mortality; toxic megacolon; ulcerative colitis

Psychosocial predictors of eye care utilization in the african american eye disease study - McKean-Cowdin, R.; Barrett, M.; Torres, M.; Fairbrother-Crisp, A.; Jiang, X.; Burkemper, B.; Varma, R. (Investigative Ophthalmology and Visual Science, 2018)
Purpose: To quantify eye care utilization in a population-based sample of African Americans approximately 12-18 months after receiving a referral for eye care due to eye disease or an annual preventive eye examination. Further to evaluate demographic, socioeconomic and psychosocial predictors of receiving eye-care subsequent to referral. Methods: A population-based sample of African American adults residing in Los Angeles County, CA underwent comprehensive clinical eye exams and questionnaire based interviews on sociodemographics, lifestyle, medical history, and psychosocial predictors of health care utilization. Examinations were completed at baseline from 2014-2017; an interview was conducted 12-18 months after baseline to evaluate follow-up eye care. Psychosocial predictors of obtaining follow-up eye care were evaluated using an Integrated Behavioral Model. Categories of variables considered included attitudes, perceived norms, and personal agency, as well as knowledge and skills, salience, environmental constraints, and habit. The proportion of participants who received eye care overall and by eye condition was calculated. The fit of the theoretical model and the individual paths in the model were evaluated using structural equation modeling. Results: Approximately 2300 participants were referred for follow-up eye care; 62% with eye disease and 52% of those referred for an annual eye exam reported receiving eye care. The highest eye care utilization was among participants diagnosed with glaucoma (82%), followed by lens opacity (61 %) and diabetic retinopathy (58%). Participants who received eye care were more likely to be older, female, college educated, and with health and vision insurance. Three psychometric constructs were predictive of receiving follow-up care including: attitude-experiential, environmental constraints and salience. Conclusions: A high proportion of African American adults did receive follow-up eye care within 12-18 months of referral when recommended by an eye care specialist. Psychosocial models indicate that factors influencing whether a person sought care were influenced by their level of concern about eye disease, availability of care, cost, insurance, knowledge of where to get care, and whether they had received messages about the importance of receiving care in the media and from their doctor.
Keywords: adult; African American; California; cataract; college; conference abstract; controlled study; diabetic retinopathy; eye care; female; follow up; glaucoma; health care utilization; health insurance; human; human tissue; interview; lifestyle; major clinical study; medical history; patient referral; psychological model; questionnaire; skill; structural equation modeling; theoretical study

Etiology and longitudinal outcomes of panuveitis in an inner city underserved population - Akhter, M.; Lin, X. (Investigative Ophthalmology and Visual Science, 2018)
Purpose : Panuveitis is defined by inflammation of the uveal tract in both the anterior and posterior segment. Panuveitis generally accounts for less than 25% of all uveitis presenting to tertiary care facilities. Successful treatment relies on consistent follow up and good compliance with treatment. The inner city population presents a unique cohort in which both follow up and treatment compliance are inconsistent. We undertook this study to evaluate the etiology and long term visual outcomes in this cohort to further understand how best to treat panuveitis patients when socioeconomic factors limits management options. Methods : A retrospective chart review was conducted on patients with a diagnosis of panuveitis from January 2012 to January 2017. Factors analyzed included demographics, visual acuity, etiology, degree of posterior involvement, treatment, including steroids, immunomodulatory therapy or intraocular therapy, loss of follow up and sequelae. IRB approval was obtained from the Wayne State University School of Medicine. All subjects were treated in accordance to the Declaration of Helsinki. Results : 101 patients were analyzed: 79% were African-American, 13% were Caucasian and 4% were other. The average age was 50. 68% of the patients were female and 32% were male. 39% of patients had systemic disease, of which sarcoidosis was the most common (49%). 30% of patients were idiopathic and 27% were infectious, of which syphilis was the most common (41%). 78% of patients were on steroids and and 54% were on immunomodulatory medication, of which methotrexate was the most common (43%). There was no significant change in vision after treatment. 25% of patients developed uveitic glaucoma. At least 18% of the patients in our study were lost to follow up two or more times. Conclusions : The etiology of panuveitis seen in our study, most notably the predominance of sarcoidosis and syphilis, is unique to our inner city population when compared to other studies. This knowledge may help guide treatment in this challenging patient population.
Keywords: methotrexate; steroid; adult; African American; Caucasian; cohort analysis; complication; conference abstract; controlled study; drug therapy; female; follow up; glaucoma; human; major clinical study; male; medical record review; middle aged; retrospective study; sarcoidosis; socioeconomics; syphilis; systemic disease; urban population; uveitis; visual acuity

Fluocinolone acetonide (0.19 mcg/day) intravitreal implant and improved treatment burden for patients with diabetic macular edema (DME) - Byun, M.; Riemann, C.D.; Osher, J.; Patel, Y. (Investigative Ophthalmology and Visual Science, 2018)
Purpose: Studies have shown that patients with diabetic macular edema (DME) have significantly greater treatment burden than non-DME patients due to frequent total health care visits.[i] Frequent injections and office visits can have a substantial impact on patient adherence and quality of life. This analysis of real-world data assesses the impact of a 0.19 mg fluocinolone acetonide (FAC) implant on treatment burden in patients with DME. Methods: This study is a single-center retrospective chart review of 30 eyes (23 patients) that received a single intravitreal injection of 0.19 mg FAc implant (ILUVIEN, Alimera Science Inc., Alpharetta, GA). Data was collected for a 12-month period pre-and post-FAc injection. Primary outcomes included the number of injections and ophthalmology-related office visits. Secondary outcomes included visual acuity (VA), intraocular pressure (IOP) and central sub-field thickness (CSFT) on optical coherence tomography (OCT). Results: The injection frequency significantly decreased from one injection every 2.6 months pre-FAc to one injection every 8.8 months post-FAc (P<0.001). 63% of the eyes did not require additional injections post-FAc. The mean number of ophthalmology-related office visits also significantly decreased from 12.7 visits pre-FAc to 9.3 visits post-FAc (P<0.001). At 12 months post-FAc, the mean VA and CSFT showed a mild improvement. In regards to IOP events, 37% of the eyes required additional IOP lowering drops post-FAc. No eyes required an incisional glaucoma surgery post-FAc. Conclusions: Our results showed that a single intravitreal injection of 0.19 mg FAc implant significantly decreased the treatment burden while maintaining/improving the VA and the CSFT. Specifically, both the frequency of injections and office visits decreased significantly post-FAc. IOP events were in-line with FAME trial and other real-world data with zero eyes requiring an incisional glaucoma surgery.
Keywords: fluocinolone acetonide; adult; ambulatory care; clinical article; conference abstract; controlled study; diabetic macular edema; drug therapy; female; glaucoma surgery; human; injection; intraocular pressure; intravitreal drug administration; intravitreal implant; male; medical record review; ophthalmology; optical coherence tomography; outcome assessment; retrospective study; thickness; visual acuity

Philadelphia telemedicine glaucoma detection and follow-up study: Adherence to community eye exam appointments - Hark, L.A.; Katz, L.J.; Myers, J.S.; Haller, J.A. (Investigative Ophthalmology and Visual Science, 2018)
Purpose: To improve eye exam appointment adherence following an innovative, practicebased eye screening model to detect, treat, and manage glaucoma in high-risk individuals in urban primary care practices (PCP) and federally qualified health centers (FQHC). Methods: Our targeted, at-risk population included African-Americans, Hispanics and Asians over age 40; adults of any ethnicity over 65 or over age 40 with a family history of glaucoma or diabetes. Participants underwent a free telemedicine eye screening (Visit 1) which included non-mydriatic fundus photography, medical and ocular history, and intraocular pressure measurements in 7 PCPs and 4 FQHCs. Participants with abnormal images, unreadable images, or ocular hypertension were invited back to the same PCP or FQHC location for a confirmation eye exam by an ophthalmologist (Visit 2). Participants who attended Visit 2 and agreed to enroll were randomized to either the Intervention or the Usual Care group for follow-up eye exams with a private practice-community ophthalmologist (Visit 3) in a new location of their choice. The Intervention consisted of using patient navigators and a social worker to provide education about their eye condition and reduce barriers to eye care utilization over a 2-year period. Results are reported on the initial adherence to Visit 3 eye exam appointments comparing the Intervention and Usual Care groups. Results: Of 906 participants screened in the community, 535 (59.1%) were invited for an eye exam. Participants who attended the confirmation eye exam (n=347) and were randomized to the Intervention group (n=172) and the Usual Care group (n=172) were predominately female (59.9%) and African American (64.3%), with a mean age of 60.6 ±11.0 (range: 40.0-99.4) years. A total of 191 (55%) participants attended an initial followup eye exam with an ophthalmologist of their choice, and of those, 130 (68.1%) were participants who had been randomized to the Intervention group compared to 61 (31.9%) participants who were randomized to the Usual Care group (P<0.05). Conclusions: There was a significantly higher adherence to eye exam appointments among participants assisted by patient navigators and a social worker. Our study presents a new perspective and showed that scheduling eye exam appointments and providing education about ocular diagnosis significantly improved adherence to follow-up eye care recommendations.
Keywords: adult; African American; Asian; conference abstract; diabetes mellitus; education; ethnicity; eye care; eye fundus; family history; female; follow up; health center; human; intraocular hypertension; intraocular pressure; major clinical study; middle aged; ophthalmologist; Pennsylvania; photography; primary medical care; private practice; randomized controlled trial; social worker; telemedicine

MLT vs SLT in the hispanic and African American population for treatment of open-angle glaucoma - Dionisio, R.G.; German, O.L.; Patrianakos, T.; Giovingo, M. (Investigative Ophthalmology and Visual Science, 2018)
Purpose: Few studies to date have compared MicroPulse laser trabeculoplasty (MLT), a newer laser utilized in lowering intraocular pressure (IOP), to selective laser trabeculoplasty (SLT), a traditional laser procedure used to treat open-angle glaucoma (OAG). The purpose of this study is to compare MLT to SLT and look at their respective effcacy and safety. Methods: A retrospective chart review of OAG patients treated at a single urban academic institution in the past 2 years was performed. Baseline IOP and number of IOP lowering medications were recorded prior to trabeculoplasty and at all subsequent visits at the following intervals: <1 mo, 1-4 mo, and >5 mo. Exclusion criteria included non-standard laser parameters and visual field defects unrelated to OAG. Utilized MLT parameters were 1000 mW power, 300-μm spot size, 300-ms duration, and >80 spots placed over 360° at 15% duty cycle. SLT parameters were .6-1.0 mJ power, 400-μm spot size, 3-ns duration, with >50 spots over >180°. Student t-tests aided in statistical analysis of pre- and postprocedural IOP and topical IOP lowering medications. Results: 14 patients and 15 eyes (MLT 7; SLT 8) with otherwise uncomplicated eye pathology met inclusion criteria. 64% were African American and 29% Hispanic. The mean pretreatment IOP for the MLT cohort was 25.7 mm Hg and 20.1 mm Hg for the SLT cohort. In comparison to baseline pre-procedural IOP, data collected through 1 month postprocedure showed MLT lowered IOP by 10.9%, while after SLT IOP increased by 12.3%. At 4 months post-treatment, both lasers decreased IOP (MLT -7.3%; SLT -8.9%). At the end of our study period, MLT lowered IOP by 39.4%, a twofold difference from SLT's 14.8% reduction. One MLT patient required the addition of 1 glaucoma medication during the study. In the SLT arm, 2 patients required 1 additional medication, and 1 required micropulse transscleral cyclodiode treatment. No complications were noted. Small sample size, medication non-compliance, and follow-up variability potentially affected our initial data. Conclusions: In this predominantly African American and Hispanic population, MLT demonstrated a greater decrease in mean IOP percentage from baseline. Additionally, subsequent interventions were minimized in the MLT cohort. We are continuing to expand our sample size as well as analyze additional end points. Thus far, MLT shows effcacy and safety in lowering IOP as compared to SLT.
Keywords: adult; African American; clinical article; complication; conference abstract; controlled study; eye disease; female; follow up; Hispanic; human; intraocular hypotension; intraocular pressure; laser; low drug dose; male; medical record review; open angle glaucoma; retrospective study; sample size; topical drug administration; trabeculoplasty; visual field defect

Compliance to topical anti-glaucoma medications among patients at a tertiary hospital in North India - Rajurkar, K.; Dubey, S.; Gupta, P.P.; John, D.; Chauhan, L. (Journal of Current Ophthalmology, 2018)
Purpose: The present study aims to estimate the prevalence of non-compliance and improper drop administration technique among glaucoma patients and describe common obstacles to medication compliance. Methods: A hospital-based cross-sectional study, using standardized questionnaire and direct observation by study personnel was conducted among glaucoma patients aged 18 years and above at a tertiary care charitable eye hospital in North India. 151 consecutive glaucoma patients on medical therapy following up at the glaucoma clinics for at least 6 months were recruited. Non-compliance was defined as missing at-least one drop of medication per week and (or) the inability to accurately describe the medication regimen. Study personnel also assessed drop administration technique during application of eye drops by patients treating ophthalmologist-provided information, including measures of disease stability. Factors such as socioeconomic status, presence of caregiver, and number of medications with their effect on compliance were studied using chi-square statistics. Results: Among 151 patients interviewed, around 49% of patients reported problems in using glaucoma medications, with 16% of them reporting total non-compliance. 35% of patients demonstrated improper drop administration technique. Forgetfulness was cited as the main reason for being non-compliant and had a significant association with non-compliance (P = 0.00). Paying patients were more compliant as compared to subsidized patients (P = 0.05). Disease was more stable in compliant patients compared to non-compliant patients (P = 0.05). No other factor had significant association with compliance (P > 0.05). Conclusions: Over 50% of the patients surveyed were non-compliant, and 35% demonstrated improper administration technique. Glaucoma patients should be educated on the importance of compliance and aids that minimize forgetfulness, and delivery systems facilitating the delivery of medications to the eye could be considered to enhance patient adherence.
Keywords: antiglaucoma agent; eye drops; adult; aged; article; caregiver; cross-sectional study; female; follow up; glaucoma; health survey; human; India; major clinical study; male; medication compliance; medication therapy management; middle aged; observational study; patient compliance; questionnaire; social status; tertiary care center

Eye care utilization and its determinants in Canada - Aljied, R.; Aubin, M.-J.; Buhrmann, R.; Sabeti, S.; Freeman, E.E. (Canadian Journal of Ophthalmology, 2018)
Objective: To provide the frequency and potential determinants of eye care utilization over the last 12 months among Canadians between the ages of 45 and 85 years old. Design: Cross-sectional population-based study. Participants: 30,097 people in the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Methods: Inclusion criteria included being between the ages of 45 and 85 years old, community-dwelling and living near one of the 11 data collection sites across 7 Canadian provinces. Eye care utilization was defined as the self-report of a visit to an optometrist or ophthalmologist in the past 12 months. Results: In the last year, 57% of 28 728 adults visited an eye care provider although there was heterogeneity between provinces. The highest eye care utilization was found in Ontario at 62%, whereas the lowest was in Newfoundland and Labrador at 50%. Of concern, 25.3% of people with diabetes above the age of 60 years had not seen an eye care provider in the last year. Our novel finding was that current smokers were less likely to use eye care compared to never smokers (odds ratio [OR] = 0.76, 95% confidence interval [CI] 0.67–0.87). Confirming previous research, men compared to women (OR = 0.67, 95% CI 0.62–0.71), people with less than a bachelor's degree compared to more than a bachelor's degree (OR = 0.87, 95% CI 0.79–0.95), and people making less income (linear trend p < 0.05) were less likely to use eye care. Conclusions: Disparities exist in eye care utilization in Canada. Efforts should be made to reduce these disparities to reduce avoidable vision loss.
Keywords: adult; age; aged; article; Canada; Canadian; cataract; cross-sectional study; eye care; female; glaucoma; health care personnel; health care utilization; household income; human; insulin dependent diabetes mellitus; longitudinal study; macular degeneration; major clinical study; male; non insulin dependent diabetes mellitus; ophthalmologist; optometrist; population research; smoking; very elderly; visual impairment

Fungal Eye Infections: New Hosts, Novel Emerging Pathogens but No New Treatments? - Chang, C.C.; Chen, S.C.-A. (Current Fungal Infection Reports, 2018)
Purpose of Review: We sought to explore the current incidence and associated risk factors associated with fungal eye infections. We also reviewed new diagnostic strategies and recent clinical studies exploring the use of topical and oral antifungal agents. Recent Findings: Incidence and associated risks continue to vary with geographic region, and access to timely healthcare. Nosocomial fungal endophthalmitis can result from minor surgical procedures to the eye. Molecular methods offer increasing diagnostic utility. Clinical treatment studies have mainly focussed on the treatment of fungal keratitis and have been conducted in South Asia. Topical natamycin remains superior to topical reconstituted voriconazole and remains the preferred therapy including for Fusarium eye infections. Neither adjunctive oral ketoconazole nor oral voriconazole has been shown to have added clear benefit to topical treatment. Summary: Larger international studies with more heterogenous populations are required for future clinical studies which should include patients with contact lens fungal keratitis and those with fungal endophthalmitis. Basic science studies exploring the immunology of fungal eye infections and drug levels to understand the differences in clinical outcomes are encouraged.
Keywords: ketoconazole; natamycin; placebo; voriconazole; article; Aspergillus; clinical trial (topic); diagnostic procedure; eye surgery; fungal endophthalmitis; fungal eye infection; fusariosis; Fusarium; geography; health care access; human; keratomycosis; morbidity; nonhuman; randomized controlled trial (topic); risk factor; Scedosporium; South Asia; visual acuity; natacyn; vfend

Estimates of visual impairment and its causes from the national eye survey in Malaysia (NESII) - Chew, F.L.M.; Salowi, M.A.; Mustari, Z.; Husni, M.A.; Hussein, E.; Adnan, T.H.; Ngah, N.F.; Limburg, H.; Goh, P.-P. (PLoS ONE, 2018)
Background Population-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique. Methods Malaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling ‘E’ Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed. Results A total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0–1.4%), 1.0% (95%CI: 0.8–1.2%) and 5.9% (5.3–6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively. Conclusion Increased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.
Keywords: Snellen chart; adult; aged; blindness; cataract extraction; controlled study; cross-sectional study; demography; diabetic retinopathy; disease severity; female; geographic distribution; glaucoma; health care access; health care delivery; health survey; human; major clinical study; Malaysia; male; medical history; middle aged; ophthalmoscopy; patient education; population research; prevalence; review; risk factor; very elderly; visual acuity; visual impairment

Prostate cancer incidence and mortality among men using statins and non-statin lipid-lowering medications in Saskatchewan, 1990-2014 - Van Rompay, M.; Solomon, K.; Ranganathan, G.; Kantoff, P.; McKinlay, J.; Nickel, C. (Canadian Urological Association Journal, 2018)
Introduction: We sought to rigorously test the hypothesis, which was based on previous small, short-duration and biased studies, that cholesterol-lowering drugs (statins and non-statin lipid-lowering medications [NSLLM]) have an effect on prostate cancer (PCa) risk (incidence and severity) in men. Methods: A retrospective cohort study of men with no history of PCa diagnosis was conducted by abstracting prescription and health service records for 249 986 men aged 40-89 years covered by Saskatchewan Health between January 1, 1990 and December 31, 2014 and comparing first-time statin and NSLLM users with age-matched non-users and glaucoma medication users (control for healthcare utilization bias) for PCa incidence, metastases at diagnosis, and PCa mortality over 25 years using survival analysis. Results: In comparing statin users to non-users, a weak association was detected with increased PCa incidence (adjusted hazard ratio [HR] 1.07; 95% confidence interval [CI] 1.02-1.12) that disappeared when statin users were compared with glaucoma medication users. In contrast, substantial protective associations were observed between statin use and metastatic PCa and PCa mortality (adjusted HRs 0.69; 95% CI 0.61-0.79, and 0.73; 95% CI 0.66-0.81, respectively), which were stronger when compared with glaucoma medication users. Similar associations were found between NSLLM and PCa incidence, severity, and mortality. Conclusions: Our analyses provide the most comprehensive findings to date that statins may reduce the risk of metastatic PCa and PCa mortality, and the first to demonstrate that NSLLM have similar effects, supporting a cholesterol-based mechanism.
Keywords: hydroxymethylglutaryl coenzyme A reductase inhibitor; lipid; adult; aged; cancer diagnosis; cancer incidence; cancer mortality; cancer risk; cancer survival; cohort analysis; conference abstract; controlled study; diagnosis; glaucoma; health care utilization; human; major clinical study; male; metastasis; prescription; prostate cancer; retrospective study; Saskatchewan; survival analysis

An audit on paediatric uveitis in the greater glasgow and clyde (GGC) service: Guideline adherence and impact on patient outcomes - Parmar, E.; Waddell, J.; Gardner-Medwin, J. (Annals of the Rheumatic Diseases, 2018)
Background: 2010 guidelines from the Scottish Paediatric and Adolescent Rheumatology Network (SPARN) and the Scottish Uveitis Network (SUN) outlined management pathways for paediatric uveitis. Given the time since its establishment and last review, an audit on the GGC service's adherence to the guidelines as well as patient outcomes was conducted. Objectives: To determine the service's compliance to the SPARN/SUN guidelines for the management of paediatric uveitis, in addition to establishing patient outcomes and identifying current shortcomings and areas for improvement in future practice. We also aimed to provide data to inform the revision and updating of the guideline for the year 2018. Methods: This retrospective audit was conducted by collecting data from patients within the GGC's Royal Hospital for Children's joint rheumatology and ophthalmology service who were diagnosed with uveitis between the 1st of January 2008 and the 31st of December 2017. The data was then compared to the guidelines set by SPARN/SUN, in addition to a study conducted by this service prior to the guideline's development. Results: 39 suitable patients were identified from the list of 253. From these patients, 92 separate events of uveitis were recorded -84 of which ended in remission within the audit period. 17 events (20%) remained active after 7 months and required ongoing treatment, falling out with the guideline's standards. Time to remission was further stratified by modality of treatment. Of the 78 eyes evaluated, 7 eyes in 5 patients were found to have had cataracts. This comprises 12.8% of patients, an improvement from the 29% of the previous study. Notably, 5 of the 7 eyes had cataracts detected at the first appointment with the service. An additional 7 eyes across 6 patients (15%) were recorded to have had cystoid macular oedema, which is comparable to the previous study's 11%. A majority of these (4 of 7 eyes, or 57%) were again discovered to already be present at the first appointment. Conclusions: Guideline adherence was commendable, though improvement is needed in treatment escalation to decrease the time taken for patients to achieve remission. There exists a tendency to maintain patients on topical steroid therapy due to relapsing and remitting disease activity, though given the high risk of glaucoma, consideration should be given to quickly progressing these patients up the treatment ladder. A large proportion of patients with severe complications of uveitis appear to have developed these prior to their first attendance at the service, suggesting a need for more stringent screening processes for early detection. Overall, outcomes in terms of the number of patients affected by complications of uveitis appear to have improved when compared to the study previously conducted by the service, implying a beneficial effect from adherence to the implemented guidelines.
Keywords: adolescent; cataract; child; clinical article; complication; conference abstract; controlled study; diagnosis; female; glaucoma; human; joint; male; ophthalmology; protocol compliance; remission; retina macula cystoid edema; retrospective study; rheumatology; steroid therapy; topical drug administration; uveitis

The determinants of therapeutic observance in open-angle glaucoma - Amara, F.; Ben Amor, H.; Kaibi, I.; Taktak, M.; Taktak, J. (Tunisie Medicale, 2018)
Adherence to medical treatment in primary open angle glaucoma is key to the success of the treatment. Most of the work show that glaucoma patients are poor observant. Poor adherence is multifactorial. The analysis of these factors is crucial. That is why the author wanted to exposethrough a literature review, the main determinants of adherence in glaucoma.
Keywords: article; human; open angle glaucoma; patient compliance

Patient satisfaction with care in an urban tertiary referral academic glaucoma clinic in the us - Peterson, K.M.; Huisingh, C.E.; Girkin, C.; Owsley, C.; Rhodes, L.A. (Patient Preference and Adherence, 2018)
Background: The purpose of this study was to determine the factors associated with glaucoma patients’ satisfaction with their medical care by fellowship-trained glaucoma specialists in an urban tertiary referral clinic in the US. Methods: A total of 110 established patients aged ≥ 60 years with a diagnosis of either primary open angle glaucoma, glaucoma suspect, or ocular hypertension monitored by an ophthalmologist with fellowship training in glaucoma were enrolled at an academic, urban, tertiary referral eye clinic. Enrolled patients were administered a general demographics questionnaire along with a Patient Satisfaction Questionnaire-18 (PSQ-18), a Likert scale validated tool. The seven dimensions of patient satisfaction from the PSQ-18 were summarized for the sample overall and by the patients’ age, race, employment status, education level, distance travelled from home address to clinic, and glaucoma therapy type. Two-sample t-tests were used to compare group means. Spearman correlation coefficients were used to correlate satisfaction scores with peripheral vision and visual acuity function. Results: Overall, the general satisfaction scores were high (mean 4.62). Patients ≥ 70 years of age had lower general satisfaction with their care (mean 4.5 vs 4.8, p=0.03), the interpersonal manner of their appointment (mean 4.7 vs 4.9, p=0.009), and with their time spent with their doctor (mean 4.4 vs 4.7, p=0.03) than patients aged 60–69 years. Non-European descent patients (47% African descent and 1% other of sample) were more satisfied with the time they spent with the doctor (mean 4.7 vs 4.4, p=0.04) and with the communication during the appointment (mean 4.8 vs 4.6, p=0.04) than European descent patients (52% of sample). Patients with a higher level of education (>high school degree) were less satisfied with the accessibility and convenience of the appointment (mean 4.3 vs ≤ high school, 4.6, p=0.02). There were no statistically significant differences in patient satisfaction based upon employment status, distance travelled to clinic, prior glaucoma therapy, or visual function. Conclusion: Overall, across all dimensions of the PSQ-18, patients were highly satisfied with the care they received at the urban tertiary care glaucoma clinic.
Keywords: adult; African; aged; article; cross-sectional study; educational status; employment status; ethnic difference; European; female; glaucoma; groups by age; health care access; human; intraocular hypertension; major clinical study; male; medical care; open angle glaucoma; patient satisfaction; Patient Satisfaction Questionnaire 18; peripheral vision; questionnaire; tertiary care center; United States; visual acuity

