The clinical utility of dynamic contour tonometry and ocular pulse amplitude - Weizer, J.S.; Asrani, S.; Stinnett, S.S.; Herndon, L.W. (Journal of Glaucoma, 2007)
PURPOSE: To determine if ocular pulse amplitude (OPA) as measured by dynamic contour tonometry (DCT) is related to severity of glaucoma, and if intraocular pressure (IOP) as measured by DCT is related to central corneal thickness (CCT). METHODS: Patients were selected from the Duke Eye Center glaucoma clinic. Fifty-five eyes of 32 patients were included; right and left eyes were analyzed separately. CCT, OPA, DCT IOP, Goldmann applanation tonometry (GAT), Tonopen applanation tonometry (TAT), and systemic blood pressure were measured. Advanced Glaucoma Intervention Study score and mean deviation of visual field, and vertical and horizontal cup-disc ratios were recorded in a masked manner. Descriptive statistics were obtained, and OPA, DCT IOP, GAT, and TAT underwent univariate analyses to assess for relationships with predictor variables. RESULTS: OPA, DCT IOP, GAT, and TAT were positively associated with CCT and with having no surgical intervention for right and left eyes, and were negatively associated with vertical and horizontal cup-disc ratios. CONCLUSIONS: Increased OPA seems to correlate with less severe glaucoma and with increased CCT. DCT IOP seems to be affected by CCT along with GAT and TAT. © 2007 Lippincott Williams & Wilkins, Inc.
Keywords: aged; article; blood pressure measurement; clinical article; controlled study; disease severity; glaucoma; health care utilization; human; intraocular pressure; oculoplethysmography; optical instrumentation; predictor variable; priority journal; scoring system; univariate analysis; visual field

Do physicians take action on high risk family history information provided by patients outside of a clinic visit? - Volk, L.A.; Staroselsky, M.; Newmark, L.P.; Pham, H.; Tumolo, A.; Williams, D.H.; Tsurikova, R.; Schnipper, J.; Wald, J.; Bates, D.W. (Medinfo. MEDINFO, 2007)
Clinically relevant family history information is frequently missing or not readily available in electronic health records. Improving the availability of family history information is important for optimum care of many patients. Family history information on five conditions was collected in a survey from 163 primary care patients. Overall, 53% of patients had no family history information in the electronic health record (EHR) either on the patient's problem list or within a templated family history note. New information provided by patients resulted in an increase in the patient's risk level for 32% of patients with a positive family history of breast cancer, 40% for coronary artery disease, 50% for colon cancer, 74% for diabetes, and 95% each for osteoporosis and glaucoma. Informing physicians of new family history information outside of a clinic visit through an electronic clinical message and note in the EHR was not sufficient to achieve recommended follow-up care. Better tools need to be developed to facilitate the collection of family history information and to support clinical decision-making and action.
Keywords: ambulatory care; anamnesis; article; clinical practice; decision making; family health; genetic predisposition; human; information processing; medical record; methodology; risk assessment

Influential factors and resolutions to medication adherence in glaucoma patients - Wu, H. (Chinese Ophthalmic Research, 2007)
Although adherence to medication regimen in glaucoma patients is important to well controlled ocular tension and good visual function, glaucoma patients may not take medicine following the doctors' orders even stop it sometimes because of kinds of factors in real lives. Clinicians need to distinguish between problems of efficacy versus those of adherence and persistence in order to achieve the best possible patient outcomes and to avoid making unnecessary and costly changes in therapy. So, clinicians should think highly of the medication adherence in glaucoma patients in clinical works. This review summarized reported articles about medication adherence in glaucoma in recent years to examine the factors affecting compliance in order to suggest ways of improving compliance with eye drops.
Keywords: antiglaucoma agent; article; drug efficacy; glaucoma; human; intraocular pressure; patient attitude; patient compliance; treatment outcome; visual discrimination

An evaluation of how glaucoma patients use topical medications: A pilot study - Tsai, T.; Robin, A.L.; Smith III, J.P. (Transactions of the American Ophthalmological Society, 2007)
Purpose: Multiple factors can influence patients' adherence to topical ophthalmic intraocular pressure-lowering medications. An important factor that is often overlooked is the method of eye drop administration, including the handling, storing, and actual administering of eye drops. These aspects of patients' eye drop administration, which may be strongly related to the success of prescribed therapies, are evaluated. Methods: A 2-page questionnaire was distributed to 253 sequential glaucoma patients at the time of their regular clinical visit with one of two geographically distinct glaucoma specialists. In addition to providing demographic data, the patients were asked to complete a 2-page questionnaire about their current use of eye drops. Results: The study participants had a mean age of 71.5 years (SD, 15.1 years) and were predominantly female (59.8%) and white (72.6%). Approximately 17% of them relied on others for the administration of drops and most commonly cited inadequate vision and trouble with manual dexterity leading to this dependency. Of those who self-administered drops, only 16.3% used a mirror. The most common location for administration was the bedroom (46.8%), followed by the bathroom (23.4%) and kitchen (16.1%). Almost 16% reported "rarely" or "never" washing their hands. Conclusions: Although most individuals may have little difficulty with the use, storage, and handling of eye drops, this study demonstrates that broad variation in reported practices exists. This finding suggests a need for better instruction in eye drop administration and illuminates some of the methodological problems that could be overcome to reduce patients' frustration, improve compliance, and increase efficacy.
Keywords: eye drops; aged; article; drug efficacy; evaluation study; female; glaucoma; human; male; patient compliance; patient education; pilot study; priority journal; questionnaire

Peer discussion - Gross, R.L.; Jones, D.B.; Brown, G.C.; France, T.D.; Anderson, D.R.; Ritch, R.; Waring III, G.O.; Robin, A.L. (Transactions of the American Ophthalmological Society, 2007)
Keywords: eye drops; drug administration; drug instillation; glaucoma; note; ophthalmology; patient compliance; patient education; pilot study; priority journal; questionnaire

Asthma in Older Adults - Braman, S.S.; Hanania, N.A. (Clinics in Chest Medicine, 2007)
Asthma is underdiagnosed and undertreated in older adults. The classic symptoms, including episodic wheezing, shortness of breath, and chest tightness, are nonspecific in this age group. Older patients may underrate symptoms, and other diseases, such as chronic obstructive pulmonary disease, congestive heart failure, and angina, may have similar presentations. Objective measurements of lung function always should complement the history taking and physical examination. Management of asthma in older adults should include careful monitoring, controlling triggers, optimizing and monitoring pharmacotherapy, and providing appropriate asthma education. Adverse effects to commonly used asthma medications are more common in older adults, and careful monitoring of their use and adverse effects is important. © 2007 Elsevier Inc. All rights reserved.
Keywords: acetylsalicylic acid; antiasthmatic agent; antiinflammatory agent; beclometasone; beta 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; betaxolol; bronchodilating agent; budesonide; cholinergic receptor blocking agent; corticosteroid; dipeptidyl carboxypeptidase inhibitor; flunisolide; fluticasone; formoterol; ibuprofen; indometacin; ipratropium bromide; leukotriene receptor blocking agent; lipoxygenase inhibitor; methylprednisolone; mometasone furoate; naproxen; prednisone; salbutamol; salmeterol; steroid; theophylline; triamcinolone; unindexed drug; add on therapy; adrenal suppression; aging; airway obstruction; allergic asthma; anamnesis; angina pectoris; asthma; asthmatic state; backache; blood pressure; bronchospasm; bronchus hyperreactivity; cardiotoxicity; cataract; chest tightness; chronic obstructive lung disease; Churg Strauss syndrome; clinical feature; congestive heart failure; contusion; corticosteroid induced myopathy; corticosteroid induced osteoporosis; coughing; diabetes mellitus; disease association; dosage schedule comparison; drug efficacy; drug fatality; dysphonia; dyspnea; fracture; geriatric patient; glaucoma; heart arrhythmia; atrial fibrillation; heart palpitation; heart ventricle extrasystole; heart ventricle tachycardia; histopathology; hoarseness; human; hypertension; hypokalemia; insomnia; ischemic heart disease; lung function test; mucosal dryness; muscle weakness; nausea and vomiting; pathophysiology; patient assessment; patient compliance; patient education; patient monitoring; physical examination; potassium blood level; priority journal; prognosis; QT prolongation; review; seizure; senescence; side effect; skin atrophy; supraventricular tachycardia; symptom; tachycardia; thrush; treatment outcome