Public Health Burden and Potential Interventions for Myopia - Modjtahedi, B.S.; Ferris, F.L.; Hunter, D.G.; Fong, D.S. (Ophthalmology, 2018)
Keywords: bifocal lens; orthokeratology lens; spectacles; atropine; dopamine; body weight control; cataract; clinical trial (topic); disease burden; disease exacerbation; early intervention; editorial; electronic medical record; European; follow up; glaucoma; groups by age; health care system; high myopia; high risk patient; human; long term care; macular degeneration; medical education; myopia; optic nerve disease; patient compliance; photophobia; population; prevalence; primary prevention; priority journal; public health; refraction error; refractive surgery; retina detachment; risk assessment; risk factor; subretinal neovascularization; treatment duration; visual impairment

Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives - Lane, M.; Lane, V.; Abbott, J.; Braithwaite, T.; Shah, P.; Denniston, A.K. (Survey of Ophthalmology, 2018)
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
Keywords: age related macular degeneration; article; cataract; diabetic retinopathy; disease association; education; eye disease; eye injury; glaucoma; health care access; health care delivery; health care policy; health disparity; health inequality; human; incidence; lowest income group; medical specialist; multiple deprivation; priority journal; randomized controlled trial (topic); social isolation; systematic review; visual impairment

Plasma rich in growth factors eye drops to treat secondary ocular surface disorders in patients with glaucoma - Sánchez-Avila, R.M.; Merayo-Lloves, J.; Fernández, M.L.; Rodríguez-Gutiérrez, L.A.; Rodríguez-Calvo, P.P.; Fernández-Vega Cueto, A.; Muruzabal, F.; Orive, G.; Anitua, E. (International Medical Case Reports Journal, 2018)
Purpose: To evaluate the efficacy and safety of plasma rich in growth factors (PRGF) eye drops in patients with glaucoma with secondary ocular surface disorders (OSDs) due to surgeries and topical hypotensive drugs use. Materials and methods: A retrospective case-series study design was used including six patients (eight eyes) diagnosed with glaucoma who received surgical (nonpenetrating deep sclerectomy and/or trabeculectomy) and medical treatments (hypotensive eye drops) to control intraocular pressure (IOP) and who developed secondary OSDs, unresponsive to conventional treatments. Patients were treated with PRGF eye drops (four times a day). Outcome measures were ocular surface disease index (OSDI), best-corrected visual acuity (BCVA, in logarithm of the minimum angle of resolution), visual analog scale (VAS), frequency and severity of symptoms, and IOP. The safety of the treatment was also evaluated. Results: Six patients (seven eyes with open-angle glaucoma and one eye with uveitic glau-coma) treated with PRGF eye drops were evaluated. Mean age was 71 years (SD=7.2, range 58–79 years). Five were female and one was male. The mean treatment time was 21.8 weeks (SD=9.0, range 12–36 weeks). The mean time to reach closure of the corneal ulcer was 14.5 (SD=5.5) weeks. A statistical significant reduction in OSDI scale (50.6%), VAS frequency (53.1%), VAS severity (42.0%), and a 41.8% improvement in BCVA were observed (p<0.05). IOP also decreased by 16.6% (p=0.010). Only one of the six patients reported itching in both eyes as an adverse event (AE); however, the patient continued with the PRGF eye drops until the end of therapy; the remaining patients did not report any AEs during the follow-up period. Conclusions: In patients with glaucoma and secondary OSDs refractive to conventional treatments, the treatment with PRGF eye drops could be considered a possible therapeutic option, because it demonstrates an improvement in the signs and symptoms of the ocular surface, as well as a better control of the IOP. This is an initial research work that can open doors for future research to confirm these findings.
Keywords: apraclonidine; bimatoprost; brimonidine; brinzolamide; dorzolamide; eye drops; latanoprost; pilocarpine; plasma rich in growth factor; timolol; travoprost; unclassified drug; adult; aged; article; best corrected visual acuity; clinical article; cornea ulcer; drug safety; dry eye; female; glaucoma; human; intraocular pressure; male; middle aged; ocular pruritus; ocular surface disease; Ocular Surface Disease Index; open angle glaucoma; patient compliance; retrospective study; sclerectomy; thrombocyte rich plasma; trabeculectomy; treatment duration; treatment outcome; uveitis; visual analog scale

Baseline health utility scores in subjects with suspected ocular disease: An interim analysis of the philadelphia telemedicine glaucoma detection and follow-up study - Mehta, R.; Prioli, K.M.; Hark, L.; Katz, L.J.; Myers, J.S.; Pizzi, L.T. (Value in Health, 2018)
Objectives: The Philadelphia Telemedicine Glaucoma Detection and Follow-up Study is a CDC-funded prospective randomized controlled trial comparing a social worker intervention (enhanced intervention, EI) to address individual and systemic barriers to ophthalmology care versus usual care (UC). The study investigates the effect of EI on adherence to recommended follow-up eyecare in underserved Philadelphia communities. Study objectives include determining incremental cost-effectiveness of EI versus UC using health utilities derived from the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Objective of this analysis was to assess differences in baseline utility by demographics. Methods: Baseline demographics and NEI-VFQ-25 responses were collected for subjects randomized into the study. Demographics were assessed using descriptive statistics, and baseline utility scores (VFQ-UI) were derived from NEI-VFQ-25 responses using a validated algorithm. T-tests and ANOVA were used to assess statistical significance of differences between mean VFQ-UI by gender, race, ethnicity, marital status, and diabetic history. Results: The sample comprised 340 subjects, n= 171 randomized to EI and n= 169 randomized UC. Mean age of the entire sample was 60.65 years (SD ±11.03), 59.1% were female, 65.0% were African American, and 55.9% reported history of diabetes. Mean sample VFQ-UI was 0.864 (SD ±0.111); mean EI VFQ-UI was 0.866 (SD: ±0.112) versus 0.862 (SD ±0.111) for UC. VFQ-UI was not statistically different by study group (p= 0.790). No statistical differences were identified in the mean reported VFQ-UI by gender (p= 0.215) or diabetes status (p= 0.604). Race, ethnicity, and marital status significantly impacted VFQ-UI (p= < 0.001, 0.005, 0.009, respectively). Conclusions: Mean VFQ-UI is generally high at baseline and did not statistically differ by study group; however, statistically significant differences were seen by race, ethnicity, and marital status, suggesting that changes in utility during the clinical trial should be measured for relevant subgroups. Future work entails evaluating change in VFQ-UI at 18 and 36 months.
Keywords: adult; African American; analysis of variance; conference abstract; controlled study; diabetes mellitus; ethnicity; female; follow up; gender; glaucoma; human; major clinical study; male; marriage; middle aged; National Eye Institute Visual Function Questionnaire; Pennsylvania; prospective study; race; randomized controlled trial; statistical significance; statistics; telemedicine

Intraocular Lymphoma: Descriptive Data of 26 Patients Including Clinico-pathologic Features, Vitreous Findings, and Treatment Outcomes - Abu Samra, K.; Oray, M.; Ebrahimiadib, N.; Lee, S.; Anesi, S.; Foster, C.S. (Ocular Immunology and Inflammation, 2018)
Purpose: To describe clinical manifestations, diagnostic approaches, therapy, and outcomes of biopsy-proven intraocular lymphoma. Methods: Review of tertiary referral center records between 2005 and 2015. Results: A total of 51 eyes of 26 patients were included; mean age of onset was 60.42 years. Common ocular complaints included floaters (42%) and blurred vision (35%); 62% of patients had ocular and central nervous system involvement; 11% had systemic lymphoma; and 27% had only ocular involvement. Vitreous analysis was positive for malignant cells in 77% of patients on initial biopsy, and in 100% of patients on repeat biopsy. In total, 20/26 patients received systemic and topical treatment before IOL diagnosis was made; 25 patients received intravitreal methotrexate and/or rituximab; one patient received intracameral rituximab. All patients achieved remission by their final visit. Conclusions: Intraocular lymphoma often masquerades as intraocular inflammation, resulting in delayed or misdiagnosis with subsequent inappropriate management. Optimal therapy is a challenge for oncologists and ophthalmologists.
Keywords: slit lamp; cyclophosphamide; doxorubicin; immunoglobulin; interleukin 10; interleukin 6; methotrexate; prednisone; rituximab; steroid; vincristine; adult; aged; anterior eye chamber; article; best corrected visual acuity; blurred vision; brain biopsy; brain radiation; branch retinal vein occlusion; cancer combination chemotherapy; cancer diagnosis; cancer mortality; cancer radiotherapy; cancer recurrence; cancer regression; cancer survival; cataract; clinical article; clinical feature; descriptive research; diffuse large B cell lymphoma; epiretinal membrane; female; gene rearrangement; glaucoma; histopathology; Hodgkin disease; human; hyphema; hypopyon; intraocular lymphoma; large cell lymphoma; lymphocytic lymphoma; lymphoma cell; male; mantle cell lymphoma; medical record review; medication compliance; nonhodgkin lymphoma; onset age; optic disk; optic nerve atrophy; paracentesis; pars plana vitrectomy; patient compliance; primary central nervous system lymphoma; retina detachment; retina macula cystoid edema; retinal pigment epithelium; retrospective study; slit lamp microscopy; stem cell transplantation; survival rate; systemic disease; systemic therapy; tertiary care center; topical treatment; treatment outcome; treatment response; tumor biopsy; uveitis; vitreous biopsy; vitreous body; vitreous floaters

Eye Drop Dispenser Type and Medication Possession Ratio in Patients With Glaucoma: Single-Use Containers Versus Multiple-Use Bottles - Na, K.-H.; Yoo, C.; Park, J.-H.; Kim, Y.Y. (American Journal of Ophthalmology, 2018)
Purpose: To determine whether the consumption of topical glaucoma medication is influenced by the type of eye drop dispenser. Design: Retrospective cohort study. Methods: We examined 366 patients with open-angle glaucoma or ocular hypertension who were bilaterally treated with 0.0015% tafluprost or 2% dorzolamide/0.5% timolol fixed combination (DTFC). The patients were grouped by the type of dispenser and content of eye drops used: (1) tafluprost in bottles (T-Bottle group); (2) tafluprost in unit-dose pipettes (T-Unit group); (3) DTFC in bottles (C-Bottle group); and (4) DTFC in unit-dose pipettes (C-Unit group). We evaluated the medication possession ratio (MPR) among groups, and factors associated with over-consumption (MPR > 1.2) or under-consumption (MPR < 0.8) in multinomial logistic regression. Results: The mean MPR was 1.49 (range, 0.69-2.91) in the T-Bottle group, 0.91 (range, 0.32-1.27) in the T-Unit group, 1.25 (range, 0.51-2.60) in the C-Bottle group, and 0.96 (range, 0.36-1.60) in the C-Unit group. The Bottle groups demonstrated higher mean values and wider ranges of MPR compared to the Unit groups. The MPR interval at which the largest number of patients were found was 1.0-1.4 in the Bottle groups and 0.8-1.2 in the Unit groups. Bottle-type dispenser (odds ratio [OR] 64.02), tafluprost medication (OR 2.84), and older age (OR 1.03) were associated with over-consumption, whereas no factor was correlated with under-consumption. Conclusions: The type of eye drop dispenser affects the consumption of glaucoma medication. Physicians should consider the type of eye drop dispenser when assessing glaucoma medication adherence.
Keywords: eye drop delivery aid; dorzolamide plus timolol; tafluprost; tafluprost plus timolol; adult; article; cohort analysis; controlled study; drug use; female; human; intraocular hypertension; logistic regression analysis; major clinical study; male; open angle glaucoma; patient compliance; priority journal; retrospective study; cosopt; taflotan

Improving Follow-up and Reducing Barriers for Eye Screenings in Communities: The SToP Glaucoma Study - Zhao, D.; Guallar, E.; Bowie, J.V.; Swenor, B.; Gajwani, P.; Kanwar, N.; Friedman, D.S. (American Journal of Ophthalmology, 2018)
Purpose: To evaluate factors associated with attendance to follow-up ophthalmic care, and to assess the impact of strategies to improve follow-up. Design: Cross-sectional study. Methods: This is an ongoing study to develop an eye screening paradigm, focusing on African Americans ≥50 years of age at multiple urban community sites in Baltimore, Maryland. Several strategies were employed aiming to increase follow-up attendance rates. Multivariable logistic regression was used to evaluate the associations between demographic, medical, and ocular factors with follow-up rate. Results: The total number of referred patients presenting for a free eye examination (attendance rate) during the first phase, during the second phase, and overall was 686 (55.0%), 199 (63.8%), and 885 (57.0%), respectively. In fully adjusted models, the odds ratio (95% confidence intervals) for attending the follow-up visit was 1.82 (1.19, 2.79) for screening in second phase vs first phase, 0.62 (0.39, 0.99) for screening sites that were 3 to <5 miles vs <1 mile from the hospital, 1.70 (1.12, 2.59) in patients with body mass index ≥ 30 vs < 25 kg/m2, 2.03 (1.28, 3.21) in patients with presenting visual acuity < 20/40 vs ≥ 20/40, and 2.32 (1.24, 4.34) for patients with an abnormal vs normal macula. Conclusions: Obesity, short distance between screening sites and hospital, poor presenting visual acuity in the better eye, and an abnormal macula on fundus photography were associated with increased follow-up rate. Implementation of a combination of strategies effectively increased the follow-up rate. Wider adoption of these strategies in other screening programs has the potential to reduce the burden of visual impairment.
Keywords: adult; African American; aged; article; body mass; clinical assessment; clinical evaluation; controlled study; cross-sectional study; demography; disease association; female; follow up; glaucoma; human; major clinical study; male; obesity; ophthalmoscopy; priority journal; retina macula lutea; urban area; visual acuity

The Efficacy and Safety of the Fixed Combination of Brinzolamide 1% and Brimonidine 0.2% in Normal Tension Glaucoma: An 18-Month Retrospective Study - Jin, S.W.; Lee, S.M. (Journal of Ocular Pharmacology and Therapeutics, 2018)
Purpose: To evaluate efficacy and safety of brinzolamide (1%)/brimonidine (0.2%) fixed combination (BBFC) in normal tension glaucoma (NTG). Methods: This retrospective study included NTG patients treated with BBFC as their primary therapy, NTG patients who had changed their medication to BBFC from brinzolamide or brimonidine, and NTG patients who had changed their medication to BBFC from concomitantly using brinzolamide and brimonidine. The intraocular pressure (IOP), mean deviation value, and adverse drug reactions were evaluated. Results: In the BBFC primary therapy group, the baseline IOP was 17.1 ± 1.4 mmHg, and the mean IOP at 18 months after using BBFC was 12.4 ± 1.8 mmHg. In the brinzolamide monotherapy group, the baseline IOP was 16.2 ± 1.4 mmHg, the mean IOP using brinzolamide was 13.4 ± 1.6 mmHg, and the mean IOP at 18 months after changing to BBFC was 12.3 ± 1.4 mmHg. In the brimonidine monotherapy group, the baseline IOP was 16.5 ± 1.5 mmHg, the mean IOP using brimonidine was 13.3 ± 1.6 mmHg, and the mean IOP at 18 months after changing to BBFC was 12.4 ± 1.4 mmHg. In the unfixed brinzolamide and brimonidine group, the baseline IOP was 17.5 ± 1.3 mmHg, the mean IOP when using unfixed brinzolamide and brimonidine was 12.4 ± 1.4 mmHg, and the mean IOP at 18 months after changing to BBFC was 12.6 ± 1.5 mmHg. There were no serious adverse drug reactions. Conclusions: BBFC provides a significant IOP reduction and is a safe antiglaucoma medication for NTG patients.
Keywords: brimonidine; brimonidine plus brinzolamide; brinzolamide; adult; allergic conjunctivitis; article; blurred vision; clinical evaluation; combination drug therapy; conjunctival hyperemia; controlled study; disease burden; drug cost; drug efficacy; drug safety; drug substitution; drug withdrawal; eye irritation; female; follow up; foreign body; human; hyperemia; intraocular pressure; low tension glaucoma; major clinical study; male; medication compliance; middle aged; monotherapy; normal value; patient compliance; retrospective study; visual field; xerostomia

Uveitis: Clinical characterization - Martínez, V.; Román, L.; Riquelme, S.; Losanto, J.; Marcos, V.; Ortíz, N.; Colman, N.; Yinde, Y.; Duarte, M. (Journal of Clinical Rheumatology, 2018)
Introduction: Uveitis is the most frequent cause of inflammatory intraocular disease, it is an important cause of blindness and visual impairment worldwide. It can be a process limited to the eyeball, or the manifestation of a systemic disease already established, including the first clinical sign of an entity that will develop over time. Themajority of patients are ofworking age, with a marked impact on their activities and impact on quality of life, aggravating the chronic or recurrent nature, complications and prolonged therapy on many occasions. Objectives: Describe the demographic characteristics of patients with uveitis. Determine the clinical characteristics and the therapeutic response. Methodology: Cross-sectional observational study, from the period between January 2016 and December 2017 in patients followed at the Ambulatory Service of the Department of Rheumatology. The variables were considered: anatomical pattern of uveitis, sex, systemic manifestations and local complications, therapeutic. Results: Thirty patients were included, 60% (18) women, and 40% (12) Male, the mean age at diagnosis was 37.78 years. Considering the anatomical pattern, corresponded: (20) to anterior uveitis, (1) intermediate, and (9) panuveitis, with bilateral involvement (8) 10 patients suffered complications, 30% (3) cataracts, 30% (3) synechiae, 10% (1) Glaucoma 30% (3) with decreased vision. Systemic autoimmune disease: 16.6% (5): with seronegative arthritis, and 2 with SLE. We confirmed the presence of HLA B27 in 2 patients. Therapeutic response: 36.84% (7) improved with corticosteroid therapy, 63% (12) required immunosuppressants with a drug (2) or in combination therapy (10): Cyclophosphamide IV (4), Azathioprine (10), Methotrexate (8), biological (infliximab) (2). Conclusion: In this study, uveitis was observed mainly in patients of productive age, mostly women; the predominant anatomical pattern was anterior uveitis, and an important percentage presented complications and sequelae, with diminished visual acuity. The systemic treatment based on corticosteroids and immunosuppressants was effective in controlling the activity of the disease in almost all patients, only two cases required biologics. Early diagnosis and treatment is essential to improve prognosis.
Keywords: azathioprine; biological product; corticosteroid; infliximab; methotrexate; adult; ambulatory care; arthritis; autoimmune disease; case report; cataract; clinical article; clinical feature; complication; conference abstract; corticosteroid therapy; diagnosis; drug combination; drug therapy; early diagnosis; female; glaucoma; human; iridocyclitis; low vision; male; observational study; prognosis; rheumatology; systemic therapy; treatment response; visual acuity

Sex disparities in health and health care utilization after parkinson diagnosis: Rethinking PD associated disability - Fullard, M.; Thibault, D.; Todaro, V.; Foster, S.; Katz, L.; Morgan, R.; Kern, D.; Schwalb, J.; Mendoza, E.U.; Shulman, L.; Dahodwala, N.; Willis, A. (Neurology, 2018)
Objective: To examine sex differences and trends in comorbid disease and health care utilization in individuals with newly diagnosed Parkinson disease. Background: There are known sex differences in the incidence of PD, as well as the burden of nonmotor symptoms, however, less is known about differences in health and health care utilization after PD diagnosis. Increased use of health care services may suggest barriers to preventative and therapeutic disease management, increased susceptibility to adverse outcomes or lack of social support. Improving quality survivorship for Parkinson's disease (PD) requires a better understanding of how health and health care use changes after PD diagnosis. Design/Methods: This is a retrospective cohort study of 131, 950 Medicare beneficiaries diagnosed with PD in the year 2002 and followed through December 31, 2008. The primary outcomes were comorbid disease diagnosis and health service use. Survival through 2008 was a secondary outcome. We compared the prevalence and cumulative incidence of common medical conditions, trends in survival and health care utilization between men and women with PD. Results: Female PD patients had higher adjusted incidence rate ratio (IRR) of depression (IRR: 1.52, 1.49-1.55), diabetes (IRR: 1.14, 1.10-1.18), glaucoma (IRR: 1.12, 1.06-1.17), hip fracture (IRR: 1.59, 1.53-1.66), osteoporosis (2.73, 2.64-2.81), rheumatoid/osteoarthritis (IRR: 1.51, 1.47-1.55), and stroke/TIA (IRR: 1.05, 1.02-1.08) than men. In spite of greater survival, women with PD used home health and skilled nursing facility care more often, and had less outpatient physician contact than men throughout the study period. Conclusions: Women experience a unique health trajectory after PD diagnosis as suggested by differing comorbid disease burden and health care utilization compared to men. Future studies of sex differences in care needs, care quality, comorbidity related disability, PD progression, and nonclinical factors associated with disability are needed to inform research agendas and clinical guidelines that may improve quality survival for women with PD.
Keywords: adult; cerebrovascular accident; cohort analysis; comorbidity; conference abstract; controlled study; depression; diabetes mellitus; diagnosis; disability; disease burden; disease exacerbation; female; glaucoma; health care utilization; hip fracture; human; incidence; male; medicare; nursing; osteoarthritis; osteoporosis; outpatient; Parkinson disease; practice guideline; prevalence; retrospective study; sex difference; survivorship

Switching from concomitant therapy to tafluprost/timolol fixed combination - Inoue, K.; Kawashima, T.; Katakura, S.; Shidara, K.; Fujimoto, T.; Kohmoto, H.; Shiokawa, M.; Moriyama, R.; Okayama, R. (Clinical Ophthalmology, 2018)
Purpose: To evaluate the efficacy and safety of tafluprost/timolol fixed combination (TTFC). Study design: A prospective clinical study. Methods: Twenty-eight patients (28 eyes) with primary open-angle glaucoma, who had used tafluprost and timolol gel for at least 3 months with good adherence, were enrolled. Concomitant administration of tafluprost and timolol was switched to TTFC without a washout period. The intraocular pressure (IOP), blood pressure, pulse rate, and ocular signs were compared between before switching (baseline), and 4 and 8 weeks after switching. A questionnaire survey was also performed 4 weeks after switching to investigate ocular comfort and patient preferences. Results: The IOP showed no significant change after switching to TTFC (14.8 ± 2.8, 14.6 ± 3.4, and 14.8 ± 3.7 mmHg at baseline, Week 4, and Week 8, respectively). The pulse rate and systolic blood pressure showed no changes, but diastolic blood pressure was significantly lower at Week 8. At baseline, fluorescein staining revealed corneal abnormalities in 3 patients, which resolved by Week 8 in 1 patient. Hyperemia was noted in 2 patients at baseline, and this also resolved by Week 8 in 1 patient. Three patients discontinued study treatment for the following reasons (1 patient each): blurred vision; ocular irritation, eyelid erythema, and asthenopia; and loss to follow-up from Week 8. The questionnaire survey revealed no significant differences between the 2 treatments, although more patients preferred TTFC. Conclusion: Among 28 patients enrolled, only 2 patients discontinued the study treatment due to adverse reactions. In patients whose adherence was considered relatively good to concomitant therapy, switching to TTFC achieved similar IOP control with good safety and a high level of patient acceptance.
Keywords: 000016052; fluorescein; tafluprost; tafluprost plus timolol; tapcom; timolol; timolol maleate; adult; aged; article; asthenopia; bedtime dosage; blurred vision; clinical article; clinical trial; conjunctival hyperemia; controlled study; diastolic blood pressure; drug efficacy; drug safety; drug substitution; drug withdrawal; eye irritation; eyelid erythema; female; follow up; human; informed consent; intraocular pressure; male; morning dosage; open angle glaucoma; patient compliance; patient preference; prospective study; pulse rate; questionnaire; systolic blood pressure; tapcom; tapros; timoptol

Ocular, otic, nasal, rectal and vaginal formulation innovations and regulatory considerations - Alany, R. (Pharmaceutical Development and Technology, 2018)
Keywords: eye bandage; aceclofenac; agents acting on the eye; antifungal agent; antiinfective agent; brimonidine; dexamethasone; metoclopramide; microbicide; nanocarrier; nose spray; silver; steroid; sucrose; tenofovir; aerosol; aqueous humor; bioavailability; cataract; choroid; clinical evaluation; conjunctiva; cornea; cornea disease; drug absorption; drug administration route; drug delivery system; drug exposure; drug formulation; dry powder; editorial; endoscopic sinus surgery; gastrointestinal tract; gel; glaucoma; human; Human immunodeficiency virus infection; in vivo study; inflammation; intranasal drug administration; intraocular drug administration; intravaginal drug administration; lens; life threat; macular degeneration; ointment; optic nerve; otic drug administration; otitis media; patient compliance; pharmacokinetic parameters; priority journal; rectal drug administration; retina macula lutea; sclera; sexually transmitted disease; suppository; uvea; World Health Organization

Topical drug delivery devices: A review - Bertens, C.J.F.; Gijs, M.; van den Biggelaar, F.J.H.M.; Nuijts, R.M.M.A. (Experimental Eye Research, 2018)
For the treatment and prevention of ocular diseases, most patients are treated with conventional drug delivery formulations such as eye drops or ointments. However, eye drops and ointments suffer from low patient compliance and low effective drug concentration at the target site. Therefore, new medical devices are being explored to improve drug delivery to the eye. Over the years, various delivery devices have been developed including resorbable devices, oval- and ring-shaped devices, rod-shaped devices, punctum plugs, contact lenses and corneal shields. Only a few devices (eg. Mydriasert®, Ozurdex®, Surodex®, Iluvien®, Lacrisert® and Retisert®) have made it to the market while others are being investigated in clinical trials. Altogether, there is a need for enhanced topical drug delivery. Only by working together (academia, industry and authorities) and by exploring parallel strategies (new drug delivery devices, enhanced drug formulations, better understanding of the pharmacokinetic properties), the therapeutic effect of drug treatments can be improved.
Keywords: contact lens; dexamethasone; drug delivery device; Evolute; eye shield; gelfoam; spine plate; fluocinolone acetonide; hydroxypropylcellulose; lens implant; ophthalmic drug insert; Ocufi SR; pilocarpine; dexamethasone; punctal plug; fluocinolone acetonide; Surodex; topical drug delivery device; Topical Ophthalmic Drug Delivery Device; amphotericin B; atropine; brimonidine; chloramphenicol; ciprofloxacin; clonidine; dexamethasone; eye drops; fluocinolone acetonide; gelfoam; hydroxypropylcellulose; idoxuridine; insulin; latanoprost; neomycin; ofloxacin; oxybuprocaine; phenylephrine; pilocarpine; pradofloxacin; sodium; sulfamethoxypyridazine; tetracaine; tropicamide; clinical trial (topic); drug delivery system; drug formulation; dry eye; eye; eye disease; glaucoma; human; keratomycosis; mydriasis; nonhuman; ointment; patient compliance; priority journal; review; gelfoam; iluvien; lacrisert; ocusert; ozurdex; Dextenza; Evolute; Gelfoam; Helios; Iluvien; Lacrisert; Mydriasert; Ocufi SR; Ocusert; Ozurdex; Retisert; Surodex; Topical Ophthalmic Drug Delivery Device