Development of the conceptual framework for the Eye-Drop Satisfaction Questionnaire (EDSQ©) in glaucoma using a qualitative study - Nordmann, J.-P.; Denis, P.; Vigneux, M.; Trudeau, E.; Guillemin, I.; Berdeaux, G. (BMC Health Services Research, 2007)
Background. Compliance is a major issue in glaucoma care. It is usually poor in glaucomatous patients, and may ultimately result in an acceleration of the disease progression and a risk of blindness. Reasons for this poor compliance are complex and multifactorial, amongst which patient satisfaction can be counted. The objective of this study was to develop a questionnaire to assess patient satisfaction and compliance with eye-drop treatment. Methods. A qualitative study was carried out to develop the questionnaire. An interview guide was developed based on a literature review. Structured interviews of fifteen French and English patients with primary open-angle glaucoma or intraocular hypertension were conducted by trained interviewers of the native language of the interviewees. General concepts and subconcepts were identified from the transcripts. The questionnaire was developed using the patient verbatim, and submitted to six patients (French and English) for cognitive debriefing. Following patients' comments, items were modified and restructured, and a pilot questionnaire was designed. Results. Analysis of data from the interviews with patients and clinicians resulted in the elicitation of concepts related to patient satisfaction and compliance with glaucomatous treatment. These were further refined and used to generate a test questionnaire, which consisted of 46 items grouped into 6 domains: patient characteristics, treatment characteristics, patient-clinician relationship, patient experience with the disease and the treatment, interaction between the patient and the treatment, and patient knowledge of the disease and the treatment. Conclusion. The Eye-Drop Satisfaction Questionnaire (EDSQ) conceptual framework and items were developed simultaneously in French and in English. This questionnaire could be used to evaluate patient satisfaction and compliance with eye-drop treatment and would facilitate the identification of patients at risk of being non-compliant prior to clinical trials or innovative device tests. A psychometric study is under way to validate the questionnaire. © 2007 Nordmann et al; licensee BioMed Central Ltd.
Keywords: eye drops; adult; aged; article; clinical article; conceptual framework; data analysis; doctor patient relationship; eye drop satisfaction questionnaire; female; glaucoma; human; information retrieval; interview; intraocular hypertension; male; open angle glaucoma; patient assessment; patient compliance; patient satisfaction; qualitative analysis; questionnaire; risk assessment; treatment indication

Inderal - A forerunner of a radically new generation of products - Bryan, J. (Pharmaceutical Journal, 2007)
Keywords: amiloride plus hydrochlorothiazide; atenolol; beta adrenergic receptor blocking agent; calcium channel blocking agent; carvedilol; dipeptidyl carboxypeptidase inhibitor; diuretic agent; fibrinolytic agent; guanethidine; labetalol; methyldopa; metoprolol; oxprenolol; pindolol; placebo; practolol; pronetalol; propranolol; reserpine; thiazide diuretic agent; add on therapy; article; clinical trial; coronary artery disease; drug design; drug eruption; drug indication; drug marketing; drug mechanism; drug potency; drug targeting; drug tolerability; eye injury; glaucoma; heart death; heart failure; heart infarction; heart output; heart rate; human; hypertension; migraine; mortality; patient compliance; renin angiotensin aldosterone system; risk reduction; cerebrovascular accident; sympathetic blocking; systemic lupus erythematosus; alderlin; alderlin; inderal; tenormin

What's in a name? Medication terms: What they mean and when to use them - Wride, N.; Finch, T.; Rapley, T.; Moreira, T.; May, C.; Fraser, S. (British Journal of Ophthalmology, 2007)
Keywords: antihypertensive agent; alcoholism; comprehension; doctor patient relationship; drug nomenclature; glaucoma; homelessness; human; intraocular hypertension; intraocular pressure; language; mental disease; money; note; patient compliance; practice guideline; priority journal; treatment refusal; tuberculosis

Using pharmacy claims data to study adherence to glaucoma medications: Methodology and findings of the Glaucoma Adherence and Persistency Study (GAPS) - Friedman, D.S.; Quigley, H.A.; Gelb, L.; Tan, J.; Margolis, J.; Shah, S.N.; Kim, E.E.; Zimmerman, T.; Hahn, S.R. (Investigative Ophthalmology and Visual Science, 2007)
PURPOSE. To develop methods for investigating adherence to glaucoma medications by using a modified claims data-based measure of adherence, validation by chart review, and patient and physician interviews. METHODS. Data from administrative claims of 13,956 subjects receiving an initial glaucoma medication, and data from overlapping samples of 300 patients' charts, 300 interviews of patients, and 103 interviews of physicians were analyzed and compared. RESULTS. The mean medication possession ratio (MPR) was 0.64 (median 0.57) for the 13,956 subjects. Although 59% potentially had an ocular hypotensive agent at 12 months, only 10% had such medication available continuously. Chart review revealed that 31% of subjects "new to therapy" in claims data had actually been previously treated; and that 90% of the 17% who had medication added to initial monotherapy were misclassified by claims-based algorithms as medication switches or no change. Twenty percent of surveyed patients received samples on a regular basis and had lower MPR than those who did not (P < 0.05). CONCLUSIONS. Large pharmacy databases offer insight into medication usage but are vulnerable to errors from sampling (since patients who receive samples will be considered to have poor adherence), misidentification of newly treated patients, and misclassification of added versus switched medications. That a large proportion of patients stop and restart medications makes MPR a robust measure of adherence over time that reflects the resumption of medication after a gap in adherence. The data confirm that adherence to treatment with glaucoma medications is poor, similar to adherence in patients with other chronic diseases. Copyright © Association for Research in Vision and Ophthalmology.
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; bimatoprost; carbonate dehydratase inhibitor; latanoprost; prostaglandin; timolol; travoprost; adult; aged; algorithm; article; clinical pharmacy; data analysis; female; glaucoma; health survey; human; interview; major clinical study; male; medical record review; methodology; patient compliance; physician; priority journal; reference database; validation study