Asthma - Papi, A.; Brightling, C.; Pedersen, S.E.; Reddel, H.K. (The Lancet, 2018)
Asthma—one of the most common chronic, non-communicable diseases in children and adults—is characterised by variable respiratory symptoms and variable airflow limitation. Asthma is a consequence of complex gene–environment interactions, with heterogeneity in clinical presentation and the type and intensity of airway inflammation and remodelling. The goal of asthma treatment is to achieve good asthma control—ie, to minimise symptom burden and risk of exacerbations. Anti-inflammatory and bronchodilator treatments are the mainstay of asthma therapy and are used in a stepwise approach. Pharmacological treatment is based on a cycle of assessment and re-evaluation of symptom control, risk factors, comorbidities, side-effects, and patient satisfaction by means of shared decisions. Asthma is classed as severe when requiring high-intensity treatment to keep it under control, or if it remains uncontrolled despite treatment. New biological therapies for treatment of severe asthma, together with developments in biomarkers, present opportunities for phenotype-specific interventions and realisation of more personalised treatment. In this Seminar, we provide a clinically focused overview of asthma, including epidemiology, pathophysiology, clinical diagnosis, asthma phenotypes, severe asthma, acute exacerbations, and clinical management of disease in adults and children older than 5 years. Emerging therapies, controversies, and uncertainties in asthma management are also discussed.
Keywords: azithromycin; benralizumab; beta 2 adrenergic receptor stimulating agent; beta interferon; corticosteroid; dupilumab; fevipiprant; formoterol; lebrikizumab; leukotriene receptor blocking agent; mepolizumab; muscarinic receptor blocking agent; omalizumab; placebo; reslizumab; tezepelumab; theophylline; tralokinumab; triamcinolone; add on therapy; adrenal insufficiency; airway remodeling; allergic asthma; asthma; biological therapy; bronchial thermoplasty; cataract; chronic obstructive lung disease; comorbidity; cytokine production; diabetes mellitus; differential diagnosis; disease severity; drug megadose; dysphonia; eosinophil count; eosinophilia; forced expiratory volume; fracture; glaucoma; growth retardation; human; inhalation test; low drug dose; medication overuse; occupational asthma; osteoporosis; pathogenesis; patient compliance; patient education; patient satisfaction; personalized medicine; priority journal; purpura; recommended drug dose; respiratory tract inflammation; review; self care; self monitoring; thrush; wheezing; xerostomia

Risk Factors for Rapid Glaucoma Disease Progression - Mowatt, L. (American Journal of Ophthalmology, 2018)
Keywords: antiglaucoma agent; cardiovascular disease; cardiovascular risk; comorbidity; disease exacerbation; glaucoma; human; intraocular pressure; letter; patient compliance; priority journal; risk factor; visual field

The Role of Minimally Invasive Glaucoma Surgery Devices in the Management of Glaucoma - Fingeret, M.; Dickerson, J.E. (Optometry and vision science : official publication of the American Academy of Optometry, 2018)
SIGNIFICANCE: Noncompliance is a problem affecting glaucoma patients. Approaches to improve adherence include the use of drug-delivery systems and safer forms of surgery. Minimally invasive glaucoma surgery (MIGS) has reduced complications, particularly in combination with cataract surgery, and with its good intraocular pressure (IOP) reduction may reduce or eliminate glaucoma medications.Glaucoma is a progressive disease and a leading cause of irreversible blindness. Elevated IOP is the most important risk factor, but effective medical management is dependent on patient adherence. This review summarizes the adherence problem in glaucoma and the efforts, including MIGS, to provide effective IOP control that is not dependent on patient compliance.The current understanding of patient adherence to pharmacological treatment of glaucoma is discussed including the challenges facing glaucoma patients. Historical approaches to providing IOP control in a sustained and reliable way are presented culminating in a review of the burgeoning use of MIGS devices.It is estimated that, in the United States, 27% of prescriptions written, across all medications, are not filled or are filled but not taken. For ocular hypotensive medications, even when filled, a large percentage (which varies widely by study) are not instilled as prescribed. To address this problem, methods for sustained drug delivery have been and continue to be developed, as well as surgical and laser approaches. Most recently, MIGS devices have gained popularity because of the ease of implantation during cataract surgery, favorable safety profile, and the possibility for effective and long-lasting IOP lowering, as well as the reduction or elimination of need for IOP-lowering medication.Poor adherence to treatment is relatively common among glaucoma patients and is associated with progression of disease. Recommending MIGS implantation during cataract surgery may offer optometrists a valuable treatment option in managing glaucoma patients, particularly where good adherence is in doubt.
Keywords: cataract extraction; glaucoma; glaucoma drainage implant; human; intraocular pressure; minimally invasive surgery; pathophysiology; patient compliance; physiology

Efficacy and safety of switching from tafluprost to a tafluprost/timolol fixed combination in patients with primary open-angle glaucoma - Inoue, K.; Ueda, T.; Ishida, K.; Tomita, G. (Open Ophthalmology Journal, 2018)
Background: The Tafluprost/Timolol Fixed Combination (TTFC) has demonstrated efficacy and safety in reducing Intraocular Pressure (IOP). However, direct comparisons of switching from tafluprost to TTFC are limited. Objective: To investigate the efficacy and safety of switching from tafluprost to TTFC in patients with Primary Open-Angle Glaucoma (POAG). Methods: Thirty-four eyes (34 patients) with POAG that did not achieve adequate IOP reduction on tafluprost were switched to TTFC with no washout period. IOP, systolic/diastolic blood pressure and pulse rate were measured 1 and 3 months later and compared with baseline values. All participants were asked about specific adverse reactions after 1 and 3 months of treatment. Patients also completed a questionnaire about preference and adherence after 1 month of treatment. Results: Mean IOP after 1 and 3 months was significantly lower than at baseline (14.2 ± 2.1 mmHg and 14.1 ± 2.3 mmHg, respectively, vs 16.0 ± 2.0 mmHg, P < 0.0001). Systolic/diastolic blood pressure and pulse rate were not significantly different from baseline after 1 and 3 months. The questionnaire indicated that the frequency of missing a dose was not different before (27.3%) or after (18.2%) switching to TTFC (P = 0.2371). There were five reports of adverse reactions (14.7%), including a corneal epithelium disorder, ocular irritation, skin irritation at the wrist, and chest pain. Two patients (5.9%) withdrew because of adverse reactions. Conclusion: Switching from tafluprost to TTFC achieved IOP control safely and was well accepted by patients.
Keywords: tafluprost; tapcom; timolol; adult; aged; article; blurred vision; clinical article; controlled study; corneal epithelium disorder; drug efficacy; drug safety; drug substitution; drug withdrawal; eye discomfort; eye disease; eye examination; eye irritation; female; glaucoma; human; intraocular pressure; major clinical study; male; oculoplethysmography; ophthalmoscopy; patient compliance; priority journal; pulse rate; randomized controlled trial; skin irritation; structured questionnaire; thorax pain; very elderly; visual acuity; tapcom; tapros

Latanoprostene bunod ophthalmic solution 0.024% in the treatment of open-angle glaucoma: Design, development, and place in therapy - Addis, V.M.; Miller-Ellis, E. (Clinical Ophthalmology, 2018)
Latanoprostene bunod (LBN) 0.024%, a modified prostaglandin analog, was approved on November 2, 2017, for the reduction of IOP in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). LBN works by combining the IOP-lowering effects of the prostaglandin analogs (through the uveoscleral pathway) with nitric oxide-induced relaxation of the trabecular meshwork and Schlemm’s canal. Nitric oxide-induced relaxation of the trabecular meshwork and Schlemm’s canal leads to increased outflow through the trabecular meshwork and thus lowering of IOP. LBN has now been shown in multiple clinical studies to be effective and safe. In this article, we summarize the clinical trials that led to LBN’s approval as well as the comparative studies that have been done to evaluate the efficacy of this drug as compared to other US Food and Drug Administration (FDA)-approved therapies for OAG and OHT. We then review the side effects of treatment that were seen in each of these studies. Finally, we will attempt to discuss the place of this drug in therapy for patients with OAG.
Keywords: eye drops; latanoprostene bunod; nitric oxide; prostaglandin derivative; abnormal sensation; application site erythema; application site hyperpigmentation; application site pain; asthenopia; blepharitis; blurred vision; cataract; clinical outcome; conjunctiva disease; conjunctival hemorrhage; conjunctival hyperemia; drug efficacy; drug mechanism; drug safety; drug screening; drug tolerability; dry eye; eye irritation; eye pain; eyelash; foreign body; hair growth; human; intraocular hypertension; intraocular pressure; nonhuman; ocular pruritus; open angle glaucoma; outcome assessment; patient compliance; phase 1 clinical trial (topic); phase 2 clinical trial (topic); phase 3 clinical trial (topic); photophobia; punctate keratitis; randomized controlled trial (topic); review; side effect; trichiasis; visual acuity; visual impairment; vitreous floaters; vyzulta

Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: A focused review of the impact data in the literature - Volmer, T.; Effenberger, T.; Trautner, C.; Buhl, R. (European Respiratory Journal, 2018)
This review provides an overview of the role of long-term treatment of severe asthma with oral corticosteroids (OCS) and its associated side-effects in adults. It is based on a systematic literature search conducted in MEDLINE, Embase and the Cochrane Library to identify relevant studies. After a short overview of severe asthma and its treatment we present studies showing a dose–response relationship in asthmatic patients treated with OCS and then consider by organ systems the undesired effects demonstrated in clinical and epidemiological studies in patients with OCS-dependent asthma. It was found that the risk of developing various OCS-related complications, including infections, diabetes and osteoporosis as well as psychiatric disorders, was higher for patients with long-term exposure to OCS compared with control groups. In addition, studies showed a significant increase in healthcare resource utilisation due to OCS treatment. Therefore, it is incumbent on every clinician to carefully weigh the potential benefit of preventing loss of asthma control against this risk before opting to prescribe long-term OCS therapy. Effective corticosteroid-sparing strategies must be used and should aim at short-term use with the lowest effective dose and start tapering as soon as possible until OCS therapy is terminated.
Keywords: corticosteroid; adrenal disease; adrenal insufficiency; anxiety disorder; asthma; bone disease; cardiovascular disease; cataract; Cushingoid syndrome; diabetes mellitus; disease association; disease severity; dose response; drug dose reduction; drug efficacy; drug megadose; drug safety; dyspepsia; eye disease; fracture; gastrointestinal disease; glaucoma; health care utilization; human; hypertension; infection; long term care; long term exposure; low drug dose; mental disease; meta analysis; metabolic disorder; muscle disease; non insulin dependent diabetes mellitus; obesity; osteopenia; osteoporosis; outcome assessment; priority journal; review; risk factor; skin disease; sleep disorder; sleep disordered breathing; systematic review

Preservative-Free Prostaglandin Analogs and Prostaglandin/Timolol Fixed Combinations in the Treatment of Glaucoma: Efficacy, Safety and Potential Advantages - Holló, G.; Katsanos, A.; Boboridis, K.G.; Irkec, M.; Konstas, A.G.P. (Drugs, 2018)
Glaucoma therapy-related ocular surface disease (OSD) is a serious pathology with a broad spectrum of insidious clinical presentations and complex pathogenesis that undermines long-term glaucoma care. Preservatives, especially benzalkonium chloride (BAK), contained in topical intraocular pressure-lowering medications frequently cause or aggravate OSD in glaucoma. Management of these patients is challenging, and to date often empirical due to the scarcity of controlled long-term clinical trials. Most of the available data are extracted from case series and retrospective analysis. Preservative-free prostaglandins and prostaglandin/timolol fixed combinations are novel options developed to remove the harmful impact of preservatives, especially BAK, upon ocular tissues. Based on what is currently known on the value of preservative-free antiglaucoma therapies it is tempting to speculate how these new therapies may affect the future medical management of all glaucoma patients. This article provides a comprehensive and critical review of the current literature on preservative-free prostaglandins and preservative-free prostaglandin/timolol fixed combinations.
Keywords: antiglaucoma agent; benzalkonium chloride; bimatoprost; drug preservative; latanoprost; preservative free prostaglandin; preservative free prostaglandin plus timolol; prostaglandin derivative; tafluprost; unclassified drug; adverse event; clinical feature; conjunctiva disease; cornea disease; drug efficacy; drug formulation; drug hypersensitivity; drug safety; drug tolerability; drug toxicity; glaucoma; human; inflammation; intraocular hypertension; ocular surface disease; open angle glaucoma; patient compliance; pharmaceutical care; prevalence; review; tear film; topical treatment; trabecular meshwork

Pharmacoepidemiological assessment of adherence and influencing co-factors among primary open-angle glaucoma patients—An observational cohort study - Frech, S.; Kreft, D.; Guthoff, R.F.; Doblhammer, G. (PLoS ONE, 2018)
The goal of this study was to assess the adherence of primary open-angle glaucoma (POAG) patients to medication, and to determine co-factors influencing adherence, using a representative sample of members of the largest German public health insurer. The observational cohort study was based on a longitudinal data set from 2010–2013 and included 250,000 insured persons aged 50 and older with 10,120 diagnosed POAG patients. Uni- and multivariate analysis was performed to investigate several aspects of glaucoma, such as prevalence, adherence, and co-factors influencing adherence. The main outcome measured adherence with prescriptions filled within a year. Multivariate panel regression analysis was used to determine the co-factors influencing this adherence. Prevalence of POAG was 3.36% [CI: 3.28–3.43%], with 2.91% [CI: 2.81–3.01%] for males and 3.71% [CI: 3.61–3.81%] for females, increasing with age. The mean level of adherence in terms of prescriptions filled was 66.5% [CI: 65.50–67.60%]. The results of this analysis revealed a significant influence of age, duration of the disease, care need, distance to death, and multimorbidity as co-factors of non-adherence, whereas gender had no influence. The analysis provided detailed information about POAG health care aspects concerning prevalence and adherence. The most endangered risk groups for non-adherence were patients aged 50–59, patients older than 80 years, patients with a longer duration of POAG, patients with care needs, and patients with three or more severe diseases in addition to glaucoma. To know the predictors responsible for an increased risk to develop POAG is of importance for all persons involved in health care management. Therefore effective strategies to increase awareness of patients and medical care personnel about non-adherence and the importance of a regular and continuous medication to avoid further nerve fiber damage and possible blindness have to be developed.
Keywords: antiglaucoma agent; adult; aged; aging; article; cohort analysis; death; disease duration; female; health care need; high risk population; human; major clinical study; male; medication compliance; multiple chronic conditions; multivariate analysis; observational study; open angle glaucoma; outcome assessment; patient compliance; prescription; prevalence; risk factor; sex difference; very elderly

Intraocular Pressure after Phacoemulsification in Open-angle Glaucoma Patients with Uncontrolled or Marginally Controlled Glaucoma and/or with Severe Visual Field Loss - Bojikian, K.D.; Chen, P.P. (Journal of Glaucoma, 2018)
Background/Aims: To evaluate intraocular pressure (IOP) after phacoemulsification in open-angle glaucoma (OAG) patients with uncontrolled or marginally controlled glaucoma and/or severe visual field (VF) loss. Patients and Methods: Retrospective case series of OAG patients without prior glaucoma surgery undergoing phacoemulsification. Uncontrolled or marginally controlled glaucoma was defined as IOP>21 mm Hg despite maximally tolerated medications or requiring >3 topical drugs for IOP control. Severe VF loss was defined as VF mean deviation ≤-12 dB. Eyes with postoperative IOP elevation were identified using 4 different definitions. Results: Of 56 eyes (56 patients), 10 eyes (17.8%) had IOP elevation ≥10 mm Hg at postoperative day 1. At 1 year (N=45), the average preoperative IOP of 14.3±3.5 mm Hg decreased to 13.8±3.6 mm Hg (P=0.312), and number of medications of 3.2±1.1 decreased to 2.8±1.2 (P=0.165). Eleven eyes (24.4%) had increase in IOP of ≥3 mm Hg, whereas 14 eyes (31.1%) had decrease of ≥3 mm Hg. Nine eyes (20.0%) had higher IOP without medication changes and 9 eyes (20.0%) required additional medications or surgery for IOP control; 3 eyes (6.7%) required trabeculectomy. Higher IOP at 1 year was associated with IOP elevation ≥10 mm Hg at postoperative week 1 (P=0.020). Conclusions: Phacoemulsification resulted in nonsignificant 1-year IOP change in OAG patients with uncontrolled or marginally controlled glaucoma and/or with severe VF loss. Although 40% of eyes had higher IOP after phacoemulsification at 1-year postoperatively, only 6.7% required trabeculectomy.
Keywords: acetazolamide; adult; aged; article; case study; cataract; disease severity; female; glaucoma; human; intraocular pressure; iridotomy; low tension glaucoma; major clinical study; male; open angle glaucoma; outcome assessment; patient compliance; phacoemulsification; postoperative period; preoperative evaluation; priority journal; retrospective study; trabeculectomy; treatment outcome; very elderly; visual field defect

Association between meibomian gland dysfunction and compliance of topical prostaglandin analogs in patients with normal tension glaucoma - Lee, T.H.; Sung, M.S.; Heo, H.; Park, S.W. (PLoS ONE, 2018)
Purpose The aim of this study was to investigate the association between tear film and meibomian gland parameters in patients with normal tension glaucoma (NTG), who underwent topical prostaglandin analog (PGA) monotherapy, and medication compliance. Methods Ocular surface disease index (OSDI), Schirmer’s test, tear film break-up time (TBUT), keratoepitheliopathy (KEP) score with fluorescein, and meibomian gland parameters were assessed in 45 eyes of 45 patients with NTG (NTG group), who received topical PGA monotherapy for more than 1 year. The results were compared to those of 40 eyes of 40 normal subjects (control group). Medication compliance was assessed by an 8-item Morisky Medication Adherence Scale (MMAS-8). Multiple logistic regression analysis was used to identify the factors associated with medication compliance. Results There was a significant difference in OSDI (P = 0.043), Schirmer’s test (P < 0.001), TBUT (P < 0.001), KEP score (P = 0.015) and all meibomian gland parameters (all P < 0.001) between two groups. When the NTG group was divided into compliant and non-compliant groups based on the scores of MMAS-8, 30 (75%) patients were classified into the compliant group. Multiple logistic regression analysis revealed that the lid margin score (OR, 0.256; 95% CI, 0.072–0.908, P = 0.035), meibum score (OR, 0.144; 95% CI, 0.023–0.915, P = 0.04), and meibo score (OR, 0.344; 95% CI, 0.140–0.845, P = 0.02) were significant factors associated with compliance in patients with NTG. The meibomian gland parameters showed a negative correlation with medication compliance (all P < 0.005). Conclusions Malfunction of the meibomian glands can be an important clinical finding associated with compliance of PGA monotherapy in patients with NTG.
Keywords: bimatoprost; fluorescein; latanoprost; prostaglandin derivative; tafluprost; 8 item morisky medication adherence scale; adult; article; clinical article; controlled study; correlational study; cross-sectional study; disease assessment; female; human; keratoepitheliopathy score; low tension glaucoma; male; medication compliance; meibomian gland dysfunction; middle aged; monotherapy; multivariate logistic regression analysis; Ocular Surface Disease Index; parameters; patient coding; patient compliance; Schirmer test; scoring system; tear film; tear break-up time; lumigan; taflotan; xalatan

Severe phenotype of keratitis-ichthyosis-deafness syndrome with presumed ocular surface squamous neoplasia - Serrano-Ahumada, A.S.; Cortes-González, V.; González-Huerta, L.M.; Cuevas, S.; Aguilar-Lozano, L.; Villanueva-Mendoza, C. (Cornea, 2018)
Purpose: The aim of this study was to describe a case of severe keratitis-ichthyosis-deafness (KID) syndrome with ocular surface squamous neoplasia. Methods: The affected patient underwent complete ocular and systemic examinations. The molecular studies included polymerase chain reaction amplification and automated DNA sequencing of the complete gap junction beta-2 (GJB2) gene coding sequence. Results: A 30-year-old man presented with generalized erythrohyperkeratosis and deafness and complaints of decreased visual acuity, tearing, and photophobia. Ophthalmic examination showed corneal erosion, vascularization, and a gray gelatinous lesion partially covering the right cornea, suggestive of squamous neoplasia. The clinical features were characteristic of KID syndrome. This diagnosis was confirmed with a DNA analysis showing the pathogenic variant p.D50N in the GJB2 gene. Presumed squamous neoplasia was treated with topical interferon α2b. Conclusions: KID syndrome is a very rare disease that has been reported with an incremental incidence of squamous cell carcinoma of the mucous membranes and skin (12%-15%). Here, we presented a case of severe systemic KID syndrome with ocular surface squamous neoplasia.
Keywords: alpha2b interferon; adult; article; case report; clinical article; cornea erosion; cornea tumor; DNA sequence; eye examination; gap junction beta 2 gene; gene; hearing impairment; human; human tissue; ichthyosis; keratitis; KID syndrome; male; medication compliance; patient compliance; photophobia; polymerase chain reaction; priority journal; rare disease; squamous cell carcinoma; visual acuity

Epidemiology and economic impact of moderate and severe neurotrophic keratopathy in Italy - Stanisic, S.; Marocco, A.; Gallo, A.; Rama, P.; Sacchetti, M.; Rolando, M.; Pocobelli, A.; Ceccuzzi, R.; Leonardi, A.; Mencucci, R.; Pedrotti, E.; Postorino, E.; et al. (Global and Regional Health Technology Assessment, 2018)
Neurotrophic keratopathy is a rare corneal disease caused by impaired corneal innervation. There is a paucity of published evidence on neurotrophic keratopathy with no published studies on the economics of neurotrophic keratopathy in the Italian or international literature. This cost analysis aimed at assessing the economic impact of moderate (persistent epithelial defect) and severe (corneal ulcer without perforation) neurotrophic keratopathy from the perspective of the National Health Service and patients in Italy. Treatment algorithm and health resource use information were collected from a panel of nine experts from Italian centres specialized in ocular/corneal conditions. National ambulatory and inpatient hospital tariffs were applied to units of service, and Agenzia Italiana del Farmaco (AIFA) published prices to pharmaceuticals. Mean annual per patient cost was derived as an average cost weighted by the proportion of patients on each respective treatment and length of the treatment. The National Health Service + patient perspective additionally included patients’ out-of-pocket expenses. The mean annual estimated National Health Service cost of treatment was €5167 (persistent epithelial defect) and €10,885 (corneal ulcer without perforation) per patient. Costs were largely driven by ambulatory visits and hospital interventions. The mean annual estimated National Health Service + patient cost was €5731 (persistent epithelial defect) and €11,478 (corneal ulcer without perforation) per patient, including cost of out-of-pocket expenses for pharmaceuticals and therapeutic contact lenses. Mean annual cost of neurotrophic keratopathy in Italy doubles with disease severity. Further research is warranted to provide more insight especially into societal costs.
Keywords: contact lens; article; cornea epithelium; cornea ulcer; cost benefit analysis; disease severity; economic aspect; health care cost; health care utilization; hospital patient; human; information processing; Italy; keratopathy; national health service; neurotrophic keratopathy; outpatient; prevalence; treatment duration

Clinical importance of puerarin for nursing of patients with glaucoma - Hao, L.; Lu, D.; Zhao, X.; Liu, X. (Biomedical Research (India), 2018)
To determine whether clinical nursing of Puerarin can improve the visual outcome for patients with primary open angle glaucoma. A total of 108 patients with primary open angle glaucoma were recruited and received treatment with Puerarin or placebo in eye drop instillation using a 5-mL plastic bottle of artificial tear solution. The visual field defect and clinical characteristics intraocular pressure, graded corneal erosion, Tear Break-Up Time (TBUT), and subjective discomfort were analyzed after treatment with Puerarin. Outcomes showed that Puerarin treatment decreased intraocular pressure and inflammation score compared to placebo group. Puerarin treatment improved graded corneal erosion, TBUT, subjective discomfort and visual acuity, glaucoma visual field defect compared to placebo group. There was no safety issues were observed in either group. Ocular hyperemia was the most common treatment-related adverse event. In conclusion, these outcomes indicate that patients receiving Puerarin maintained better treatment adherence compared with control through 6 months of on-therapy evaluation, which suggest that Puerarin may provide improved long-term therapeutic outcomes for glaucoma patients.
Keywords: plastic bottle; placebo; puerarin; adult; article; blood level; conjunctival hyperemia; controlled study; cornea erosion; disease severity assessment; drug blood level; drug efficacy; drug instillation; eye discomfort; female; headache; human; hypertension; inflammation severity score; intraocular pressure; long term care; major clinical study; male; middle aged; motion sickness; open angle glaucoma; patient compliance; sex ratio; stomach disease; treatment duration; treatment outcome; urine level; visual acuity; visual field defect; vomiting

Icare® rebound tonometers: Review of their characteristics and ease of use - Nakakura, S. (Clinical Ophthalmology, 2018)
The rebound tonometer has a unique mechanism for measuring intraocular pressure (IOP) and has become popular worldwide due to its ease of use. The most notable advantages are the lack of an air-puff and need for topical anesthesia, ease of operation and transport, and the ability to use it with children. Four rebound tonometers (Icare® TA01i, Icare PRO, Icare HOME, and Icare ic100) are currently available for clinical examination. It is important to understand the characteristics of each tonometer and select the most appropriate one because the IOP values and the purpose of measurement are different. In this review, with the goal of improving the understanding of a range of tonometers, the issues with each device are discussed.
Keywords: tonometer; aging; circadian rhythm; corneal hysteresis; corneal resistance; elasticity; glaucoma; human; illumination; intraocular pressure; measurement accuracy; measurement precision; measurement repeatability; patient compliance; patient satisfaction; prospective study; review; sensory system parameters; visual field defect; Icare TA01i

Changes in adherence and associated factors among patients on newly introduced prostaglandin analog and timolol fixed-combination therapy - Hasebe, Y.; Kashiwagi, K.; Tsumura, T.; Suzuki, Y.; Yoshikawa, K.; Suzumura, H.; Maeda, T.; Takeda, R.; Saito, H.; Araie, M. (Patient Preference and Adherence, 2018)
Purpose: We investigated patient adherence and factors related to a newly introduced prostaglandin analog and timolol fixed-combination eye drops (PGTFC). Patients and methods: The Glaucoma Research on Adherence to fixed-Combination Eye drops in Japan (GRACE) study group performed a nationwide prospective questionnaire survey. Participants in this study were patients with glaucoma who were scheduled to receive any type of PGTFC for the first time. The participants answered a questionnaire on the day of PGTFC introduction and again at a return visit 4–6 weeks after PGTFC introduction. The physicians in charge were asked to complete a separate questionnaire on the day of PGTFC introduction. One of two leaflets was randomly delivered to each participant before the description of the PGTFC. One leaflet explained how to correctly instill the eye drops, and the other explained the clinical meaning of intraocular pressure reduction in addition to explaining how to correctly instill the eye drops. Nonadherence was defined as forgetting to instill the eye drops one or more times during the week before the return visit. Results: In total, 3,597 patients (age, 68.4±12.2 years) met the study protocol requirements. PGTFC introduction significantly reduced the number of antiglaucoma eye drops from 1.93±0.78 to 1.34±0.54 (P<0.0001) and significantly improved adherence (P<0.00001). Factors significantly associated with nonadherence at the return visit included a history of nonadherence as reported by either the patient or their physician before introduction, acceptable instillation times as reported by the patient, and burdensome eye drop instillation as reported by the patient. No significant difference was observed between the two leaflets in terms of their effects on adherence. Conclusion: PGTFC significantly improved adherence and some of the factors that were significantly associated with adherence. Registration number: UMIN000013696.
Keywords: 00001369; bimatoprost plus timolol; latanoprost plus timolol; prostaglandin derivative; tafluprost plus timolol; timolol; timolol plus travoprost; aged; article; cohort analysis; combination drug therapy; drug instillation; drug utilization; female; glaucoma; human; major clinical study; male; patient attitude; patient compliance; treatment refusal

Topical medication compliance among patients with normal tension glaucoma at the saiful anwar hospital, malang - Effendi, M.M.; Aulia, N. (Annals of Tropical Medicine and Public Health, 2018)
Therapeutic compliance in normal tension glaucoma (NTG) patients remains a challenge as NTG can result in irreversible blindness. This study will provide data on medication compliance among patients with NTG, and factors associated with medication compliance.This cross-sectional observational study was performed at the Saiful Anwar Hospital (RSSA), Malang. Data on sex, distance to the hospital, marital status, employment status, living alone or not, and educational level were collected. Respondents were interviewed with the Glaucoma Treatment and Compliance Assessment Tool (GTCAT), and underwent eyedrop weighing to determine therapeutic compliance. Data analysis comprised correlations and regression tests.Data from 40 NTG patients were collected, 42.5% were men and 57.5% were women, aged 58.43 ± 12.5 years. The rate of treatment compliance was 40%. Educational level and glaucoma knowledge were significantly correlated with therapeutic compliance. Other variables which showed higher compliance rates were male gender, lives within 7.5 km from hospital, married, does not work, does not live alone, uses eye drops three times a day, good doctor and patient relationship, and does not forget to bring drugs while traveling. Many factors are associated with higher compliance rates, but only educational level and glaucoma knowledge were significantly correlated with compliance. This highlights the need for patient education to ensure better medication compliance, leading to effective NTG management.
Keywords: eye drops; adult; aged; article; blindness; clinical article; cross-sectional study; doctor patient relationship; female; Glaucoma Treatment and Compliance Assessment Tool; human; Indonesia; knowledge; low tension glaucoma; male; medication compliance; observational study; patient compliance; patient education; questionnaire; travel

Improving patient satisfaction in glaucoma care - Islam, S.; Salha, A.; Azizi, S. (Clinical Ophthalmology, 2017)
Keywords: clinical effectiveness; clinical outcome; education program; eye care; glaucoma; health care personnel; health service; human; intraocular pressure; letter; patient compliance; patient education; patient referral; patient satisfaction; primary medical care; social psychology

The Current State of Teleophthalmology in the United States - Rathi, S.; Tsui, E.; Mehta, N.; Zahid, S.; Schuman, J.S. (Ophthalmology, 2017)
Telemedicine services facilitate the evaluation, diagnosis, and management of the remote patient. Telemedicine has rapidly flourished in the United States and has improved access to care, outcomes, and patient satisfaction. However, the use of telemedicine in ophthalmology is currently in its infancy and has yet to gain wide acceptance. Current models of telemedicine in ophthalmology are largely performed via “store and forward” methods, but remote monitoring and interactive modalities exist. Although studies have examined the effects of telemedicine, few reports have characterized its current status. We perform a descriptive analysis of the current state of teleophthalmology in the United States. We describe the use of teleophthalmology in the hospital and outpatient settings. We also review the applications to retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration, and glaucoma, as well as anticipated barriers and hurdles for the future adoption of teleophthalmology. With ongoing advances in teleophthalmology, these models may provide earlier detection and more reliable monitoring of vision-threatening diseases.
Keywords: age related macular degeneration; diabetic retinopathy; emergency care; glaucoma; health care access; human; ophthalmology; outpatient care; priority journal; remote sensing; retrolental fibroplasia; review; teleconsultation; telemedicine; teleophthalmology; United States

Patient-Physician Communication on Medication Cost during Glaucoma Visits - Slota, C.; Davis, S.A.; Blalock, S.J.; Carpenter, D.M.; Muir, K.W.; Robin, A.L.; Sleath, B. (Optometry and vision science : official publication of the American Academy of Optometry, 2017)
SIGNIFICANCE: This article is the first to investigate the nature of medication cost discussions between ophthalmologists and glaucoma patients. Only 87 of the 275 office visits analyzed had a discussion of medication cost. Providers should consider discussing medication cost with patients to identify potential cost-related barriers to medication use. PURPOSE: Glaucoma is an incurable chronic eye disease affecting a growing portion of the aging population. Some of the most commonly utilized treatments require lifelong use, requiring high patient adherence to ensure effectiveness. There are numerous barriers to glaucoma treatment adherence in the literature, including cost. The aim of this secondary analysis was to describe the frequency and nature of patient-physician communication regarding medication cost during glaucoma office visits. METHODS: This was a mixed-methods secondary analysis of video-recorded participant office visits (n = 275) from a larger observational study of glaucoma communication. We analyzed medical information, demographic characteristics, and interviewer-administrated questionnaires, as well as verbatim transcripts of interviews. RESULTS: Only 87 participants discussed medication cost during their glaucoma office visit. The majority of the subjects who discussed cost had mild disease severity (51%), took one glaucoma medication (63%), and had Medicare (49%) as well as a form of prescription insurance (78%). The majority of glaucoma office visits did not discuss medication cost, and providers often did not ask about cost problems. Of the few conversations related to cost, most focused on providers offering potential solutions (n = 50), medical and prescription service coverage (n = 41), and brand or generic medication choices (n = 41). CONCLUSIONS: Our findings are similar to previous studies showing few patients have conversations with providers about the cost of glaucoma medications. Providers should consider bringing up medication cost during glaucoma office visits to prompt a discussion of potential cost-related barriers to medication use.
Keywords: antihypertensive agent; adult; aged; ambulatory care; doctor patient relationship; drug cost; economics; female; glaucoma; human; interpersonal communication; male; middle aged; ophthalmologist; patient compliance; patient participation; statistics and numerical data; very elderly

Developing a children's glaucoma passport: Mapping innovations in healthcare - Bruynseels, A.; Cross, V.; Sii, F.; Shah, P.; Abbott, J. (Eye (Basingstoke), 2017)
Keywords: consultation; glaucoma; health care management; health care system; human; note; patient compliance; self care

Prevalence and causes of blindness, visual impairment, and cataract surgery in Timor-Leste - Correia, M.; Das, T.; Magno, J.; Pereira, B.M.; Andrade, V.; Limburg, H.; Trevelyan, J.; Keeffe, J.; Verma, N.; Sapkota, Y. (Clinical Ophthalmology, 2017)
Purpose: To estimate the prevalence and causes of blindness and visual impairment, cataract surgical coverage (CSC), visual outcome of cataract surgery, and barriers to uptake cataract surgery in Timor-Leste. Method: In a nationwide rapid assessment of avoidable blindness (RAAB), the latest population (1,066,409) and household data were used to create a sampling frame which consists of 2,227 population units (study clusters) from all 13 districts, with populations of 450-900 per unit. The sample size of 3,350 was calculated with the assumed prevalence of blindness at 4.5% among people aged ≥50 years with a 20% tolerable error, 95% CI, and a 90% response rate. The team was trained in the survey methodology, and inter-observer variation was measured. Door-to-door visits, led by an ophthalmologist, were made in preselected study clusters, and data were collected in line with the RAAB5 survey protocol. An Android smart phone installed with mRAAB software was used for data collection. Result: The age-gender standardized prevalence of blindness, severe visual impairment, and visual impairment were 2.8%, (1.8-3.8), 1.7% (1.7-2.3), and 8.1% (6.6-9.6), respectively. Cataract was the leading cause of blindness (79.4%). Blindness was more prevalent in the older age group and in women. CSC was 41.5% in cataract blind eyes and 48.6% in cataract blind people. Good visual outcome in the cataract-operated eyes was 62% (presenting) and 75.2% (best corrected). Two important barriers to not using available cataract surgical services were accessibility (45.5%) and lack of attendants to accompany (24.8%). Conclusion: The prevalence of blindness and visual impairment in Timor-Leste remains high. CSC is unacceptably low; gender inequity in blindness and CSC exists. Lack of access is the prominent barrier to cataract surgery.
Keywords: smartphone; adult; age; aged; article; best corrected visual acuity; blindness; cataract; cataract extraction; central nervous system disease; cornea opacity; eye disease; female; glaucoma; health care access; human; information processing; lung tuberculosis; major clinical study; male; middle aged; observer variation; ophthalmologist; pathogenesis; prevalence; refraction error; sample size; sex ratio; Timor-Leste; treatment outcome; very elderly; visual impairment; visual system examination

Effect of latanoprost on thyroid orbitopathy - Ha, J.; Zunz, E.; Sagili, S. (Expert Review of Ophthalmology, 2017)
Background: Prostaglandin F2α analogues are known to reduce human orbital fibroblasts proliferation and adipogenesis and may be used as a potential therapy for treatment of thyroid orbitopathy. The aim of this study was to identify any beneficial effect of latanoprost on thyroid orbitopathy, in the form of reduction in proptosis, secondary to prostaglandin associated periorbitopathy. Methods: A retrospective case review of 11 patients (22 eyes) with thyroid eye disease who were using latanoprost for management of ocular hypertension. Patients receiving systemic immunosuppressants were excluded. Orbital imaging was analysed where available. A change in proptosis was analysed based on Hertel exophthalmometry. Results: Three patients (27%) had ≥ 2 mm reduction in proptosis and they all had fat predominant thyroid orbitopathy, as evident on orbital imaging. Proptosis remained unchanged or improved by less than 2mm in the rest of the patients (73%). Overall, mean pre treatment exophthalmometry was 22.4 mm (range 15–30 mm) and mean post treatment exophthalmometry was 20.6 mm (range 15–29 mm). Conclusion: Latanoprost was well tolerated in patients with thyroid orbitopathy. Objective reduction in proptosis of 2mm or more was noted in 3 patients (27%) and none of the patients had an increase in proptosis. The improvement in proptosis may be more pronounced in patients with fat predominant orbits.
Keywords: exophthalmometer; Hertel; carbimazole; latanoprost; thyroxine; adult; aged; article; clinical article; computer assisted tomography; drug tolerability; endocrine ophthalmopathy; exophthalmometry; exophthalmos; female; human; hyperthyroidism; intraocular hypertension; intraocular pressure; nuclear magnetic resonance imaging; patient compliance; smoking; visual system examination; Hertel

Management of high-risk corneal transplantation - Di Zazzo, A.; Kheirkhah, A.; Abud, T.B.; Goyal, S.; Dana, R. (Survey of Ophthalmology, 2017)
The cornea is the most commonly transplanted tissue in medicine. The main cause of corneal graft failure is allograft rejection. The incidence of graft rejection depends on the presence of high-risk characteristics, most notably corneal neovascularization. Although corneal grafting has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates because of a high incidence of immune-mediated graft rejection. To improve the survival of high-risk corneal transplantation, various preoperative, intraoperative, and postoperative measures can be considered; however, the key step in the management of these grafts is the long-term use of local and/or systemic immunosuppressive agents. Although a number of immunosuppressive agents have been used for this purpose, the results vary significantly across different studies. This is partly due to the lack of an optimized method for their use, as well as the lack of a precise stratification of the degree of risk in each individual patient. New targeted biologic treatments, as well as tolerance-inducing methods, show promising horizons in the management of high-risk corneal transplantation in near future.
Keywords: aciclovir; aflibercept; bevacizumab; corticosteroid; cyclosporine; dexamethasone; dexamethasone sodium phosphate; difluprednate; loteprednol; methylprednisolone; mycophenolate mofetil; prednisolone; prednisolone acetate; ranibizumab; rapamycin; tacrolimus; vasculotropin A; anemia; artery thrombosis; atopic keratoconjunctivitis; cataract; chronic graft versus host disease; cornea neovascularization; cornea transplantation; Cushing syndrome; cytokine release; drug withdrawal; dry eye; gastrointestinal symptom; gastrointestinal toxicity; glaucoma; graft failure; graft rejection; graft survival; graft versus host reaction; headache; human; hyperglycemia; hyperlipidemia; hypertension; immunomodulation; immunosuppressive treatment; infection; intraocular hypertension; intrastromal drug administration; leukopenia; liver toxicity; malaise; nephrotoxicity; nonhuman; osteoporosis; pathophysiology; patient compliance; penetrating keratoplasty; postoperative inflammation; preoperative care; priority journal; review; suture technique; uveitis; vernal conjunctivitis; wound healing impairment; fk 506

Reply - Rim, T.H.; Lee, S.Y.; Lee, J.S.; Kim, S.S.; Kim, C.Y. (Journal of Hypertension, 2017)
Keywords: antihypertensive agent; antihypertensive therapy; diagnostic accuracy; glaucoma; human; hypertension; incidence; letter; medication compliance; patient compliance; prescription; priority journal

Living with low vision: Strategies supporting daily activity - Smallfield, S.; Berger, S.; Hillman, B.; Saltzgaber, P.; Giger, J.; Kaldenberg, J. (Occupational Therapy in Health Care, 2017)
The purpose of this research was to describe the strategies that older adults with low vision use to support daily living. A descriptive qualitative study of 10 older adults with low vision was conducted using semistructured, audio-recorded interviews. The data was coded and grouped into categories, and the findings were summarized. Four major themes were identified: (a) device nonuse; (b) sensory strategies and devices; (c) environmental strategies; and (d) resourcefulness. Older adults with low vision try many devices and strategies to find the ones that allowthem to participate in meaningful activity within their physical and social environment. These findings support the use of a client-centered, multicomponent, problem-solving approach to low vision rehabilitation to maximize performance of daily activity despite declining vision.
Keywords: assistive technology device; aged; article; assisted living facility; assistive technology; clinical article; daily life activity; female; food processing; glaucoma; health care access; home environment; human; illumination; literacy; low vision; macular degeneration; male; problem solving; qualitative research; self care; suburban area; touch; urban area; very elderly

The CHADS2 and CHA2DS2-VASc scores for predicting healthcare utilization and outcomes: Observations on the Appropriate Use and Misuse of Risk scores - Tse, G.; Lip, G.Y.H.; Liu, T. (International Journal of Cardiology, 2017)
Keywords: aged; body mass; cerebrovascular accident; CHADS2 score; chronic kidney failure; clinical observation; clinical practice; comorbidity; congestive heart failure; coronary artery disease; editorial; female; glaucoma; health care cost; health care system; health care utilization; health service; heart failure; heart left ventricle ejection fraction; heart rate; hospital admission; hospitalization; human; hypertension; incidence; kidney function; length of stay; male; mortality; non insulin dependent diabetes mellitus; priority journal; risk factor; risk score; scoring system; systolic blood pressure; thromboembolism; transient ischemic attack; univariate analysis; vascular disease

Time to revisit the strategy of massive vitamin A prophylaxis dose administration to the under five children in India – An analysis of available evidence - Bhattacharya, S.; Singh, A. (Clinical Nutrition ESPEN, 2017)
Childhood blindness due to corneal ulceration has historically been prevalent among poor Indian children. To tackle this situation the National Institute of Nutrition (NIN), Hyderabad, India, launched (after field-testing) massive dose based national vitamin A (Vit-A) prophylaxis program. Over a period of time reduction in childhood mortality was also hailed as a beneficial effect of the program. Data from the Indian Council for Medical Research (ICMR) indicate that in most Indian states there has been a gradual reduction in the prevalence of Bitot's spots. However, it was not attributed to the prophylaxis program because of its low and patchy coverage. It was, rather, attributed to the control of malnutrition, along with measles vaccination and improvement in healthcare access. Various studies have concluded that massive dose vitamin A prophylaxis does not reduce childhood mortality; this may have been due to the Hawthorne effect; whereby beneficial effects arose from frequent contact of health workers with community members. Paradoxically, harmful effects of massive doses of Vit-A are documented, e.g. acute toxicity in certain groups of children, ranging from increased intracranial pressure, mental retardation (postnatal period), and even death. Vit-A also intensifies bone demineralization, and increased levels can lead to calcium deficiency and, hence, growth retardation in vulnerable children. According to the present authors, for children who have Bitot's spots or who have just recovered from an attack of measles, the best approach is to give Vit-A in therapeutic doses along with adequate daily intake of vegetables and fruits. Public-spirited citizens, along with the scientific community, must ensure the scrapping of the universal massive dose Vit-A prophylaxis approach, to avoid Vit-A toxicity and reduce economic burden to the health system.
Keywords: measles vaccine; retinol; acute toxicity; article; blindness; bone demineralization; bone density; calcium deficiency; childhood blindness; childhood mortality; growth retardation; health care; health care access; health insurance; human; intracranial pressure; measles vaccination; mental deficiency; public health; respiratory tract infection; systematic review; vitamin supplementation

Recurrent herpetic keratitis despite antiviral prophylaxis: A virological and pharmacological study - Rousseau, A.; Boutolleau, D.; Titier, K.; Bourcier, T.; Chiquet, C.; Weber, M.; Colin, J.; Gueudry, J.; M'Garrech, M.; Bodaghi, B.; Burrel, S.; Agut, H.; et al. (Antiviral Research, 2017)
Recurrent herpes simplex keratitis (HSK) is a leading infectious cause of blindness in industrialized countries. Antiviral prophylaxis (AVP) may fail to prevent recurrence of HSK due to viral resistance, inadequate dosing, or poor patient compliance. In this prospective multicenter study, we enrolled immunocompetent patients with recurrent HSK despite AVP. Ocular samples were tested by PCR for herpes simplex virus 1 (HSV-1). HSV-1 drug resistance was assessed with a genotypic assay based on UL23 and UL30 gene sequencing. After curative full dose valacyclovir (VACV) treatment was started, peak and trough acyclovir (ACV) plasma concentrations were measured, and patient compliance to AVP was assessed with a questionnaire. The study sample was comprised of 43 patients. Six (14%) patients were positive for HSV-1 using PCR, of whom 5 (83%) harbored genotypically ACV-resistant (ACVR) virus, due to mutations in UL23 (n = 4) or UL30 (n = 1). Disease duration was statistically significantly longer in patients with viral resistance compared to other HSK patients [35.5 ± 23.4 years (range, 6.8–68.4 years) versus 11.1 ± 12.3 years (range, 0.8–56.3 year) respectively; Mann-Whitney p = 0.01)]. While patients were treated with full dose VACV, trough ACV plasma concentrations were below the threshold for ACV sensitivity in 9.5% of cases, and compliance was poor in 5.3% of cases. To summarize, HSV-1 resistance to ACV seems to be a significant cause of failure of prophylaxis in patients with HSK and is associated with longer disease duration. Most PCR-positive samples contained genotypically ACVR virus and identification may aid in adapting treatment. Incomplete 24-h drug coverage may also explain some cases of failure of prophylaxis.
Keywords: aciclovir; valaciclovir; adult; aged; article; clinical article; disease duration; drug blood level; drug megadose; lack of drug effect; female; gene sequence; genotyping technique; herpes simplex keratitis; human; Human alphaherpesvirus 1; infection prevention; male; medication compliance; middle aged; multicenter study; patient compliance; polymerase chain reaction; priority journal; prospective study; recurrent infection; very elderly; virus mutation; virus resistance; young adult

In situ delivery of corticosteroids for treatment of oral diseases - Caro, V.D.; Sutera, F.M.; Giannola, L.I. (Therapeutic Delivery, 2017)
In many mucocutaneous disorders, corticosteroids therapy is currently central. Systemic therapy is restricted to severe disorders whereas topical applications are considered as the first-line treatment. The oral cavity environment, the medication form and other factors related to the delivery method are key factors for the therapy efficiency and effectiveness. Current marketed medications are not able to avoid wrong drug exposure and scarce patients' compliance. Innovative in situ delivery systems are able to prolong the drug retention time on the mucosa and to avoid the drawbacks of conventional formulations. This review is intended to give a general overview of oral mucocutaneous pathologies and highlight the potential of new technologies in designing innovative delivery systems able to release corticosteroids in situ for the treatment of various oral cavity disorders.
Keywords: beclomethasone dipropionate; betamethasone sodium phosphate; betamethasone valerate; carbopol 934; carboxymethylcellulose; chitosan; clobetasol propionate; corticosteroid; dexamethasone; fluocinolone acetonide; fluocinonide; fluticasone propionate; hydrocortisone sodium succinate; hydroxypropylmethylcellulose; kenacort a orabase; liposome; macrogol; macrogol 6000; magnesium stearate; mannitol; methylprednisolone; octadecylamine; phosphatidylcholine; poloxamer; povidone; prednisolone; prednisone; retinol; silymarin; triamcinolone acetonide; unindexed drug; allergic rhinitis; antiinflammatory activity; aphthous stomatitis; cataract; dose response; drug delivery system; drug efficacy; drug formulation; drug mechanism; drug potency; drug release; drug response; drug solubility; erythema chronicum migrans; erythema multiforme; film; gel; glaucoma; herpes labialis; human; immunomodulation; incidence; intraocular hypertension; lichen planus; lipodystrophy; mental disease; mouth cancer; mouth disease; mouth ulcer; mucoadhesion; mucous membrane pemphigoid; nonhuman; patient compliance; pemphigus vulgaris; periodontal disease; priority journal; psoriasis; review; systemic therapy; tablet; thrush; unspecified side effect; corlan; kenacort a orabase

Changing Initial Glaucoma Medical Therapy Increases Healthcare Resource Utilization - Trese, M.G.J.; Lewis, A.W.; Blachley, T.S.; Stein, J.D.; Moroi, S.E. (Journal of Ocular Pharmacology and Therapeutics, 2017)
Purpose: To determine the frequency and economic impact of changing initial glaucoma therapy for patients with newly diagnosed open-angle glaucoma (OAG) or ocular hypertension (OHT). Methods: This retrospective longitudinal cohort study identified individuals within a large managed care network in the United States, who were newly diagnosed with OAG or OHT from 2001 to 2012 and were prescribed either a topical beta blocker (BB) or a prostaglandin analog (PGA). Claims data were analyzed over the 12-month period following their index prescription to determine physician prescribing habits, healthcare resource utilization patterns, and sociodemographic factors which may have contributed to changing the initial treatment strategy. Results: A total of 15,019 beneficiaries were identified with newly diagnosed OAG or OHT and whose index therapy was either a topical BB or PGA. Among these enrollees 80.9% were started on PGAs, while 19.1% were started on BBs. Of these beneficiaries, 29.2% of those started on PGAs and 39.5% of those started on BBs underwent a change in therapy within 12 months of their index prescription. Those in the topical BB treatment group had a 38% increased odds of changing glaucoma therapy relative to those started on PGAs (odds ratio [OR] 0.61, 95% CI:0.56-0.68). Patients who changed therapy required more frequent office visits (P < 0.0001) and incurred higher median eye care related charges (P < 0.0001) compared to those who remained on the index therapy unchanged. Conclusions: Changing initial ocular hypotensive therapy is common. Individuals who undergo a change in therapy required more frequent face-to-face monitoring and incurred higher healthcare related costs. Identifying strategies capable of optimizing the process of initiating ocular hypotensive therapy are appealing and possess the potential to improve patient outcomes and reduce healthcare costs.
Keywords: beta adrenergic receptor blocking agent; prostaglandin derivative; adult; age; ambulatory care; article; Black person; Caucasian; clinical article; cohort analysis; drug cost; ethnicity; eye care; female; health care cost; health care utilization; Hispanic; human; income; intraocular hypertension; longitudinal study; male; managed care; middle aged; open angle glaucoma; prescription; retrospective study; sex difference; United States

Better Persistence Rates with Mirabegron: Questions Raised - Wein, A.J. (European Urology, 2017)
Keywords: angiotensin receptor antagonist; bisphosphonic acid derivative; darifenacin; eye drops; fesoterodine; hydroxymethylglutaryl coenzyme A reductase inhibitor; mirabegron; muscarinic receptor blocking agent; oral antidiabetic agent; oxybutynin; propiverine; prostaglandin derivative; solifenacin; tolterodine; age; doctor patient relationship; drug cost; drug efficacy; drug release; drug safety; editorial; gender; glaucoma; human; interpersonal communication; medication compliance; overactive bladder; patient compliance; patient education; patient satisfaction; priority journal; quality of life; treatment outcome; urinary urgency; urine incontinence

The relative burden of menopausal and postmenopausal symptoms versus other major conditions: A retrospective analysis of the medical expenditure panel survey data - Assaf, A.R.; Bushmakin, A.G.; Joyce, N.; Louie, M.J.; Flores, M.; Moffatt, M. (American Health and Drug Benefits, 2017)
BACKGROUND: The direct costs associated with menopausal and postmenopausal symptoms (hereafter “menopausal symptoms”) may include the costs of physician and emergency department visits, medications, laboratory testing, and the management of side effects. However, much remains unknown about the costs related to menopausal symptoms, including how they compare with the costs of other diseases that are common among menopausal women. OBJECTIVE: To compare the economic burden of menopausal symptoms with other select prevalent chronic conditions among a nationally representative sample of US menopausal women aged 45 to 65 years. METHODS: Women aged 45 to 65 years who have not had a hysterectomy and who participated in the 2010-2012 Medical Expenditure Panel Survey Household Component were included in the analysis. We estimated the direct costs of care associated with the management of menopausal symptoms and compared them with the direct costs of care for other indications, including osteoporosis, influenza, disorders of lipid metabolism, essential hypertension, mood disorders, esophageal disorders, headache, osteoarthritis, urinary tract infections, asthma, glaucoma, anxiety disorder, diabetes, chronic obstructive pulmonary disease/bronchiectasis, and cataract. Regression analyses were used to estimate the differences in direct costs, which included total expenditures and charges for inpatient, outpatient, and emergency department visits. RESULTS: The annual per-patient direct cost of menopausal symptoms was $248 in 2010-2012 dollars. Based on the modeled costs, menopausal symptoms were associated with significantly higher annual costs than osteoporosis, disorders of lipid metabolism, and esophageal disorders; and these annual costs were comparable to those of influenza, asthma, anxiety disorder, essential hypertension, and headache. The direct costs associated with the management of menopausal symptoms were significantly lower than the direct costs associated with osteoarthritis, mood disorders, chronic obstructive pulmonary disease/ bronchiectasis, urinary tract infections, diabetes, glaucoma, and cataract. CONCLUSION: The direct costs of care for menopausal symptoms are substantial and are similar to or greater than the direct healthcare costs associated with a number of medical conditions often requiring medical attention in menopausal women.
Keywords: adult; anxiety disorder; article; asthma; bronchiectasis; chronic obstructive lung disease; drug cost; emergency ward; essential hypertension; female; headache; health care cost; health care utilization; human; hysterectomy; menopausal syndrome; middle aged; mood disorder; osteoarthritis; osteoporosis; sensitivity analysis; urinary tract disease

Follow-up of non-complicated filtering surgeries under ambulatory care with no control at Day 1 - Jeancolas, A.L.; Conart, J.B.; Trechot, F.; Berrod, J.P.; Angioi-Duprez, K.; Maalouf, T. (Acta Ophthalmologica, 2017)
Purpose In most cases, filtering glaucoma surgery is performed as an outpatient procedure and recommendations suggest performing follow-up at least at Day 1, Day 8, Day 15 and Day 30. As many of our patients have difficulties to come to follow-up and because of the economical cost of medical transportations we decided to evaluate the results of a group of patients without clinical control at Day 1. Methods Retrospective monocentric study in the department of ophthalmology. All patients (naïve of surgical treatment for glaucoma) underwent of surgery of a primary open-angle glaucoma in an ambulatory care unit between May 2014 and July 2016. A nurse made a phone call to the patients at Day 1. Clinical controls were due at Day 5 and Day 21. In case of problems detected during the phone call, patients were examined earlier. Results One hundred and forty-four eyes (126 patients) were consecutively included in our study. The mean preoperative IOP was 20.4 ± 6.4 mmHg. After the phone call, only five patients were examined before the first planned control at Day 5. For 3 of them the examination revealed the presence of a hyphema and their topical treatment was changed. The others two patients had no medical modifications. At Day 5, the mean IOP was 10.6 ± 5.9 mmHg. Thirty-two eyes (22.2%) needed a change in their treatment at Day 5. The mean IOP at Day 21 was 12.9 ± 4.6 mmHg. Our success rate (IOP < 21 mmHg with no topical) at day 21 was 95.6%. Conclusions We replaced the Day 1 control with a phone call. We didn't notice a substantial rate of complications. The criteria of success of a filtering glaucoma surgery vary according to the different articles in the literature. Our success rate seems to be similar to those we find in the literature and may suggest that the control at Day 1 is not necessary if the surgery is not complicated.
Keywords: adult; ambulatory care; complication; female; filtering operation; follow up; human; hyphema; intraocular pressure; major clinical study; male; nurse; open angle glaucoma; ophthalmology; retrospective study; surgery; topical drug administration; topical treatment

Glaucoma medication preferences among glaucoma specialists in Mexico - Lazcano-Gomez, G.; Alvarez-Ascencio, D.; Haro-Zuno, C.; Turati-Acosta, M.; Garcia-Huerta, M.; Jimenez-Arroyo, J.; Castañeda-Diez, R.; Castillejos-Chevez, A.; Gonzalez-Salinas, R.; Dominguez-Dueñas, F.; Jimenez-Roman, J. (Journal of Current Glaucoma Practice, 2017)
Aim: To determine the glaucoma specialists’ preferences for the different brands of topical glaucoma medications available in Mexico. Materials and methods: A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice. Results: Data from 111 (74%) glaucoma specialists were collected. Imot (timolol 0.5%; Sophia, Mexico) was the preferred brand for the beta-blockers (BB) class by 71% (n = 79) of the participants. Azopt (brinzolamide 1%; Alcon Lab, US) was the preferred carbonic anhydrase inhibitor (CAI) by 54% (n = 60) of the glaucoma specialists. Lumigan (bimatoprost 0.01% and 0.03%; Allergan Inc., U.S.) was the first choice for the prostaglandin analogues (PGAs) in 62% (n = 70) of the answers. The most frequently prescribed alpha-agonist (AA) was Agglad (brimonidine 0.2%; Sophia Lab, Mexico) in 44% (n = 49) of the answers. Medication accessibility (31%), cost (29%), and recommended dose (23%) were the three main factors influencing the glaucoma specialists’ preferences. Conclusion: Medication cost and accessibility, as well as posology, remain the main factors influencing brand preferences among glaucoma doctors. In our professional opinion, the therapeutic effect must be the leading factor when prescribing topical medications in the daily practice, so that patients receive the best treatment option. Clinical significance: This survey provides an understanding of the decision-making process when prescribing glaucoma medications by glaucoma specialists in a Latin American developing country. Ideally, patient treatment should be individualized and aimed to achieve the best results possible for their specific condition.
Keywords: agglad; bimatoprost; brimonidine; brinzolamide; combigan d; imot; krytantek; timolol; article; cross-sectional study; drug cost; drug preference; glaucoma; health care access; health care cost; health insurance; health survey; human; major clinical study; medical specialist; Mexico; prescription; questionnaire; recommended drug dose; agglad; azopt; combigan d; imot; krytantek; lumigan

Understanding the reasons for loss to follow-up in patients with glaucoma at a tertiary referral teaching hospital in Korea - Kim, Y.K.; Jeoung, J.W.; Park, K.H. (British Journal of Ophthalmology, 2017)
Background/aims To assess the reasons and factors for discontinuation of follow-up among patients with glaucoma at a tertiary referral teaching hospital in Seoul, Korea. Methods We identified all adult patients with glaucoma (≥18years), who had visited the glaucoma clinic of Seoul National University Hospital between April 2012 and March 2014 and had missed an appointment by at least 12months. These patients were traced via cellular phone, and their true status and reasons for discontinuation of follow-up were documented. Results A total of 6848 patients with glaucoma (3512 men and 3336 women) were considered. Among them, 247 (3.61%) had missed a scheduled appointment by 12months or more. Among 230 (93.1%) who were successfully traced, 4 (1.7%) had died and 96 (41.7%) had self-transferred to another glaucoma clinic. Of the 130 patients left, 123 (94.6%) had treatment and follow-up interruptions, and 7 (5.4%) had been treated with alternative medicine. The two main reasons cited for treatment and follow-up interruptions were lack of understanding regarding the necessity of follow-up (46.3%) and unawareness of appointment schedule (30.9%). In stepwise linear regression analysis, older age (p=0.001. β=0.13), male gender (p=0.013, β=0.08) and lower baseline intraocular pressure (p=0.005, β=0.11) were independently associated with follow-up loss involving treatment interruptions. Conclusions This study's results emphasise the need for ongoing educational support and improved appointment notification, especially for the elderly, men and patients with low baseline intraocular pressure.
Keywords: adult; aging; alternative medicine; article; controlled study; female; follow up; glaucoma; hospital management; human; intraocular pressure; Korea; major clinical study; male; mobile phone; priority journal; sex difference; tertiary care center

Effect of oral paracetamol on intraocular pressure: a pilot study - Jampel, H.D. (Clinical and Experimental Ophthalmology, 2017)
Keywords: NCT02366065; latanoprost; paracetamol; travoprost; adult; aged; case study; circadian rhythm; clinical article; controlled clinical trial; controlled study; drug effect; female; human; intraocular hypertension; intraocular pressure; letter; male; middle aged; patient compliance; pilot study; very elderly

Reducing unmeasured confounding by frailty through restriction when estimating influenza vaccine effectiveness in older adults - Zhang, H.T.; McGrath, L.J.; Ellis, A.R.; Wyss, R.; Lund, J.L.; Stürmer, T. (Pharmacoepidemiology and Drug Safety, 2017)
Background: Unmeasured confounding by frailty may explain the exaggerated protective association between seasonal influenza vaccination and all-cause mortality prior to the influenza season reported in non-experimental studies. Since frail patients are less likely to initiate preventive drugs, restricting influenza vaccine cohorts (vaccinated and unvaccinated) to initiators of preventive drugs should reduce the prevalence of frailty and result in less confounded vaccine effect estimates. Objectives: To determine if restriction to new users of preventive drugs reduces unmeasured confounding by frailty when estimating the association between influenza vaccination and pre-influenza season mortality, a negative control outcome, in older adults. Methods: We identified U.S. Medicare beneficiaries who were ≥66 years of age on September 1, 2010, with ≥14 months of prior continuous fee-for-service Parts A, B, and D enrollment for assessment of demographics, comorbidities, healthcare use, prescription drug use, and frailty predictors. We then identified those initiating statins, anti-glaucoma drugs, or beta blockers in August 2010. We followed beneficiaries for all-cause mortality until the start of the influenza season. This process was repeated for the influenza seasons starting in 2011-2013, resulting in a cohort covering 4 influenza seasons. We used multivariable Cox proportional hazards models with a time-varying exposure to estimate adjusted hazard ratios (aHRs) for the association between influenza vaccination and all-cause mortality. Results: We followed a total of 9,210,919 beneficiaries up to a maximum of 150 days (median: 84 days). Only 47% were vaccinated while 1.6% died. We then identified 67,483 statin, 23,002 anti-glaucoma, and 51,787 beta blocker initiators. The pre-season aHR was 0.71 (95% CI: 0.70, 0.72) in the full cohort, 0.78 (0.66, 0.92) in statin initiators, 0.78 (0.58, 1.03) in anti-glaucoma initiators, and 0.62 (0.54, 0.71) in beta blocker initiators. Additional restrictions excluding use of 10 drug classes associated with increased mortality moved the aHR to 0.78 (0.47, 1.20) in statin initiators, 1.00 (0.49, 2.06) in antiglaucoma initiators, and 0.80 (0.50, 1.27) in beta blocker initiators. Conclusions: Restricting to new users of preventive drugs can reduce unmeasured confounding by frailty, but this improvement is not consistent across drug classes. Additional restrictions may further reduce unmeasured confounding by frailty.
Keywords: beta adrenergic receptor blocking agent; hydroxymethylglutaryl coenzyme A reductase inhibitor; influenza vaccine; prescription drug; aged; all cause mortality; case report; comorbidity; controlled study; drug therapy; female; frailty; glaucoma; hazard ratio; health care utilization; human; influenza vaccination; male; medicare; prevention; proportional hazards model; season

Adherencia a la dieta mediterránea en pacientes afectos de glaucoma primario de ángulo abierto - Abreu-Reyes, J.A.; Álvarez-Luis, D.; Arteaga-Hernández, V.; Sánchez-Mendez, M.; Abreu-González, R. (Archivos de la Sociedad Espanola de Oftalmologia, 2017)
Keywords: aged; diet therapy; female; human; male; Mediterranean diet; open angle glaucoma; patient compliance; self report; statistics and numerical data

Cost-effectiveness and cost utility of community screening for glaucoma in urban India - John, D.; Parikh, R. (Public Health, 2017)
Objectives Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. Study design A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. Methods Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. Results The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being Image 1, 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. Conclusions In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding), the introduction of a community screening programme for glaucoma for the 40–69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India.
Keywords: adult; aged; article; blindness; closed angle glaucoma; controlled study; cost effectiveness analysis; cost utility analysis; eye protection; follow up; glaucoma; groups by age; health care cost; human; India; open angle glaucoma; prevalence; quality adjusted life year; screening; sensitivity analysis; tertiary care center; urban area

Resource Utilization Among Glaucoma Patients in the UK Treated with Beta-Blocker and Non-Beta-Blocker Adjunctive Therapy: A Retrospective Cohort Analysis - Viswanathan, A.; Spera, C.; Mullins, A.; Covert, D.; Banhazi, J.; McDwyer, P.; Hudson, E.; Ferreira, A. (Advances in Therapy, 2017)
Introduction: Few studies have examined outcomes and potential complications among glaucoma patients who are prescribed topical beta-blockers. This study examined resource usage (number of GP visits and hospitalizations) and diagnoses of respiratory or cardiovascular conditions among glaucoma patients prescribed beta-blockers compared to patients not prescribed beta-blockers. Methods: A retrospective cohort analysis was conducted using data from the UK Clinical Practice Research Datalink (CPRD) database over the period January 1, 2006 to March 31, 2014. Adult patients with at least one diagnosis of glaucoma were categorized into beta-blocker users and non-beta-blocker users. Beta-blocker users were further separated into patients that maintained beta-blocker therapy and patients that discontinued beta-blocker treatment in year 2 of the post-index period. The CPRD data was queried directly to obtain the number of GP visits, and hospitalizations were extracted by linking the CPRD and Hospital Episode Statistics (HES) patient-level data. Results: In the 12 months after being prescribed beta-blockers, patients that later discontinued beta-blocker treatment had a significantly higher average number of hospitalizations than patients that maintained beta-blocker therapy and the non-beta-blocker users (p < 0.05). In the year after beta-blocker initiation, there was a statistically significant within-group difference pre- and post-beta-blocker initiation for all groups, but the greatest number of GP visits occurred in the patients that subsequently discontinued beta-blocker treatment (mean 19.27). Patients that discontinued beta-blocker treatment were significantly more likely to have cardiovascular events than non-beta-blocker users in the post-index period (p < 0.05). Conclusion: This study suggests that the introduction of beta-blockers in a certain group of patients who later discontinue their use is associated with increased use of medical resources (higher number of GP visits and hospitalizations) in glaucoma patients in the UK, which may be indicative of a potential relationship between use of topical beta-blockers in glaucoma therapy and adverse outcomes.
Keywords: beta adrenergic receptor blocking agent; aged; article; cardiovascular disease; Charlson Comorbidity Index; cohort analysis; controlled study; drug cost; drug withdrawal; female; glaucoma; health care utilization; hospital cost; hospitalization; human; major clinical study; male; prescription; respiratory tract disease; retrospective study; United Kingdom

A review on nanoparticle cross-linked collagen shield for sustained delivery of drug in Glaucoma - Kukkar, P.M.; Savkare, A.D.; Bhavsar, M.R.; Gholap, V.D. (International Journal of Pharmaceutical Sciences and Research, 2017)
Glaucoma is a disease of the optic nerve. Progressive damage of the optic nerve will causes irreversible reduction in visual acuity; it leads to visual field loss and blindness. The main treatment of glaucoma is the reduction of intraocular pressure. Current therapy involves frequent administration of eye drops which results in poor patient adherence and therapeutic outcomes. This review is focusing on to overcome these limitation by developing a novel nanoparticle cross-linked collagen shield for sustained delivery of suitable drug. The drug is incorporate into the shield and cross-linked by cross-linking agent with the help of Ultraviolet irradiation. Metal oxide nanoparticles is most suitable as cross-linking agent.e.g-polyvinylpyrrolidone (PVP) capped zinc oxide (ZnO/PVP).There is some evaluation parameter for nanoparticle cross-linked collagen shield like cytotoxicity as well as shield transparency. Cross-linked collagen shields characterise for their mechanical strength, swelling capacity and bioadhesive properties, ZnO/PVP NP cross-linked shields is the most favourable characteristics compare to plain film. It release drug over a period of 14 days offering a promising sustained release treatment option for glaucoma. The purpose of this review article is to provide information about novel Nanoparticle cross-linked collagen shield for sustained delivery of drug.
Keywords: acylazide; collagen; cross linking reagent; cyanamide; cyclosporine; epoxide; eye drops; formaldehyde; glutaraldehyde; hexamethylene diisocyanate; metal oxide; metal oxide nanoparticle; nanoparticle; povidone; unclassified drug; zinc oxide; collagen shield; cytotoxicity; glaucoma; human; intraocular pressure; medical device; medication compliance; nonhuman; optic nerve injury; patient compliance; review; strength; sustained drug release; treatment outcome; ultraviolet radiation; visual acuity; visual field defect; Biocora; Chiron; Irvine; MediLenso; ProshieldO

Non-adherence to eye care in people with diabetes - Murchison, A.P.; Hark, L.; Pizzi, L.T.; Dai, Y.; Mayro, E.L.; Storey, P.P.; Leiby, B.E.; Haller, J.A. (BMJ Open Diabetes Research and Care, 2017)
Objective Evaluate individual factors that impact adherence to eye care follow-up in patients with diabetes. Design and methods A 4-year retrospective chart review was conducted for 1968 patients with diabetes over age 40 from an urban academic center. Data collected included demographics, insurance, visual acuity, smoking status, medications, dates of dilated fundus examinations (DFE), and reported hemoglobin A1C and blood glucose levels. The primary outcome was timely DFE follow-up adherence following the initial eye exam visit. Results Overall, 41.6% of patients adhered to initial follow-up eye care recommendations. Multivariable analysis demonstrated that patients with severe diabetic retinopathy (DR) were more adherent than patients with mild DR (OR 1.86). Other variables associated with increased adherence were visual impairment and reported A1C or blood glucose. Smoking was associated with decreased adherence. Ethnicity and insurance were also significantly associated with adherence. Longitudinal follow-up rates were influenced by additional factors, including ethnicity and neighborhood deprivation index. Conclusions Patients with moderate to severe DR and/ or visual impairment were more likely to adhere to timely DFE follow-up. This could relate to the presence of visual symptoms and/or other systemic manifestations of diabetes. Smokers were less likely to adhere to timely DFE follow-up. One hypothesis is patients who smoke have other symptomatic health problems which patients prioritize over asymptomatic ocular disorders. In order to reduce vision loss from DR, practitioners should be aware that patients with mild and moderate DR, patients with normal vision, and smokers are at greater risk for poor follow-up eye care adherence.
Keywords: hemoglobin A1c; insulin; adult; aged; article; best corrected visual acuity; car driving; cataract; comorbidity; diabetes mellitus; diabetic retinopathy; ethnicity; eye care; female; glaucoma; glucose blood level; human; hyperlipidemia; insurance; major clinical study; male; mental health; neighborhood; patient compliance; priority journal; retrospective study; smoking; social status; visual impairment

Assessment of eye drop instillation technique in glaucoma patients - Gomes, B.F.; Paredes, A.F.; Madeira, N.; Moraes, H.V.; Santhiago, M.R. (Arquivos brasileiros de oftalmologia, 2017)
Purpose:: To study the technique of eye drop instillation in glaucoma patients and identify independent factors that may influence their performance. Methods:: In this cross-sectional study, 71 consecutive patients with glaucoma or ocular hypertension, self-administering topical anti-glaucoma medications for ≥6 months were evaluated. All patients instilled a tear substitute into the eye with the worst eyesight using the technique normally used at home. The following parameters were evaluated: age, number of years receiving treatment with ocular hypotensive eye drops, time spent to instill the first drop, number of drops instilled, correct location of the eye drops, contact of the bottle with the eye, closing of the eyelids or occlusion of the tear punctum, and asepsis of the hands. Results:: The mean age of the patients was 66 ± 10.8 years, and patients were on ocular hypotensive drugs for 11.3 ± 7.3 (range, 2-35) years. Only 28% of the patients were able to correctly instill the eye drops (squeeze out 1 drop and instill it into the conjunctival sac without bottle tip contact). Touching the tip of the bottle to the globe or periocular tissue occurred in 62% of the patients. In 49% of the patients, the eye drops fell on the eyelids or cheek. Two or more drops were squeezed by 27% of the patients. Conclusions:: The majority of glaucoma patients were unable to correctly instill eye drops. Age was an independent factor associated with eye drop instillation performance.
Keywords: eye drops; adult; age; aged; cross-sectional study; drug effect; drug instillation; evaluation study; female; glaucoma; human; intraocular hypertension; intraocular pressure; male; middle aged; patient compliance; patient education; time factor; very elderly; visual acuity

Preservative-free fixed combination of tafluprost 0.0015% and timolol 0.5% in patients with open-angle glaucoma and ocular hypertension: Results of an open-label observational study - Pillunat, L.E.; Erb, C.; Ropo, A.; Kimmich, F.; Pfeiffer, N. (Clinical Ophthalmology, 2017)
Background: Efficacy, tolerability and safety of the novel preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5% (Taptiqom®) were investigated in an observational study in Germany. Objective: To assess efficacy, tolerability and safety of the preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5% in a real-life setting. Methods: Intraocular pressure (IOP) was recorded for each eye at baseline (any previous therapy or untreated) and 4–16 weeks after changing medical treatment to or initiating treatment with the preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5%. Change in IOP was evaluated over the study period for all patients and for specific pretreatment subgroups. Clinical signs such as conjunctival hyperemia and lid-parallel conjunctival folds (LIPCOF) were recorded using standardized comparative photographs. Corneal staining, subjective symptoms and local comfort were measured using a four-step scale. All adverse events were recorded. Results: Among 1,157 patients enrolled, 1,075 patients were treated with the preservative-free fixed combination as the only medication at the final visit. Medical treatment was initiated in 741 patients because of an insufficient IOP-lowering effect of the prior medication. In 343 patients, medication was changed because of tolerability issues. The preservative-free fixed combination lowered IOP significantly in the subgroup of naïve patients, all subgroups with prior monotherapy and patients with prior fixed combinations: naïve patients: −8.9 mmHg, alpha-2-agonists: −6.4 mmHg, beta-blockers: −5.7 mmHg, carbonic anhydrase inhibitors: −5.2 mmHg, prostaglandins: −4.7 mmHg, fixed-combination prostaglandins/timolol: −2.4 mmHg. At the final visit, clinical signs and subjective symptoms were improved in patients with prior medical therapy. Local comfort was rated as “very good” or “good” by 89.1% of patients at the final visit. Only few adverse events occurred during the treatment period. Conclusion: The preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5% was effective, well tolerated and showed a good safety profile.
Keywords: alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost plus timolol; brimonidine plus brinzolamide; brimonidine plus timolol; brinzolamide plus timolol; carbonate dehydratase inhibitor; dorzolamide plus timolol; latanoprost plus timolol; miotic agent; prostaglandin; prostaglandin derivative; tafluprost plus timolol; timolol; timolol plus travoprost; adult; aged; allergy; article; asthma; blepharitis; blurred vision; burn; chemosis; conjunctiva disease; conjunctival hyperemia; corneal staining; cost; coughing; drug contraindication; drug efficacy; drug safety; drug tolerability; dry eye; epiphora; eye pain; female; Germany; hair loss; heart palpitation; human; hyperemia; intraocular hypertension; intraocular pressure; irritability; lid parallel conjunctival fold; major clinical study; male; medication compliance; monotherapy; multicenter study; muscle hypertonia; observational study; open angle glaucoma; open study; patient compliance; patient preference; prospective study; pruritus; side effect; staining; symptom; vertigo

The expanding role of the clinical pharmacist - David, F. (Prescriber, 2017)
The Clinical Pharmacy Congress held in London in May focused on the ever-growing importance of pharmacists in a variety of healthcare settings. The presentations covered a diverse range of subject areas, from tackling issues of antimicrobial resistance in urinary tract infections to the management of long-term conditions.
Keywords: amoxicillin plus clavulanic acid; anticoagulant agent; antivitamin K; beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; budesonide plus formoterol; ciprofloxacin; corticosteroid; fluticasone; fluticasone propionate plus salmeterol xinafoate; fosfomycin; low molecular weight heparin; nitrofurantoin; pivmecillinam; salbutamol; street drug; terbutaline sulfate; trimethoprim; adrenal suppression; antibiotic resistance; anticoagulant therapy; asthma; bloodstream infection; chronic disease; diabetes mellitus; drug megadose; dry powder inhaler; glaucoma; Gram negative infection; human; inappropriate prescribing; intravenous drug abuse; metered dose inhaler; mortality; note; osteoporosis; patient compliance; pharmacist; pregnant woman; primary medical care; side effect; skin disease; skin thinning; skin thinning; urinary tract infection; venous thromboembolism; bricanyl; seretide; symbicort; ventolin; Accuhaler

Distance to surgery center and graft failure in penetrating keratoplasty for keratoconus - McElhinny, E.; Fullerton, J. (Investigative Ophthalmology and Visual Science, 2017)
Purpose: To determine: 1) Do patients who live at increased distance from the surgery center have increased rates of graft failure/rejection or worse visual outcomes? 2) What factors affect graft failure? Methods: This was a retrospective chart review of Virginia Commonwealth University Hospital records from 1996-2016. Patients were identified by icd-9 coding for corneal transplant (v42.5). Statistical analysis used SPSS. This research was approved by the hospital office of research subject protection. Results: 29 patients (35 eyes) of 196 patient charts reviewed had penetrating keratoplasty (PKP) for keratoconus. 6 patients (6 eyes) had at least one failed PKP. 20 patients (23 eyes) had at least one clear PKP. Graft failure was diagnosed at average 8 months (range 1-22) and etiology of failure included spastic entropion (1), medication noncompliance (1), endothelial rejection (2), elevated intraocular pressure (1), and stromal thinning/inferior ectasia (1). Follow up in the clear graft group ranged from 12-276 months. Age and sex were not significantly different between the clear graft and graft failure groups. Average distance from surgery center was 28 miles (range 5-116) in the clear graft group and 46 miles (5-102) in the graft failure group but was not significantly different (p 0.14). All patients in the graft failure group had a previous failed PKP compared to 14% of the clear graft group (p<0.001). Patient cancellation and no show rates were not worse in the graft failure group with 50% of clear graft patients and 33% of graft failure patients having at least one cancellation. Patients who lived further from the hospital were not more likely to miss appointments. All graft failure patients had insurance, while 3 patients in the clear graft group were self pay for some of their visits. Vision in the clear graft group ranged from logMAR 0 to -3 with mode of -0.2 and 52% achieving vision of -0.3 or better, with glaucoma diagnosis for patients with the worst vision. No trend to worsening vision and further distance from surgery center was noted. Conclusions: In this population, greater distance from surgery center was not associated with graft failure or worse visual outcomes. Previous graft failure was strongly associated with repeat graft failure. Access to resources may be a more important factor in corneal transplant success than distance.
Keywords: adult; conference abstract; controlled study; data analysis software; diagnosis; entropion; female; follow up; glaucoma; graft failure; human; ICD-9; insurance; intraocular pressure; keratoconus; major clinical study; male; medical record review; patient history of transplantation; penetrating keratoplasty; research subject; retrospective study; statistical analysis; surgery; treatment failure; university hospital; vision

Shared medical appointments in glaucoma management at a Tertiary Care Eye Hospital - A randomized trial - Venkatesh, R.; Srinivasan, K.; Sonmez, N.; Buell, R.; Ramdas, K. (Investigative Ophthalmology and Visual Science, 2017)
Purpose: Glaucoma is a chronic disease and highly asymptomatic in early stages. Patients' understanding and knowledge about the disease is important to improve compliance to treatment and follow up, and also to prevent progression. Shared medical appointments (SMAs), in which patients are examined by their physician as a group, have been found to be successful in managing chronic conditions like obesity, diabetes. The primary objective of this study was to examine how SMA affects the level of patient's knowledge and satisfaction in glaucoma care provision. Methods: A prospective randomized trial involving 265 patients was conducted involving primary glaucoma on treatment for one year. Fifty-three groups of five patients were randomly assigned to either the SMA or one-on-one (control) group. While one patient in the SMA group is being examined and treated, the other 4 in the group get to listen to them. Those in the one-on-one group engage with the doctor while the other 4 patients wait outside the consultation suite. During the appointment, patients in both conditions experience an eye examination and receive recommendations from the doctor, and have the opportunity to ask questions. After their examination, patients received a survey that included questions assessing their level of knowledge about glaucoma and their satisfaction level with the experience. Results: One hundred sixty patients were randomized into the one-on-one group while 105 were recruited into the SMA group. Patients randomized in the SMA group were 12% more satisfied with their appointment experience than patients who received a one-on-one appointment (p<0.05). In addition, glaucoma knowledge scores were 5% higher amongst patients randomized to the SMA group when compared to patients attending one-on-one appointments, though the differences were not statistically significant (p=0.31). Conclusions: The results support the use of SMA in glaucoma management since it has a potential for increasing the satisfaction and knowledge level of patients. We believe, this will improve patient compliance and follow up rates, indirectly reducing the burden of glaucoma blindness.
Keywords: adult; blindness; conference abstract; consultation; controlled study; eye examination; female; follow up; human; major clinical study; male; primary glaucoma; prospective study; randomized controlled trial; satisfaction; tertiary health care

Lower levels of adherence to topical glaucoma medications are associated with increased risk of visual field progression - Fong, D.S.; Batech, M.; Mattox, C.; Luong, T.; Jimenez, J.; Campbell, J.; Chandwani, H. (Investigative Ophthalmology and Visual Science, 2017)
Purpose: To determine the effect of glaucoma medication adherence on visual field (VF) progression among newly diagnosed glaucoma patients taking intraocular pressurelowering medication. Methods: Medication utilization and visual field data were assessed for patients with newly diagnosed glaucoma who filled a prescription within 90 days of diagnosis in 2001-2011. Pharmacy dispensary records were used to determine the medication proportion of days covered (PDC) in the year prior to each visual field, and averaged over the patient's entire length of follow-up. Adherence was classified as low (0<PDC<20%), medium (20%≤PDC<80%), or high (80%≤PDC≤100%). Visual field data (mean deviation [MD]) were collected from Humphrey Visual Field machines and progression was defined as > 3 dB loss from baseline. Multivariable analysis of probability of progression included covariates measuring age, sex, race/ethnicity, baseline severity, and history of stroke or diabetic retinopathy. Results: 9,514 patients met study criteria; mean age was 66.3 years (SD = 10.8), 53.2% were male, and 30.7% White, non-Hispanic. At baseline, 38% patients had mild glaucoma (-2<MD < 2 dB); 40% moderate glaucoma (-6<MD≤-2 dB), and 15% severe glaucoma (-12<MD ≤-6 dB). Patients with moderate to severe disease severity had greater risk of progression during follow-up (RR=1.15 and 1.47, p<0.001). At the end of follow-up, 8.4% of patients had low medication adherence, 44% moderate, and 48% high adherence. Among patients with high adherence, 31% of patients progressed, compared with 34% among patients with low or moderate adherence (p<0.001). After multivariable adjustment, low and moderate adherence remained significantly associated with VF progression (low, HR: 1.45, 95% CI: 1.22-1.73; moderate, HR: 1.35, 95% CI: 1.18-1.55) compared with patients with high adherence. The difference in progression between low and moderate adherers was not significant. Conclusions: In this study, patients with low or moderate medication adherence had a greater likelihood of VF progression than patients with high medication adherence (PDC>80%). This risk persisted even after adjustment for factors such as age, sex, race/ethnicity, and baseline glaucoma severity. Additional research is needed to identify facilitators for and barriers to long-term medication adherence, particularly among patients presenting with moderate to severe glaucoma.
Keywords: age; aged; cerebrovascular accident; conference abstract; controlled study; diabetic retinopathy; diagnosis; ethnicity; female; follow up; glaucoma; human; information processing; machine; major clinical study; male; medication compliance; pharmacy (shop); prescription; probability; race; topical drug administration; visual field

A comparison of resource use and costs for patients who are newly diagnosed with exfoliation syndrome glaucoma versus primary open-angle glaucoma - Rathi, S.; Andrews, C.; Greenfield, D.S.; Stein, J.D. (Investigative Ophthalmology and Visual Science, 2017)
Purpose: The purpose of this study was to characterize differences in resource utilization patterns and health care costs for patients with incident exfoliation glaucoma (XFG) compared to primary open-angle glaucoma (POAG) in the United States. Methods: Claims data from a 20% sample of Medicare enrollees throughout the US were analyzed to identify all persons age ≥ 65 who were continuously enrolled in Medicare for ≥5 years and were newly diagnosed with POAG or PXG during 2008-2014. Persons with pre-existing POAG or XFG during a three year lookback period were excluded as well as those who had records of medical, laser, or surgical glaucoma treatment during this three year period. Persons newly diagnosed with POAG or XFG and received ≥1 confirmatory diagnosis were followed for two years. Resource utilization and costs associated with visits, diagnostic procedures, medications, cataract and incisional glaucoma surgery were captured during the two year timeframe. Results: There were 223 persons with newly diagnosed XFG (73% female) and 8366 persons with newly-diagnosed POAG (65% female) who met the inclusion criteria. Persons with POAG had slightly more office visits (mean 7.5 POAG, 6.4 XFG; p<0.001) over the first 2 years. The proportion of patients treated with glaucoma medications was greater in the POAG group (79% vs. 41%, p=0.00) while the proportion of persons undergoing laser trabeculoplasty (12.8% POAG vs. 9.8% XFG, p=0.18) and incisional glaucoma surgery (16% POAG vs. 12% XFG, p=0.11) were similar between groups. A greater proportion of persons with XFG underwent cataract surgery (25.5% vs. 18.3%, p=0.006) in the first two years. The mean total cost of care per person was higher in the XFG group ($2464 ± 2760) vs POAG ($2371 ± 2058, p=0.02). Conclusions: Newly diagnosed POAG patients utilize clinic and operative glaucoma resources more frequently compared to XFG patients. However, XFG patients have cataract surgery earlier and incur higher average costs compared to POAG patients. Further research is needed to elucidate differences in utilization and costs of care beyond initial diagnosis.
Keywords: adult; ambulatory care; cataract extraction; conference abstract; controlled study; diagnosis; diagnostic procedure; female; health care cost; human; information processing; laser; major clinical study; male; medicare; open angle glaucoma; pseudoexfoliation; trabeculoplasty; United States

Infliximab after Boston Keratoprosthesis in Stevens–Johnson Syndrome: An Update - Robert, M.; Črnej, A.; Shen, L.Q.; Papaliodis, G.N.; Dana, R.; Foster, C.S.; Chodosh, J.; Dohlman, C.H. (Ocular Immunology and Inflammation, 2017)
Purpose: To report our experience using intravenous infliximab for the treatment of tissue melt after Boston keratoprosthesis (B-KPro) types I and II in patients with autoimmune disease. Methods: Case series. Results: We identified four patients who were treated with intravenous infliximab in the context of tissue melt after B-KPro. Stevens–Johnson syndrome-associated corneal blindness was the primary surgical indication for B-KPro implantation in all patients. Two patients received a B-KPro type I and two patients received a B-KPro type II. The patients received intravenous infliximab for skin retraction around B-KPro type II, melting of the carrier graft or leak. Treatment resulted in a dramatic decrease in inflammation and, in some cases, arrest of the melting process. Cost and patient adherence were limiting factors to pursuing infliximab therapy. In addition, one patient developed infusion reactions. Conclusions: Intravenous infliximab may be considered as globe- and sight-saving therapy for tissue melt after B-KPro.
Keywords: keratoprosthesis; keratoprosthesis; acetazolamide; antifungal agent; carbonate dehydratase inhibitor; doxycycline; infliximab; methylprednisolone sodium succinate; mycophenolate mofetil; polytrim; promethazine; vancomycin; adult; aged; Ahmed valve; Alternaria; article; blindness; keratoprosthesis; case report; cornea disease; cornea melting; cornea melting; cornea tissue; cornea ulcer; cost; disease severity; drug dose reduction; drug efficacy; drug withdrawal; dry eye; eye redness; female; glaucoma; human; inflammation; infusion related reaction; intracapsular cataract extraction; keratitis; keratomycosis; keratoprosthesis; leukopenia; low drug dose; male; medical history; middle aged; ocular surface disease; patient compliance; postoperative period; reoperation; retrospective study; scar formation; Stevens Johnson syndrome; swelling; tissue necrosis; toxic epidermal necrolysis; treatment outcome; visual acuity; vitrectomy; vitritis; young adult; allergan; polytrim

Systematic review of community-engaged research in ophthalmology - Harris Nwanyanwu, K.; Grossetta Nardini, H.K.; Shaughness, G.; Nunez-Smith, M.; Newman-Casey, P.-A. (Expert Review of Ophthalmology, 2017)
Introduction: Community-engaged research (CEnR) allows researchers and community organizations to partner together to improve health outcomes and to decrease health disparities. While prevalent in other fields of medicine, it is rarely used in ophthalmology. Areas covered: A comprehensive search of Ovid MEDLINE, NLM PubMed, Ovid Embase, Scopus and the Cochrane Library for the Medical Subject Headings (MeSH) ‘Community-based participatory research’ and text word variations including participatory research, community engagement, community research, partnered research, community–institutional relations, CEnR, CBPR in addition to variations on ophthalmology, eye diseases, vision disorders and eye injuries yielded 451 unique references. Two ophthalmologists (KHN, PANC) reviewed the titles and abstracts and identified 37 relevant studies. Expert consultation yielded an additional reference. After reviewing the full texts and excluding non-English texts, 18 articles met the necessary criteria. The eighteen articles all utilized at least one of the nine principles of CEnR. Expert commentary: Ophthalmology is perfectly positioned to benefit from CEnR. Increased community engagement in ophthalmic research would expand the reach of our work and address some of the most difficult problems in vision disparities and outcomes.
Keywords: community engaged research; education program; eye care; eye irritation; glaucoma; health care access; health disparity; human; interdisciplinary communication; medical research; migrant; ophthalmology; participatory research; presbyopia; primary medical care; refraction error; review; systematic review; trust; visual impairment

Orthokeratology treatment in pediatric myopia - Nelson, L.B. (Journal of Pediatric Ophthalmology and Strabismus, 2017)
Keywords: axial measurement; child; cornea ulcer; editorial; health care access; health care cost; human; incidence; keratitis; medical literature; myopia; neurological and sensorial procedures; orthokeratology treatment; refraction error; risk benefit analysis; spherical refractive error; visual system parameters

CUA guideline on adult overactive bladder - Corcos, J.; Przydacz, M.; Campeau, L.; Gray, G.; Hickling, D.; Honeine, C.; Radomski, S.B.; Stothers, L.; Wagg, A. (Canadian Urological Association Journal, 2017)
Keywords: beta 3 adrenergic receptor stimulating agent; botulinum toxin A; cholinergic receptor blocking agent; cholinesterase inhibitor; darifenacin; fesoterodine; galantamine; herbaceous agent; mirabegron; muscarinic receptor blocking agent; oxybutynin; placebo; propiverine; solifenacin; tolterodine; trospium chloride; warfarin; abdominal pain; accommodation disorder; adult disease; aging; backache; bacteriuria; behavior therapy; bladder reconstruction; blurred vision; Canada; cardiovascular mortality; cardiovascular risk; central nervous system disease; closed angle glaucoma; cognitive defect; constipation; cystalgia; cystoscopy; daily life activity; delirium; dementia; device infection; dietary intake; dietary supplement; drug fatality; drug potentiation; drug withdrawal; dry eye; dyspepsia; dysuria; exercise; exhaustion; eye toxicity; fatigue; fluid intake; follow up; gastrointestinal symptom; headache; health care organization; heart arrhythmia; heart palpitation; heat intolerance; hematuria; human; hypertension; indwelling catheter; injection site reaction; lifestyle modification; medical history; meta analysis (topic); multicenter study (topic); nausea; nephrotoxicity; nerve stimulation; neurotoxicity; overactive bladder; patient compliance; patient education; patient isolation; pelvic floor muscle training; peripheral tibial nerve stimulation; phase 2 clinical trial (topic); phase 3 clinical trial (topic); physical activity; physical examination; postvoid residual urine volume; potentially inappropriate medication; practice guideline; prevalence; productivity; pruritus; psychological aspect; QT prolongation; quality of life; questionnaire; randomized controlled trial (topic); review; rhinopharyngitis; sacral nerve stimulation; sexuality; skin manifestation; smoking cessation; social psychology

The importance of and potential for continuous monitoring of intraocular pressure - McMonnies, C.W. (Clinical & experimental optometry, 2017)
Monitoring intraocular pressure (IOP) is a critically important part of glaucoma management; however, clinical tonometry predominantly involves sitting postures and is unable to detect variations in response to posture changes, muscular effort, deep respirations and during a wide range of activities, such as playing high wind-resistance instruments and wearing swimming goggles in addition to eye touching and rubbing. For example, the usefulness of 24-hour tonometric phasing may be increased, if nocturnal assessments included side and prone sleeping postures rather than being limited to supine posture tonometry. Continuous monitoring of IOP, which allows unrestricted involvement in a full range of sleep and non-sleep IOP elevating activities would provide an ideal method of quantifying the frequency, duration and degree of episodes of elevation in addition to physiological and pathological circadian rhythmic variations due to treatment. Apart from the degree of exposure to episodes of elevation of IOP, genetic influences and family history of glaucoma, other factors which are or could be associated with increased susceptibility to develop or progress glaucomatous pathology include age, frailty, race, type and degree of refractive error, systemic hypotension and hypertension, vasospasm, migraine, pigmentary dispersion syndrome, pseudoexfoliation syndrome, obstructive sleep apnoea syndrome, diabetes as well as medication interactions and side effects. Such information, when combined with all details relating to episodes of elevation of IOP, appears likely to be a strong basis for the detection, diagnosis and treatment of glaucoma. This review examines the limitations of methods of longitudinal monitoring of IOP with reference to their validity and the varying degrees of invasiveness involved. Also mentioned is the potential value of knowing the frequency, duration and level of variations of optic nerve subarachnoid space pressure, as the interaction of such changes with IOP and their potential influence on the lamina cribrosa, may help determine pathological significance.
Keywords: ambulatory monitoring; circadian rhythm; glaucoma; human; intraocular pressure; oculoplethysmography; pathophysiology; physiology; procedures; reproducibility

Early Experience with Technology-Based Eye Care Services (TECS): A Novel Ophthalmologic Telemedicine Initiative - Maa, A.Y.; Wojciechowski, B.; Hunt, K.J.; Dismuke, C.; Shyu, J.; Janjua, R.; Lu, X.; Medert, C.M.; Lynch, M.G. (Ophthalmology, 2017)
Purpose The aging population is at risk of common eye diseases, and routine eye examinations are recommended to prevent visual impairment. Unfortunately, patients are less likely to seek care as they age, which may be the result of significant travel and time burdens associated with going to an eye clinic in person. A new method of eye-care delivery that mitigates distance barriers and improves access was developed to improve screening for potentially blinding conditions. We present the quality data from the early experience (first 13 months) of Technology-Based Eye Care Services (TECS), a novel ophthalmologic telemedicine program. Design With TECS, a trained ophthalmology technician is stationed in a primary care clinic away from the main hospital. The ophthalmology technician follows a detailed protocol that collects information about the patient's eyes. The information then is interpreted remotely. Patients with possible abnormal findings are scheduled for a face-to-face examination in the eye clinic. Participants Any patient with no known ocular disease who desires a routine eye screening examination is eligible. Methods Technology-Based Eye Care Services was established in 5 primary care clinics in Georgia surrounding the Atlanta Veterans Affairs hospital. Main Outcome Measures Four program operation metrics (patient satisfaction, eyeglass remakes, disease detection, and visit length) and 2 access-to-care metrics (appointment wait time and no-show rate) were tracked. Results Care was rendered to 2690 patients over the first 13 months of TECS. The program has been met with high patient satisfaction (4.95 of 5). Eyeglass remake rate was 0.59%. Abnormal findings were noted in 36.8% of patients and there was >90% agreement between the TECS reading and the face-to-face findings of the physician. TECS saved both patient (25% less) and physician time (50% less), and access to care substantially improved with 99% of patients seen within 14 days of contacting the eye clinic, with a TECS no-show rate of 5.2%. Conclusions The early experience with TECS has been promising. Tele-ophthalmology has the potential to improve operational efficiency, reduce cost, and significantly improve access to care. Although further study is necessary, TECS shows potential to help prevent avoidable vision loss.
Keywords: adult; age related macular degeneration; cataract; comorbidity; conference paper; diabetic retinopathy; drusen; experience; eye care; female; follow up; glaucoma; health service; hospital; human; hypertension retinopathy; major clinical study; male; middle aged; patient satisfaction; priority journal; retina disease; screening; telemedicine; time

Adherence to Fixed-Combination Versus Unfixed Travoprost 0.004%/Timolol 0.5% for Glaucoma or Ocular Hypertension: A Randomized Trial - Barnebey, H.S.; Robin, A.L. (American Journal of Ophthalmology, 2017)
Purpose To assess adherence to treatment with fixed-combination travoprost 0.004%/timolol 0.5% (TTFC) compared with separate containers of travoprost 0.004% and timolol 0.5% (TRAV+TIM; unfixed) using electronic dosing aids. Design Randomized, controlled, observer-masked clinical trial. Methods SETTING: Two US clinical sites. PATIENT POPULATION: Eligible patients were adults diagnosed with open-angle glaucoma or ocular hypertension. Patients (n = 81) were sequentially randomized 1:1 to receive TTFC or TRAV+TIM for 12 months. INTERVENTION: TTFC was administered once daily in the morning or evening with a single dosing aid. Patients randomized to TRAV+TIM administered TRAV once daily in the evening and TIM once daily in the morning using separate dosing aids. MAIN OUTCOME MEASURE: Adherence with administered medication, as recorded by the dosing aids. Results Mean ± SD patient age was 60 ± 10 years; most patients were male and white. Compared with TRAV+TIM (n = 40), patients receiving TTFC (n = 41) were consistently adherent on a greater percentage of days through month 12 (60% vs 43%). At months 1, 3, 6, and 12, 80% adherence was achieved by 71% vs 38%, 53% vs 30%, 45% vs 16%, and 32% vs 11% of patients receiving TTFC vs TRAV+TIM, respectively. Significantly more patients were adherent on ≥80% of days with TTFC compared with TRAV+TIM (P < .001 to P = .041). Both treatments reduced IOP from baseline, and no safety issues were identified in either group. Ocular hyperemia was the most common treatment-related adverse event (n = 3/group). Conclusions Patients receiving TTFC maintained better treatment adherence compared with patients receiving TRAV+TIM through 12 months of on-therapy evaluation. This suggests that, for patients requiring multiple IOP-lowering medications, a fixed combination may provide improved long-term adherence compared with unfixed therapy.
Keywords: NCT00465803; timolol; travoprost; adult; alopecia; anemia; article; controlled study; evening dosage; eye disease; eye irritation; eye pain; female; hip arthroplasty; human; hyperemia; intraocular hypertension; intraocular pressure; major clinical study; male; medication compliance; morning dosage; open angle glaucoma; outcome assessment; patient compliance; photophobia; priority journal; randomized controlled trial; single drug dose; treatment duration; duotrav

Osteo-Odonto-Keratoprosthesis in Severe Ocular Graft versus Host Disease - Plattner, K.; Goldblum, D.; Halter, J.; Kunz, C.; Koeppl, R.; Gerber-Hollbach, N. (Klinische Monatsblatter fur Augenheilkunde, 2017)
Keywords: antifungal agent; botulinum toxin A; adult; article; best corrected visual acuity; blindness; case report; cornea disease; cornea perforation; cornea ulcer; corneal blindness; disease severity; endoprosthesis; follow up; graft versus host reaction; high myopia; human; keratoconjunctivitis sicca; keratoconus; keratomycosis; male; medical history; middle aged; mucosal flap; ocular graft versus host disease; osteo odonto keratoprosthesis; patient compliance; penetrating keratoplasty; retina hemorrhage; slit lamp; tissue flap; treatment outcome; vitreous hemorrhage

The treatment of diabetic macular oedema (DMO) in UK real-life clinical practice with ILUVIEN® (fluocinolone acetonide)–its impact on current clinical practice - Mourtzoukos, S. (Expert Review of Ophthalmology, 2017)
Keywords: NCT00344968; aflibercept; fluocinolone acetonide; ranibizumab; vasculotropin inhibitor; best corrected visual acuity; diabetic macular edema; drug cost; drug efficacy; drug safety; drug substitution; drug withdrawal; editorial; glaucoma; human; injection site reaction; intraocular hypertension; intraocular pressure; medication compliance; patient compliance; patient history of cataract surgery; patient worry; pseudophakia; quality of life; side effect; United Kingdom; iluvien

New classes of glaucoma medications - Schehlein, E.M.; Novack, G.D.; Robin, A.L. (Current Opinion in Ophthalmology, 2017)
Purpose of review To discuss recent advances in the medical management of glaucoma and to highlight future medical therapies currently in development. Recent findings In 1996, latanoprost (Xalatan) was approved in the United States as a new chemical entity and new class (prostaglandin analogs) for the topical treatment of ocular hypertension and glaucoma. In the period from the late 1990s-2010s, while there were additional new chemical entities, fixed dose combinations, and formulation improvements, there were no new classes of ocular hypotensive medications approved worldwide. We summarize new pharmacological treatments that are currently in clinical trials-new classes, new molecules and new delivery systems. Summary Although challenges in medical treatment of glaucoma exist, particularly in patient adherence, medical therapy remains the first line treatment for almost all glaucoma patients. Few new medications for glaucoma therapy are currently available for our patients, but multiple drugs with novel mechanisms of action, new formulations, and new delivery mechanisms are currently in development.
Keywords: antiglaucoma agent; bamosiran; cannabinoid derivative; drug preservative; latanoprost; latanoprost plus netarsudil; latanoprostene bunod; netarsudil; omidenepag isopropyl; ripasudil; trabodenoson; unclassified drug; drug approval; drug classification; drug delivery system; drug mechanism; glaucoma; human; intraocular hypertension; medication compliance; nonhuman; patient compliance; phase 1 clinical trial (topic); phase 2 clinical trial (topic); phase 3 clinical trial (topic); priority journal; randomized controlled trial (topic); review; topical treatment; ar 13324; de 117; glanatec; ino 8875; ono 9054; syl 040012; xalatan

Increasing healthcare costs: Can we influence the costs of glaucoma care? - Töteberg-Harms, M.; Berlin, M.S.; Meier-Gibbons, F. (Current Opinion in Ophthalmology, 2017)
Purpose of review Despite a decrease in real average growth rates per capita since 2009, healthcare costs continue to rise worldwide. Numerous patient-related and doctor-related factors have contributed to this rise. Glaucoma is the leading cause of irreversible blindness and requires chronic, usually lifelong treatment. As with other chronic diseases, the adherence to prescribed treatment is often low and maybe influenced by the cost of the therapy. The purpose of this review is to seek potential solutions to best control the escalating costs of glaucoma care. Recent findings The studies we selected for this review can be divided into four different categories: costs of diagnostic tests; costs of direct comparisons between drugs or laser and conventional surgery; patient-related factors (such as adherence); and general aspects regarding costs: Theoretical models and calculations. Summary It is challenging to find reliable studies concerning this subject matter. As patients are under the umbrellas of variously organized healthcare systems which span different cultures, the costs between countries are difficult to compare. However, one common aspect to lower costs in glaucoma care is to improve patient adherence. Theoretical models with actual patient studies could enable cost reductions by comparing multiple diagnostic and therapeutic scenarios.
Keywords: antiglaucoma agent; brimonidine plus timolol; dorzolamide plus timolol; eye drops; generic drug; latanoprost plus timolol; prescription drug; advanced glaucoma; advanced glaucoma; calculation; Canada; cataract extraction; childhood disease; comparative study; cost control; cost effectiveness analysis; demography; diagnostic imaging; diagnostic kit; diagnostic test; evaluation study; glaucoma; health care cost; health care utilization; health economics; human; intraocular hypertension; laser surgery; medicare; medication compliance; medication therapy management; optical coherence tomography device; patient compliance; prescription; priority journal; review; screening; theoretical model; trabeculoplasty; treatment refusal; United States; Heidelberg

Increased healthcare use up to 10 years among relapse-free Hodgkin lymphoma survivors in the era of intensified chemotherapy and limited radiotherapy - Glimelius, I.; Eloranta, S.; Ekberg, S.; Chang, E.T.; Neovius, M.; Smedby, K.E. (American Journal of Hematology, 2017)
With today's excellent cure rates for Hodgkin lymphoma (HL), the number of long-term survivors is increasing. This study aims to provide a global assessment of late adverse effects for working-age HL survivors treated with contemporary protocols (combination chemotherapy and limited radiotherapy). From Swedish nationwide registers we identified 1017 HL survivors diagnosed in 2000–2009, aged 18–60 years (median 32) and surviving at least one year post-diagnosis, and 4031 age-, sex-, and calendar-year-matched population comparators. Incidence rate ratios (IRR) and 95% confidence intervals (95%CI) for outpatient visits and inpatient bed-days after the first year up to 14 years post-diagnosis (through 2013) were estimated across treatment subgroups, considering relapse-free time and using negative binomial regression. Scheduled outpatient visits for HL were excluded. The rate of outpatient visits was nearly double (IRR = 1.8, 95%CI: 1.6–2.0) that among comparators and higher rates persisted up to 10 years post-diagnosis. The rate of inpatient bed-days among relapse-free survivors was more than three-fold (IRR = 3.6, 95%CI: 2.7–4.7) that of comparators and the increase persisted up to four years post-diagnosis. Patients requiring 6-8 chemotherapy courses had higher rates of outpatient visits (IRR = 1.4, 95%CI: 1.1–1.7) and bed-days (IRR = 4.7, 95%CI: 2.9–7.8) than patients treated with 2–4 courses + radiotherapy. Previously seldom reported reasons for the excess healthcare use included chest pain, keratitis, asthma, diabetes mellitus, and depression. Contemporary treatment, chemotherapy in particular, was associated with excess healthcare use among HL survivors during the first decade postdiagnosis. The reasons for healthcare visits reflected a wide range of disorders, indicating the need of broad individualized care in addition to specific screening programs.
Keywords: bleomycin; cyclophosphamide; dacarbazine; doxorubicin; etoposide; prednisone; procarbazine; vinblastine; vincristine; acute myeloid leukemia; acute stress disorder; adult; article; asthma; brain tumor; cancer chemotherapy; cancer radiotherapy; cardiovascular disease; condyloma; controlled study; depression; diabetes mellitus; dyspnea; erysipelas; female; health care utilization; herpes zoster; Hodgkin disease; hospital patient; human; Human immunodeficiency virus infection; infertility; keratitis; length of stay; lung cancer; major clinical study; male; myelodysplastic syndrome; nasopharynx tumor; outpatient care; pigmented nevus; pneumonia; postmenopause bleeding; priority journal; recurrence free survival; skin disease; Sweden; testis disease; thorax pain; thyroid disease

Author’s reply to comments to: Comparison of eyedrop instillation technique with and without a delivery device in inexperienced patients - Santhiago, M.R.; Gomes, B.F.; Moraes, H.V. (European Journal of Ophthalmology, 2017)
Keywords: eye drops; color vision defect; comparative study; eyedrop instillation technique; Food and Drug Administration; glaucoma; human; letter; medical error; medical procedures; ophthalmic drug delivery device; patient compliance; priority journal; topical treatment; Xal Ease

Preoperative characteristics and compliance with follow-up after trabeculectomy surgery in rural southern China - Yang, K.; Jin, L.; Li, L.; Zeng, S.; Dan, A.; Chen, T.; Wang, X.; Li, G.; Congdon, N. (British Journal of Ophthalmology, 2017)
Purpose To evaluate preoperative characteristics and follow-up in rural China after trabeculectomy, the primary treatment for glaucoma there. Methods Patients undergoing trabeculectomy at 14 rural hospitals in Guangdong and Guangxi Provinces and their doctors completed questionnaires concerning clinical and sociodemographic information, transportation, and knowledge and attitudes about glaucoma. Follow-up after surgery was assessed as cumulative score (1 week: 10 points, 2 weeks: 7 points, 1 month: 5 points). Results Among 212 eligible patients, mean preoperative presenting acuity in the operative eye was 6/120, with 61.3% (n=130) blind (≤6/60). Follow-up rates were 60.8% (129/212), 75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month, respectively. Patient predictors of poor follow-up included elementary education or less (OR=0.37, 95% CI 0.20 to 0.70, p=0.002), believing follow-up was not important (OR=0.62, 95% CI 0.41 to 0.94, p=0.02), lack of an accompanying person (OR=0.14, 95% CI 0.07 to 0.29, p<0.001), family annual income <US$800 (OR=0.28, 95% CI 0.11 to 0.72, p=0.008) and not requiring removal of scleral flap sutures postoperatively (OR=0.11, 95% CI 0.06 to 0.22, p<0.001). Age, sex, employment, travel distance/time/costs, patient preoperative clinical factors and physician factors were unassociated with follow-up. Conclusions Follow-up after 2 weeks was inadequate to provide optimal clinical care, and surgery is being applied too late to avoid blindness in the majority of patients. Earlier surgery, support for return visits and better explanations of the importance of follow-up are needed. Directing all patients to return for possible scleral flap suture removal may be a valid strategy to improve follow-up.
Keywords: adult; age; article; attitude to illness; blindness; China; clinical feature; controlled study; demography; educational status; employment status; female; follow up; glaucoma; hospital physician; human; income; knowledge; major clinical study; male; patient compliance; postoperative period; prediction; preoperative period; questionnaire; rural area; scoring system; sex; suture removal; suture technique; trabeculectomy; visual acuity

Outcomes of surgical interventions for primary childhood glaucoma in Northern Tanzania - Fieß, A.; Furahini, G.; Bowman, R.; Bauer, J.; Dithmar, S.; Philippin, H. (British Journal of Ophthalmology, 2017)
Aim To evaluate goniotomy, trabeculotomy, transscleral cyclophotocoagulation (TSCPC) and trabeculectomy as initial procedures in children with primary childhood glaucoma from Northern Tanzania. Methods A retrospective analysis of consecutive interventions for primary childhood glaucoma from 2000 to 2013 was conducted at the Kilimanjaro Christian Medical Centre. Success was defined as postoperative intraocular pressure (IOP) below 22 mmHg. Success rates, IOP, visual acuity (VA), subsequent interventions and potential risk factors for failure were reported for the respective interventions. Results The study included 116 eyes of 70 children (age 4.6±5.9 years) with primary childhood glaucoma; 46 (65.7%) children were male. The preoperative IOP was 33.1±10.2 mmHg, the preoperative cup/disc (CD) ratio 0.71±0.3 and the corneal diameter 13.3±1.4 mm. As a primary intervention, 61 (52.6%) eyes underwent goniotomy, 10 (8.6%) eyes trabeculotomy, 12 (10.3%) TSCPC and 33 (28.4%) trabeculectomy. Follow-up data after 12 months were available for 63 (54.3%) eyes. Success rates at 12 months were 38% (goniotomy), 30% (trabeculotomy), 17% (TSCPC) and 64% (trabeculectomy). All interventions achieved a statistically significant IOP reduction at 3, 6 and 12 months, except for trabeculotomy after 6 months and TSCPC at all time points. Postoperative endophthalmitis occurred in one child treated with trabeculectomy. VA in 82% of all eyes was maintained or had improved after 12 months. Conclusions Based on the success rates of this retrospective analysis, goniotomy or trabeculotomy for younger and trabeculectomy for older children can be recommended in our setting to reduce IOP. Late presentation in combination with advanced glaucomatous damage as well as erratic postoperative follow-up and treatment were likely factors that compromised overall success rates. More efforts are necessary to detect the blinding disease earlier and improve adherence to follow-up.
Keywords: adolescent; age; cataract; cataract extraction; child; conference paper; cornea opacity; endophthalmitis; female; follow up; glaucoma; glaucoma surgery; goniotomy; human; intermethod comparison; intraocular pressure; keratopathy; laser coagulation; major clinical study; male; postoperative period; preschool child; reoperation; retrospective study; risk factor; school child; surgical technique; Tanzania; trabeculotomy; treatment failure; treatment indication; treatment outcome; visual acuity

Cataract in the Adult Eye Preferred Practice Pattern® - Olson, R.J.; Braga-Mele, R.; Chen, S.H.; Miller, K.M.; Pineda, R.; Tweeten, J.P.; Musch, D.C. (Ophthalmology, 2017)
Keywords: lens implant; ambulatory surgery; anesthesia; anterior eye segment; anterior segment analysis system; article; biometry; calcification; calculation; capsule opacification; cataract; cataract extraction; checklist; choroid hemorrhage; clinical evaluation; clinical practice; comorbidity; cornea disease; cost effectiveness analysis; endophthalmitis; eye examination; eye toxicity; follow up; glaucoma; health care cost; health care utilization; hospital discharge; human; incision; infection prevention; intraocular pressure; intraoperative floppy iris syndrome; keratoplasty; lens capsule rupture; lens implant; lens implantation; lens luxation; managed care; mandatory reporting; medical history; meta analysis (topic); outcome assessment; patient counseling; patient referral; physician quality reporting system; posterior capsular opacification; postoperative care; postoperative complication; postoperative inflammation; practice guideline; preoperative care; primary prevention; priority journal; quality of life; randomized controlled trial (topic); refraction error; refractive surgery; retained lens fragment; retina detachment; retina macula cystoid edema; risk factor; social status; suprachoroidal hemorrhage; surgical technique; systematic review (topic); systemic disease; total quality management; toxic anterior segment syndrome; treatment contraindication; treatment indication; United States; uveitis; vision; visual acuity; visual impairment; vitreoretinal surgery

Glaucoma blindness at the end of life - Mokhles, P.; Schouten, J.S.A.G.; Beckers, H.J.M.; Azuara-Blanco, A.; Tuulonen, A.; Webers, C.A.B. (Acta Ophthalmologica, 2017)
Keywords: aging; bilateral blindness; blind death; blindness; clinical practice; cost effectiveness analysis; diagnostic test; disease association; disease course; disease severity; early diagnosis; editorial; eye care; eye examination; eye surgery; false positive result; glaucoma; glaucoma blindness; health care access; health care policy; health care quality; health care system; health insurance; health service; human; intraocular pressure; life expectancy; medical research; ophthalmologist; optic nerve; practice guideline; prevalence; prognosis; public health; quality of life; retrospective study; risk factor; terminal care; unilateral blindness; vision; visual field; visual field defect

Glaucoma: Hot topics in pharmacology - Balendra, S.I.; Shah, P.A.; Jain, M.; Grzybowski, A.; Cordeiro, M.F. (Current Pharmaceutical Design, 2017)
Background: Glaucoma comprises a group of neurodegenerative diseases resulting in retinal ganglion cell death within the optic nerve head. It is projected to affect almost 80 million people worldwide by 2020. The condition’s asymptomatic nature translates to over half of glaucoma sufferers being unaware of their condition. By the time of diagnosis, irreversible blindness is likely to have occurred. Prime areas of glaucoma research therefore include identification and optimization of risk factors for the disease, accurate and early diagnostic tools and novel therapeutic methods. Methods: The goal of this review was to summarize main areas of latest glaucoma research into risk factors of glaucoma, diagnostic tools and treatments. PubMed was used to search for terms including glaucoma risk factors, glaucoma diagnostics, glaucoma treatment, glaucoma drug delivery and glaucoma IOP. Results: The evidence for risk factors of low CSF pressure, IOP, smoking, vascular risk factors and light toxicity is described. Latest diagnostic and monitoring techniques for glaucoma include SD-OCT, DARC and IOP telemetry. Current and emerging medical and surgical treatments in glaucoma are discussed. Rho kinase inhibitors have the potential to both lower IOP and also provide neuroprotection, several of which are in clinical trials. Several other new medical treatments such as calcium channel blockers and neurotrophic agents also have the capacity to provide neuroprotection. Minimally Invasive Glaucoma Surgery (MIGS) devices provide an improved safety profile compared to traditional trabeculectomy; the latest ab interno and ab externo devices are described. Novel drug delivery methods, including punctual plugs and contact lenses, help overcome the challenges with patient adherence. Conclusion: The ultimate goals are to reduce the individual patient risk factors associated with glaucoma, diagnose the condition early and to find treatments that not only reduce IOP but also reverse neurodegeneration of RGCs. The usage of combinations of novel medical and surgical treatments may help maximize IOP reduction and neuroprotection. and neuroprotection.
Keywords: NCT02024464; calcium channel blocking agent; neuroprotective agent; neurotrophic factor; Rho kinase inhibitor; apoptosis; article; contact lens; diagnostic procedure; drug delivery system; glaucoma; glaucoma surgery; human; intraocular pressure; meta analysis (topic); minimally invasive surgery; multicenter study (topic); nerve degeneration; neuroprotection; patient compliance; patient safety; phase 2 clinical trial (topic); phototoxicity; priority journal; punctal plug; randomized controlled trial (topic); retina ganglion cell; risk factor; risk reduction; smoking; spectral domain optical coherence tomography; telemetry; trabeculectomy

Should the next step in glaucoma treatment be alternative drug therapies rather than gene therapy? - Kaufman, P.L. (Expert Review of Ophthalmology, 2017)
Keywords: beta 2 adrenergic receptor; beta 2 adrenergic receptor blocking agent; carbonate dehydratase; carbonate dehydratase inhibitor; prostaglandin F2 alpha; down regulation; editorial; gene mutation; gene therapy; glaucoma; human; intraocular pressure; nonhuman; patient compliance; protein expression; signal transduction; survival rate; upregulation

A Randomized Controlled Trial to Determine the Effect of Inhaled Corticosteroid on Intraocular Pressure in Open-Angle Glaucoma and Ocular Hypertension: The ICOUGH Study - Moss, E.B.; Buys, Y.M.; Low, S.A.; Yuen, D.; Jin, Y.-P.; Chapman, K.R.; Trope, G.E. (Journal of Glaucoma, 2017)
Purpose: The purpose of this study was to determine the risk of a steroid pressure response from inhaled corticosteroids. Patients and Methods: This randomized, double-masked, placebo-controlled trial included 22 adults with well-controlled open-angle glaucoma or ocular hypertension. Consenting participants were randomized to a 6-week course of twice-daily fluticasone propionate 250-μg metered-dose inhaler or saline placebo metered-dose inhaler. Biweekly clinic visits included masked Goldmann applanation tonometry and assessment to identify adverse effects. Primary outcome was mean intraocular pressure (IOP) at week 6. Secondary outcomes included IOP elevation of >20% at 2 consecutive visits, adherence, side effects, and logMAR visual acuity. Results: A total of 10 patients in each arm completed the study. There were no statistically significant differences in IOP between groups at baseline (14.3±3.0 and 15.6±3.6 mm Hg in steroid and placebo groups, respectively, P=0.39) or at week 6 (14.7±2.4 and 14.8±3.8 mm Hg in steroid and placebo groups, respectively, P=0.92). Adherence was >80% for all participants. There were no statistically significant differences between groups in any secondary measures. One patient in the steroid group met the secondary end point of >20% elevation in IOP (IOP increased from baseline of 9 to 11 mm Hg at weeks 2 and 4). Conclusions: We found no clinically significant increase in mean IOP in patients with well-controlled open-angle glaucoma and ocular hypertension after 6 weeks of twice-daily inhaled fluticasone propionate compared with inhaled placebo. No participants exceeded their individualized target IOP. There were no differences in secondary outcomes.
Keywords: NCT02338362; fluticasone propionate; placebo; adult; aged; clinical article; clinical study; conference paper; controlled study; disease association; drug efficacy; drug response; female; Goldmann applanation tonometer; human; intraocular hypertension; intraocular pressure; male; metered dose inhaler; oculoplethysmography; open angle glaucoma; patient compliance; randomized controlled trial; risk factor; treatment duration; very elderly; visual acuity

Long-term safety and efficacy of autologous platelet lysate drops for treatment of ocular GvHD - Pezzotta, S.; Del Fante, C.; Scudeller, L.; Rossi, G.C.; Perotti, C.; Bianchi, P.E.; Antoniazzi, E. (Bone Marrow Transplantation, 2017)
Current ocular GvHD (oGvHD) treatments are suboptimal. We investigated the safety and efficacy of long-term continuous treatment with autologous platelet lysate (PL) drops in patients with oGvHD Dry Eye Syndrome (DES) score 2-3 refractory to topical conventional therapy. Ophthalmic evaluation was performed at 6 month intervals. Symptoms were assessed using the Glaucoma Symptom Scale (GSS). Patients were defined 'responders' when showing a reduction at least one grade on National Institutes of Health Eye Score from baseline at the 6 month visit. Thirty-one patients were included, and 16 (51%) completed 36 months of follow-up (range 6.5-72.7). At 6 months all patients were classified as responders: median GSS symptom score decreased from 70 to 41 (33 at 36 months), median GSS function score reduced from 68 to 46 (33 at 36 months) (all P<0.001). Median Tear Break Up Time improved from 3 to 6 s after 6 months and was maintained over time. All signs improved at 6 and 36 months (clinical and statistical significance). No severe adverse events occurred. Long-term treatment with PL drops is secure and effective for oGvHD and can be an efficient therapy option from initial stages of oGvHD to prevent permanent ocular impairment and improving quality of life.
Keywords: artificial tear; autologous platelet lysate eye drops; unclassified drug; absence of side effects; adult; adverse outcome; article; best corrected visual acuity; clinical article; clinical trial; cohort analysis; disease exacerbation; disease severity; drug efficacy; drug safety; dry eye; female; follow up; Glaucoma Symptom Scale; graft versus host reaction; human; immunosuppressive treatment; long term care; male; ocular graft versus host disease; patient compliance; priority journal; prospective study; quality of life; questionnaire; relapse; systemic therapy; tear break-up time; visual system parameters

In Reply: - Tsoukanas, D.; Xanthopoulou, P.; Charonis, A.C.; Theodossiadis, P.; Kopsinis, G.; Filippopoulos, T. (Journal of Glaucoma, 2017)
Keywords: Ahmed valve; disease transmission; feasibility study; follow up; health care utilization; human; implantation; letter; neovascular glaucoma; penetrating keratoplasty; sclera; surgical approach; survival; tissue graft

Trends in Prevalence of Diagnosed Ocular Disease and Utilization of Eye Care Services in American Veterans - Saeedi, O.; Ashraf, H.; Slade, E.P.; Medoff, D.R.; Li, L.; Friedman, D.S.; Kreyenbuhl, J. (American Journal of Ophthalmology, 2017)
Purpose To assess trends in prevalence of diagnosed ocular disease and use of eye care services in the Veterans Affairs (VA) health care system. Design Prevalence study. Methods We performed a retrospective study of all eligible veterans in the VA Capitol Health Care Network from 2007 to 2011. The VA database was used to abstract demographic and socioeconomic variables, including age, race, sex, marital status, service connection, prescription copay, homelessness, and VA facility. Primary outcome measures were the prevalence of diagnosed ocular disease and use of eye care. Ocular diagnoses were determined by International Classification of Diseases, 9th revision codes and use by prescription medication fills, visits to eye care clinics, and cataract surgery frequency. Results The average age of veterans ranged from 59.8–60.9, most veterans were male (88.1–89.8%), and there was a high proportion of African Americans (29.5–30%). The prevalence of all ocular diagnoses increased from 20.5% in 2007 to 23.3% in 2011 (P < .01), a 13.7% increase. Similarly, the prevalence of diagnosed cataract increased by 35.7% (P = .02) from 7.1% in 2007 to 9.6% in 2011. Diagnosed glaucoma prevalence increased by 9.4% (P = .03) from 6.7 to 7.4%. The percent of patients seen in eye clinics increased 11.6%% in the 5-year study period to 24.0% in fiscal year 2011 (P = .05). The use of ophthalmic medications increased 20% (P < .01). The rate of cataract surgery did not change significantly during the study period. Conclusions The prevalence of diagnosed eye conditions among American Veterans is increasing, as is the use of eye care services. Cataract surgery rates did not increase, which may indicate a need to increase availability of these services.
Keywords: adult; African American; American; article; cataract; cataract extraction; eye care; eye disease; female; glaucoma; health care utilization; human; ICD-9; major clinical study; male; outcome assessment; prevalence; priority journal; trend study; veteran

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma: An economic evaluation based on data from the EAGLE trial - Javanbakht, M.; Azuara-Blanco, A.; Burr, J.M.; Ramsay, C.; Cooper, D.; Cochran, C.; Norrie, J.; Scotland, G. (BMJ Open, 2017)
Keywords: ISRCTN44464607; lens implant; antiglaucoma agent; aged; article; Asian; clinical article; closed angle glaucoma; controlled study; cost effectiveness analysis; economic evaluation; female; follow up; health care cost; health care utilization; human; intraocular pressure; iridotomy; laser surgery; lens implant; lens implantation; lensectomy; male; multicenter study; primary glaucoma; quality adjusted life year; randomized controlled trial; United Kingdom; visual acuity

Herpes simplex keratitis: Challenges in diagnosis and clinical management - Azher, T.N.; Yin, X.-T.; Tajfirouz, D.; Huang, A.J.; Stuart, P.M. (Clinical Ophthalmology, 2017)
Herpes simplex virus is responsible for numerous ocular diseases, the most common of which is herpetic stromal keratitis. This is a recurrent infection of the cornea that typically begins with a subclinical infection of the cornea that establishes a latent infection of sensory gan-glia, most often the trigeminal ganglia. Recurring infections occur when the virus is reactivated from latency and travels back to the cornea, where it restimulates an inflammatory response. This inflammatory response can lead to decreased corneal sensation, scarring, and blindness. The diagnosis of these lesions as the result of a recurrent herpes simplex virus infection can at times be problematic. Currently, herpetic stromal keratitis is diagnosed by its clinical presentation on the slit-lamp examination, but the literature does not always support the accuracy of these clinical findings. Other diagnostic tests such as polymerase chain reaction assay, enzyme-linked immunosorbent assay, immunofluorescent antibody, and viral cultures have provided more definitive diagnosis, but also have some limitations. That said, accurate diagnosis is necessary for proper treatment, in order to prevent serious consequences. Current treatment reduces the severity of lesions and controls further viral spread, but does not provide a cure.
Keywords: aciclovir; antivirus agent; CD4 antigen; cidofovir; corticosteroid; DNA polymerase; foscarnet; ganciclovir; idoxuridine; immunoglobulin A antibody; oxybuprocaine; placebo; rose bengal; secretory immunoglobulin; steroid; trifluridine; valaciclovir; vidarabine; virus antigen; virus DNA; amebic infection; anterior eye segment; antibody detection; antiviral activity; astigmatism; asymptomatic infection; blindness; blurred vision; CD4+ T lymphocyte; clinical examination; clinical feature; cornea disease; cornea edema; cornea epithelium; cornea necrosis; cornea opacity; cornea thickness; cornea transplantation; cornea ulcer; corneal hypoesthesia; corneal scarring; corneal scraping; cost; dendritiform epithelial lesion; diagnostic accuracy; diagnostic error; diarrhea; differential diagnosis; disciform keratitis; disease classification; disease severity; drug bioavailability; drug choice; drug megadose; drug specificity; dry eye; endothelial keratitis; endothelial keratitis; enzyme linked immunosorbent assay; epiphora; eye discharge; eye examination; eye irritation; eye pain; eye redness; eyelid reflex; false negative result; false positive result; fungal eye infection; gastrointestinal symptom; gene amplification; geographic epithelial keratitis; graft rejection; herpes simplex; herpes simplex keratitis; Herpes simplex virus; herpes zoster ophthalmicus; human; immune response; immunocompromised patient; immunofluorescence assay; immunomediated simplex keratitis; infection prevention; inflammation; intermethod comparison; iritis; lacrimal fluid; latent period; multidrug resistance; mycosis; nausea; necrotizing keratitis; neovascularization (pathology); neurotrophic keratopathy; nonhuman; ocular fibrosis; ocular pruritus; pathophysiology; patient compliance; photophobia

Systematic review of the current status of programs and general knowledge of diagnosis and management of retinoblastoma - Ramírez-Ortiz, M.A.; Lansingh, V.C.; Eckert, K.A.; Haik, B.G.; Phillips, B.X.; Bosch-Canto, V.; González-Pérez, G.; Villavicencio-Torres, A.; Etulain-González, A. (Boletin Medico del Hospital Infantil de Mexico, 2017)
Background This systematic review aims to report the current knowledge of retinoblastoma (Rb) and its implications in Mexico. We analyzed clinical and demographic data of patients with Rb at select hospitals with Rb programs or that treat and refer patients with Rb, and identified the gaps in practice. We propose solutions to improve diagnosis, provide adequate treatment, and improve patient uptake. Methods A general review was conducted on PubMed of peer-reviewed literature on Rb in Mexico. Ophthalmology Department Heads or Directors of Rb programs at seven hospitals in Mexico were contacted for data available on their patients with Rb. Results Five hospitals provided clinical data on 777 patients with Rb in a period spanning 2000-2015. Of the 122 patients with treatment, 83.4% underwent enucleation. From 33 to 45.3% of Rb tumors in Mexico reach an advanced intraocular stage of development. Knowledge of the disease is limited, despite the fact that the Mexican Retinoblastoma Group has elaborated Rb treatment guidelines and is developing a national Rb registry. Especially in the Southern states, prevalence and outcomes are comparable to African and Asian countries, and only few patients are referred to national treatment centers. Only three institutions have comprehensive Rb programs. Conclusions There is an immediate need in Mexico to expand primary care providers’ knowledge of Rb and to expand and upgrade current Rb programs to meet the needs of the population adequately. Diagnosis and care of Rb patients in Mexico can also be improved by the establishment of a national Rb registry and a national early detection program, and by increased use of the national treatment protocol.
Keywords: age; article; buphthalmos; cancer center; cancer chemotherapy; cancer registry; cancer staging; cancer therapy; childhood cancer; clinical feature; clinical protocol; continuing education; cryotherapy; delayed diagnosis; early cancer diagnosis; eye enucleation; eye pain; gender; genetic analysis; health care access; health care need; health program; human; hypopyon; low level laser therapy; Mexico; practice guideline; professional knowledge; retinoblastoma; scientific literature; systematic review; thermotherapy

Corneal transplantation in Auckland, New Zealand, 1999-2009: Indications, patient characteristics, ethnicity, social deprivation, and access to services - Crawford, A.Z.; McKelvie, J.; Craig, J.P.; McGhee, C.N.J.; Patel, D.V. (Cornea, 2017)
Purpose: To analyze characteristics and indications for corneal transplantation in patients undergoing penetrating, lamellar, and endothelial keratoplasty in Auckland, New Zealand (NZ). Methods: Corneal transplantation data from the NZ National Eye Bank and hospital records of corneal transplant recipients in the Auckland region from January 1, 2000, to December 31, 2009, were collated. Patient demographics, preoperative diagnosis, indication, ocular and medical history, visual acuity, deprivation index, and access to transplantation surgery were analyzed. Results: A total of 941 corneal transplants involving 770 patients were included for analysis. Mean age was 46 years. Age and ethnicity varied according to the transplant indication. A male preponderance and disproportionally high rates of Māori and Pacific ethnicity with a mean age of 30 years were observed in transplants for keratoconus. A total of 67.2% of corneal transplants were completed in the public health system and were associated with higher levels of deprivation than those completed in private facilities. Preoperative visual acuity varied according to the transplant type and indication. The most common clinical indication for corneal transplantation was keratoconus (41.3%), followed by repeat transplantation (21.0%). There was no significant change in the relative proportion of transplant indications in any year over the duration of this study (P = 0.41). A contralateral corneal transplant was present in 24.4% and glaucoma in 12.8% of penetrating keratoplasty recipients. Conclusions: Keratoconus is the leading indication for corneal transplantation in Auckland, NZ, and involves a disproportionately high rate of Māori and Pacific transplant recipients with a male preponderance and comparatively low mean age at the time of surgery.
Keywords: adolescent; adult; aged; article; child; cornea transplantation; deep lamellar endothelial keratoplasty; endothelial keratoplasty; ethnicity; European; female; glaucoma; graft recipient; health care access; human; Indian; keratoconus; lens implant; major clinical study; male; Maori (people); New Zealand; Pacific Islander; penetrating keratoplasty; preoperative evaluation; priority journal; public health service; reoperation; social isolation; treatment indication; visual acuity

Hyoscine butylbromide (Buscopan) versus acetaminophen for nonsurgical abdominal pain in children: A randomized controlled superiority trial - Poonai, N.; Butter, A.; Ashok, D.; Rieder, M.; Ali, S. (Canadian Journal of Emergency Medicine, 2017)
Background: Children with abdominal pain in the emergency department (ED) are at particular risk of suboptimal analgesia due to fears of missing appendicitis and absent guidelines. Many still experience pain at discharge. Acetaminophen is the most commonly used analgesic and efficacy of hyoscine butylbromide (HBB) is supported by adult evidence. However, no evidence exists for either agent in children with abdominal pain. Objective: To determine if HBB is superior to acetaminophen for abdominal pain in children. Methods: We will consecutively recruit children 8-17 years presenting to the ED with presumed non-surgical abdominal pain rated >4/10 on the Faces Pain Scale - Revised (FPS-R) and described as colicky, excluding:-Suspected appendicitis or bowel obstruction-Anticholinergic, analgesic, or antispasmodic <12 hours-Peritoneal inflammation-Unable to swallow pills-Hypersensitivity to either intervention-Medically unstable- Previous bowel obstruction, abdominal surgery, myasthenia gravis, liver disease, glaucoma, or recent abdominal trauma (<48 hours)-Toxin ingestion (<24 hours)-Vomiting-Pregnancy Randomization and allocation concealment will be pharmacy-controlled and performed using a computerized random number generator and sequentially numbered, opaque, sealed envelopes, respectively. The physician, research assistant, nurse, and participant will be blinded. Due to perceptible differences, participants will be randomized in a double-dummy approach to:- HBB 10 mg tablet + acetaminophen placebo OR-Acetaminophen 15 mg/kg liquid (maximum 975 mg) + HBB placebo. The primary outcome will be the difference from baseline on the FPS-R at 120 minutes, reflecting HBB's time to peak plasma concentration. The FPS-R has been validated in children >five years. Secondary outcomes include:-Pain scores at 15, 30, 45, 60, 80, 100, and 120 minutes postintervention (FPS-R and 100 mm visual analog scale)-Discharge pain score-Rescue analgesia-Time to achieve a 20% reduction in pain- Adverse effects-Recidivism <48 hours-Missed surgical diagnoses (National Ambulatory Care Reporting System (NACRS) database)- Caregiver satisfaction (five-item Likert scale). Using the intention to treat principle, ordinal, ratio, and categorical data will be analyzed using the Mann-Whitney, paired t-test, and Pearson's chi-square, respectively and summarized using 95% confidence intervals. Assuming a standard deviation of 2 faces, 83 children per group will be required to detect a 1-face difference at 5% significance with 90% power. Increasing by 20% equals 100 participants per group. P values <0.05 will be considered significant. An institutional audit revealed 380 eligible patients per year during research assistant availability. Given a 30% refusal rate, we expect five participants enrolled per week for 40 weeks. Importance: Our findings will guide evidence-based analgesic choices for children with non-surgical abdominal pain in the ED.
Keywords: paracetamol; placebo; scopolamine butyl bromide; toxin; abdominal injury; abdominal pain; abdominal surgery; adverse drug reaction; ambulatory care; analgesia; appendicitis; caregiver; child; clinical trial; confidence interval; controlled clinical trial; controlled study; data base; diagnosis; drug combination; drug therapy; emergency ward; Faces Pain Scale; female; glaucoma; human; human tissue; hypersensitivity; ingestion; intestine obstruction; Likert scale; liver disease; major clinical study; myasthenia gravis; nurse; pharmacy (shop); physician; pill; pregnancy; randomization; randomized controlled trial; recidivism; satisfaction; scientist; side effect; single blind procedure; statistical significance; Student t test; surgery; time to maximum plasma concentration; visual analog scale; vomiting

Adjustable Dual Muscle Speculum for Simplified Placement of a 350 Baerveldt Implant - Grover, D.S.; Fellman, R.L. (Journal of Glaucoma, 2017)
The authors have designed a muscle hook speculum that simultaneously allows the surgeon to isolate and expose both rectus muscles (either the superior and temporal or medial and inferior) for ease of placement of a 350-mm 2 Baerveldt implant. This instrument facilitates the exposure and subsequent placement of either a superior-temporal tube or an infero-nasal tube in a more independent manner. By using the dual muscle hook speculum, an individual surgeon, without a glaucoma-trained assistant, can hook typically both the superior and lateral recti muscles while gaining simultaneous exposure of the quadrant. The purpose of this report is to describe the instrument, how it is used, and how it can improve efficiency in the operating room.
Keywords: article; Baerveldt glaucoma implant; developing country; equipment design; health care access; health care cost; lateral rectus muscle; ophthalmic speculum; priority journal; professional competence; resident; superior rectus muscle; surgical technique; surgical training; United States

A case of bilateral pigment dispersion syndrome following many years of uninterrupted treatment with atropine 1% for bilateral congenital cataracts - Gizzi, C.; Mohamed-Noriega, J.; Murdoch, I. (Journal of Glaucoma, 2017)
Purpose: Describe an unusual case of bilateral pigment dispersion syndrome (PDS) following years of uninterrupted treatment with atropine 1% for bilateral congenital cataracts, speculate on potential mechanisms leading to this condition. Design: This is a case report. Case: A 45-year-old white patient on long-term treatment with atropine 1% ointment since his infancy for bilateral congenital cataracts developed PDS with secondary ocular hypertension. Results: The patient showed all the hallmarks of PDS with secondary ocular hypertension. An anterior segment Swept-Source optical coherence tomography was obtained to review the iris profile. The patient showed good pressure response to topical prostaglandin therapy. Conclusions: This is the second case report of PDS in a patient with chronic use of topical atropine. The proposed mechanisms for pigment dispersion are discussed and the possibility raised of dispersion being a potential side effect of the drug.
Keywords: optical coherence tomography device; atropine; latanoprost; prostaglandin; adult; amblyopia; anthropometric parameters; article; astigmatism; best corrected visual acuity; bilateral congenital cataract; bilateral pigment dispersion syndrome; case report; clinical article; clinical feature; congenital cataract; convergent strabismus; disc cup asymmetry; eye fundus; family history; glaucoma; gonioscopy; human; human cell; intraocular hypertension; intraocular pressure; iris; iris disease; Krukenberg spindle; long term care; male; middle aged; optic disk; optical coherence tomography; patient compliance; patient counseling; priority journal; spindle cell; trabecular meshwork; treatment duration; treatment outcome

Adherence to Follow-up Recommendations among Individuals in the Philadelphia Glaucoma Detection and Treatment Project - Hark, L.A.; Leiby, B.E.; Waisbourd, M.; Myers, J.S.; Fudemberg, S.J.; Mantravadi, A.V.; Dai, Y.; Gilligan, J.P.; Resende, A.F.; Katz, L.J. (Journal of Glaucoma, 2017)
Purpose: To evaluate rates of adherence to free follow-up eye exam appointments among participants in the Philadelphia Glaucoma Detection and Treatment Project. Patients and Methods: Ophthalmologists and testing equipment were brought directly to participants at risk for glaucoma at 43 community sites in Philadelphia. Those diagnosed with glaucoma-related pathology were recommended to return for follow-up to be reexamined on site. Rates of adherence and clinical and demographic risk factors for adherence were evaluated. Results: Five hundred thirty-one participants were diagnosed with glaucoma-related conditions and recommended to attend community-based follow-up exams. Follow-up adherence rate was 61.2% (n=325/531). Significant factors associated with greater eye exam appointment adherence, based on our univariable analysis, included final diagnosis of glaucoma (risk ratio [RR]=1.33; 95% confidence interval [CI], 1.13-1.57), male sex (RR=1.19; 95% CI, 1.04-1.36), white race (RR=1.26; 95% CI, 1.08-1.48), age (RR=1.17; 95% CI, 1.00-1.37) recommendation for glaucoma medication (RR=1.52; 95% CI, 1.35-1.71), recommendation for laser peripheral iridotomy (RR=1.18; 95% CI, 1.02-1.35), diagnosis of age-related macular degeneration (RR=1.42; 95% CI, 1.13-1.77) and an increased intraocular pressure (>22 mm Hg in the worse eye) (RR=1.23; 95% CI, 1.06-1.42). On the basis of our multivariable model, diagnosis, sex, and recommended glaucoma medications were significantly associated with follow-up adherence. Conclusions: This study demonstrates that individuals living in underserved urban communities would take advantage of free eye exams in community sites and return for follow-up eye exams in these same settings. Future studies could investigate interventions to improve eye exam appointment adherence in community-based settings to detect glaucoma-eye conditions.
Keywords: age; age related macular degeneration; aged; article; automated perimeter; controlled study; demography; eye photography; female; follow up; glaucoma; human; intraocular pressure; iridotomy; laser surgery; major clinical study; male; ophthalmologist; patient compliance; Pennsylvania; priority journal; race; retrospective study; risk assessment; risk factor; sex difference; Octopus 300 Visual Field Analyzer; Volk Pictor

Ophthalmic Timolol Hallucinations: A Case Series and Review of the Literature - Nanda, T.; Rasool, N.; Callahan, A.B.; Stamper, R.L.; Odel, J.G. (Journal of Glaucoma, 2017)
Purpose: Systemic absorption and central nervous system (CNS) penetration of timolol drops are a well-studied phenomenon, resulting in common side effects such as bradycardia, bronchospasm, fatigue, and confusion. More serious CNS side effects, such as psychosis and depression, however, are rarely attributed to eye drops. We report a case series in which patients developed visual hallucinations secondary to topical ocular timolol use. Methods: This study is a case series and review of the literature. Results: Four patients with glaucoma developed visual hallucinations while using topical timolol. The patients were all elderly, caucasian females with associated CNS pathology. All patients had resolution of symptoms upon discontinuation and a positive retrial test to confirm the association. Conclusions: The rarity of this side effect and its anecdotal predilection for elderly, caucasian females with underlying neurological dysfunction, may involve a yet unknown predisposition or hypersensitivity to beta blocker action, such as blood brain barrier disruption leading to increased susceptibility to the medication. This case series highlights an important, although rare, side effect of this medication which clinicians should be aware of especially when using it in elderly patients who may have coexisting CNS pathology. It is important that this side effect be recognized and appropriately managed to prevent otherwise unnecessary investigations and treatment.
Keywords: dorzolamide; epinephrine; latanoprost; pilocarpine; timolol; aged; Alzheimer disease; case report; case study; cataract; cataract extraction; Caucasian; clinical article; confusion; dementia; drug dose reduction; drug substitution; drug withdrawal; female; follow up; glaucoma; glaucoma surgery; human; intraocular pressure; medical history; multiple sclerosis; paranoia; patient compliance; priority journal; review; very elderly; visual hallucination

Trabeculectomy or Transscleral Cyclophotocoagulation as Initial Treatment of Secondary Childhood Glaucoma in Northern Tanzania - Fieß, A.; Shah, P.; Sii, F.; Godfrey, F.; Abbott, J.; Bowman, R.; Bauer, J.; Dithmar, S.; Philippin, H. (Journal of Glaucoma, 2017)
Purpose: The purpose is to describe the outcome of trabeculectomy with transscleral cyclophotocoagulation (TSCPC) as an initial intervention for secondary childhood glaucoma in Northern Tanzania. Methods: A retrospective, consecutive case series was analyzed of all children with secondary childhood glaucoma who underwent initial trabeculectomy or TSCPC between 2000 and 2013 at a referral eye unit in Northern Tanzania. Retrospective data were collected on causes of glaucoma, intraocular pressure (IOP), visual acuity, complications, and subsequent interventions. Outcomes were evaluated using Kaplan-Meier survival analysis and compared with Cox regression analysis. The main outcome measure was failure (IOP>21 mm Hg). Results: Thirty-six eyes of 27 children (male, 21; median age, 9 y; range, 0.3 to 15 y) with secondary childhood glaucoma underwent trabeculectomy (19 eyes, 53%) or TSCPC (17 eyes, 47%). Causes included ocular trauma (13, 36%), previous cataract surgery (12, 33%), congenital aniridia (5, 14%), Sturge-Weber syndrome (2, 6%), steroid-induced glaucoma (2, 6%), uveitis (1, 3%), and unspecified leucoma (1, 3%). After 12 months, success was achieved in 48% after trabeculectomy and 18% after TSCPC, with visual acuity remaining unchanged in 11 of 14 (79%) and 4 of 5 eyes (80%), respectively. One third of the children did not return for follow-up after 1 year. Distance to the hospital (>100 km) was a significant risk factor for trabeculectomy failure (P=0.031). Conclusions: A high proportion of secondary childhood glaucoma in Northern Tanzania was caused by trauma and previous cataract surgery. Trabeculectomy was associated with better IOP control but also a higher complication rate. The ability to maintain visual function was comparable after both interventions. Failure was associated with a journey to the eye hospital (>100 km) possibly leading to late presentation with advanced disease and erratic follow-up.
Keywords: cyclopentolate; dexamethasone; ofloxacin; steroid; aniridia; case study; cataract extraction; child; clinical article; conference paper; controlled study; disease severity; endophthalmitis; eye injury; female; health care access; human; intraocular pressure; laser coagulation; male; preschool child; priority journal; retrospective study; risk factor; secondary glaucoma; Sturge Weber syndrome; survival rate; Tanzania; trabeculectomy; treatment failure; treatment outcome; uveitis; visual acuity; vitrectomy

Evaluating the Quality of Life of Glaucoma Patients Using the State-Trait Anxiety Inventory - Otori, Y.; Takahashi, G.; Urashima, M.; Kuwayama, Y. (Journal of Glaucoma, 2017)
Purpose: To evaluate anxiety felt by glaucoma patients. Patients and Methods: In total, 472 glaucoma patients responded to a questionnaire on anxiety, subjective symptoms, and vision-related quality of life (VR-QOL) associated with glaucoma. Anxiety was evaluated using the State-Trait Anxiety Inventory (STAI), state anxiety (STAI-State) subscale along with our novel questionnaire, assessing visual function and subjective symptoms, specialized for glaucoma. VR-QOL was evaluated using 5 subitems from the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). Adherence to ophthalmic antiglaucoma agents was confirmed. As indexes of visual function, corrected visual acuity (measured by eye chart), mean deviation (MD) score (measured with static perimetry), and 4 thresholds at the center of vision were determined. Stages were classified according to the Aulhorn Classification. From the STAI-State scores, the prevalence of anxiety in glaucoma patients was evaluated. We analyzed the correlation between the STAI-State and VFQ-25, anxiety, subjective symptoms, adherence, and visual function indexes. Results: In total, 78% of glaucoma patients experienced at least an intermediate level of anxiety. The STAI-State correlated significantly with anxiety and subjective symptoms as measured by our novel questionnaire, particularly for questions "current anxiety about loss of vision" and "current anxiety in life" (r=0.468 and 0.500; both P<0.0001). However, STAI-State correlated weakly with VFQ-25, and not at all with visual function indexes and adherence. Conclusions: Many glaucoma patients feel anxiety. The STAI-State is correlated with the VR-QOL and anxiety in glaucoma patients, making it useful for understanding the anxiety present in glaucoma patients.
Keywords: antiglaucoma agent; adult; aged; anxiety; article; closed angle glaucoma; female; glaucoma; human; Japanese (people); major clinical study; male; medication compliance; National Eye Institute Visual Function Questionnaire; open angle glaucoma; patient compliance; prevalence; priority journal; quality of life; secondary glaucoma; State Trait Anxiety Inventory; visual acuity

Comparisons of Self-reported Glaucoma Medication Adherence with a New Wireless Device: A Pilot Study - Gatwood, J.D.; Johnson, J.; Jerkins, B. (Journal of Glaucoma, 2017)
Purpose: To compare use of topical medications between a wireless monitoring device and validated self-reported measures of glaucoma medication adherence. Patients and Methods: This study involved adults from a group ophthalmology practice diagnosed with and being medicinally treated for glaucoma who were not scheduled for a surgery during the study period. Subjects were required to use a new wireless device to dispense their glaucoma medication for 2 months, and were surveyed at baseline and immediately following the study to assess mobile phone use, glaucoma-related self-efficacy, and medication adherence. Results: Complete data (survey and accurate device recordings) were available for 23 subjects at both baseline and endpoint. Median adherence, as measured by the device, was 82% and dropped slightly between 30-day periods, from 83% to 77%. Similarly, the percent adherent (dosing at least 75% of the time) dropped significantly between months according to both the device (78.3% and 52.2%) and a self-reported measure (63% and 56%). Kappa statistics indicated low agreement between the device and self-report when classifying adherent status. A majority of subjects interviewed found the device easy to use, indicated that it did not interfere with medication-taking or normal activities, and were not bothered by their physician knowing when medication was dispensed. Conclusion: In this pilot, nearly all Kali Drop devices performed as expected, providing real-time data on medication use over a 60-day period. Data suggested that self-reported and electronic estimates of glaucoma medication use differ, but additional testing of this new device is needed to corroborate the data observed.
Keywords: Kali Drop; mobile phone; monitor; antiglaucoma agent; aged; article; clinical article; cohort analysis; controlled study; female; glaucoma; human; intermethod comparison; male; medication compliance; patient compliance; pilot study; priority journal; prospective study; self concept; self report; wireless monitoring device; Kali Drop

A case of peripheral ulcerative keratitis associated with autoimmune hepatitis - Eshraghi, H.; Mahtabfar, A.; Dastjerdi, M.H. (Case Reports in Medicine, 2017)
Purpose. To describe a case of peripheral ulcerative keratitis in the setting of autoimmune hepatitis and possible overlap syndrome with primary sclerosing cholangitis. Case Report. A 48-year-old African American female with autoimmune hepatitis with possible overlap syndrome with primary sclerosing cholangitis presented with tearing, irritation, and injection of the left eye that was determined to be peripheral ulcerative keratitis. The patient was treated with topical and systemic steroids, immunosuppressant drugs (azathioprine and mycophenolate mofetil), a biologic (rituximab), and surgery (conjunctival resection), and the peripheral ulcerative keratitis epithelialized but ultimately led to corneal perforation. Conclusion. In this unique case, a patient with peripheral ulcerative keratitis who underwent treatment ultimately had a corneal perforation. This case may suggest a possible relationship between autoimmune hepatitis and peripheral ulcerative keratitis.
Keywords: slit lamp; artificial tear; azathioprine; doxycycline; methylprednisolone; methylprednisolone sodium succinate; moxifloxacin; mycophenolate mofetil; prednisolone acetate; prednisone; rituximab; steroid; adult; article; autoimmune hepatitis; case report; clinical article; conjunctiva; cornea perforation; cornea ulcer; disease association; disease exacerbation; endoscopic retrograde cholangiopancreatography; epithelization; eye irritation; eye redness; eye surgery; female; human; intraocular pressure; keratitis; middle aged; patient compliance; patient monitoring; peripheral ulcerative keratitis; primary sclerosing cholangitis; tear flow; visual acuity

The role of oral co-trimoxazole in treating Nocardia farcinica keratitis: a case report - Sharma, N.; O’Hagan, S. (Journal of Ophthalmic Inflammation and Infection, 2016)
Nocardia farcinica is one of the more recently identified species of the Nocardia genus. Nocardia farcinica keratitis is a rare occurrence, with only eight previously reported cases. Semi-permeable rigid contact lens use was associated with one of these reported cases. We report the first case of an extended wear soft contact lens-related Nocardia farcinica keratitis and recommend a new treatment regime. A 47-year-old lady presented with a right eye keratitis after wearing her extended wear soft contact lenses for five continuous weeks. There was no history of trauma or swimming with contact lenses in. Empirical ciprofloxacin and tobramycin eye drops were not tolerated due to ocular surface irritation on application, and instead, empirical treatment was with chloramphenicol and fortified gentamicin 1.5 % eye drops. Corneal scrapings grew Nocardia farcinica after 3 weeks—sensitive to amikacin and co-trimoxazole. Treatment was changed to amikacin 2.5 % eye drops, resulting in partial resolution of the corneal infiltrates. Oral co-trimoxazole 160 mg/800 mg BD was added, due to cultured drug sensitivity and its high ocular penetration, with good results and a final right eye best-corrected visual acuity of 6/5. Nocardia farcinica keratitis should be considered in the differential diagnosis of contact lens-related keratitis. We report the first case occurring in association with extended wear soft contact lenses. Nocardia species can mimic fungal and acanthamoeba keratitis. Treatment with oral co-trimoxazole has not been previously reported. This case demonstrates the role of co-trimoxazole in treating Nocardia farcinica keratitis based on cultured drug sensitivities.
Keywords: extended wear contact lens; amikacin; atropine; cefalotin; chloramphenicol; ciprofloxacin; cotrimoxazole; gentamicin; homatropine; prednisolone acetate; tobramycin; adult; anterior eye chamber; antibiotic resistance; antibiotic sensitivity; antibiotic therapy; bacterial growth; bacterial keratitis; bacterium detection; blepharospasm; case report; Caucasian; cornea edema; cornea epithelium; cornea stroma; corneal biopsy; device infection; drug dose increase; drug dose reduction; drug substitution; drug withdrawal; extended wear contact lens; eye discomfort; eye examination; eye irritation; eye pain; eye redness; female; human; intraocular pressure; letter; microscopy; middle aged; Nocardia farcinica; Nocardia farcinica keratitis; nocardiosis; ocular surface disease; patient compliance; photophobia; priority journal; retreatment; scar; treatment duration; treatment response; visual acuity; vitreous body

Application of lipid nanoparticles to ocular drug delivery - Battaglia, L.; Serpe, L.; Foglietta, F.; Muntoni, E.; Gallarate, M.; Del Pozo Rodriguez, A.; Solinis, M.A. (Expert Opinion on Drug Delivery, 2016)
Introduction: Although eye drops are widely used as drug delivery systems for the anterior segment of the eye, they are also associated with poor drug bioavailability due to transient contact time and rapid washout by tearing. Moreover, effective drug delivery to the posterior segment of the eye is challenging, and alternative routes of administration (periocular and intravitreal) are generally needed, the blood–retinal barrier being the major obstacle to systemic drug delivery. Areas covered: Nanotechnology, and especially lipid nanoparticles, can improve the therapeutic efficiency, compliance and safety of ocular drugs, administered via different routes, to both the anterior and posterior segment of the eye. This review highlights the main ocular barriers to drug delivery, as well as the most common eye diseases suitable for pharmacological treatment in which lipid nanoparticles have proved efficacious as alternative delivery systems. Expert opinion: Lipid-based nanocarriers are among the most biocompatible and versatile means for ocular delivery. Mucoadhesion with consequent increase in pre-corneal retention time, and enhanced permeation due to cellular uptake by corneal epithelial cells, are the essential goals for topical lipid nanoparticle delivery. Gene delivery to the retina has shown very promising results after intravitreal administration of lipid nanoparticles as non-viral vectors.
Keywords: aciclovir; antibiotic agent; antifungal agent; antivirus agent; chloramphenicol; gatifloxacin; itraconazole; ketoconazole; levofloxacin; lipid; nanoparticle; tobramycin; anatomy; anterior eye segment; antibiotic therapy; conjunctivitis; cornea disease; cornea injury; drug delivery system; eye; eye disease; eye infection; eye inflammation; glaucoma; human; nanotechnology; nonhuman; oxidative stress; patient compliance; physiology; posterior eye segment; retina disease; review; safety; visual disorder; wound healing

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