Liposomal amphotericin B eye drops to treat fungal keratitis: Physico-chemical and formulation stability - Morand, K.; Bartoletti, A.C.; Bochot, A.; Barratt, G.; Brandely, M.L.; Chast, F. (International Journal of Pharmaceutics, 2007)
Local fungal infections with Candida, Fusarium, Curvularia and Aspergillus can lead to serious ulceration of the cornea and must be treated rapidly. The current treatment consists of 0.15% (w/v) amphotericin B eye drops prepared from Fungizone®, containing deoxycholate, irritant for the cornea, which reduces patient compliance. Eye drops based on liposomal amphotericin B (AmBisome®) would be a convenient alternative; however, according to the manufacturer's instructions, AmBisome® can only be kept refrigerated for 1 week after reconstitution. A longer shelf-life at ambient temperature would be preferable for a preparation made in a hospital pharmacy and delivered to patients. Thus, the possibility of storing an ophthalmic preparation of 0.5% (w/v) liposomal amphotericin B after reconstitution was investigated. After 6 months at room temperature or at +2-8 °C, the hydrodynamic diameter measured by quasi-elastic light scattering remained constant at 108 ± 30 nm with a polydispersity index lower than 0.15. Amphotericin B content, checked by a validated HPLC method, was maintained between 94 and 107%. Amphotericin B and soy phosphatidylcholine proportions remained constant, indicating that the liposomes remained intact and retained the drug. These results show the feasibility of an ophthalmic preparation based on liposomal amphotericin B developed in hospital pharmacies. © 2007.
Keywords: amphotericin B deoxycholate; amphotericin B lipid complex; deoxycholic acid; liposome; phosphatidylcholine; article; cornea; drug stability; environmental temperature; freezing; high performance liquid chromatography; hospital pharmacy; human; keratomycosis; light scattering; patient compliance; priority journal; room temperature; shelf life; ambisome; fungizone

Treating the ocular component of allergic rhinoconjunctivitis and related eye disorders - Bielory, L.; Katelaris, C.H.; Lightman, S.; Naclerio, R.M. (MedGenMed Medscape General Medicine, 2007)
Context: Allergy symptoms that affect the eyes are common in adults and children worldwide, and are often associated with nasal allergy symptoms, prompting the term 'rhinoconjunctivitis' to describe the condition. However, this condition has not always been recognized, and earlier literature reported allergic conjunctivitis only within a subset of nasal allergy patients. Evidence Acquisition: To assess the current state of ocular allergy epidemiology, pathophysiology, and currently available treatment options, we performed a MEDLINE search for articles regarding ocular allergy, rhinoconjunctivitis, vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC), and giant papillary conjunctivitis (GPC). Evidence Synthesis: The more severe forms of ocular allergy are not only distressing, but can also threaten a patient's vision. Each type of ocular allergy is associated with ocular redness, itching, and tearing; however, AKC and VKC can threaten the cornea, and research has revealed that involvement of different immune cell populations (mast cells, eosinophils, and lymphocytes) may cause these more severe symptoms. A variety of treatment options exist to control ocular allergy symptoms. Nonpharmacologic options include allergen avoidance and lubrication with saline, and if these fail to be sufficiently effective, symptom relief may be provided by medicinal agents that are either applied topically to the eye or taken orally. Recent evidence suggests that nasal allergy treatments applied topically to the nose may also positively affect ocular allergy symptoms, which raises the interesting possibility that a parasympathetic nasal-ocular neural reflex pathway may be involved in the stimulation of allergic responses in the eye. Conclusions: Ocular allergy is underdiagnosed and has a significant impact on the life of the patient. It is vital to reach a better understanding of ocular allergic mechanisms and inflammation, which may lead to improved treatment. © 2007 Medscape.
Keywords: allergen; antihistaminic agent; azelastine; cetirizine; corticosteroid; cromoglycate disodium; decongestive agent; desloratadine; dexamethasone; eye drops; fexofenadine; fluticasone propionate; ketorolac trometamol; ketotifen fumarate; levocabastine; lodoxamide trometamol; loratadine; loteprednol etabonate; nedocromil; nonsteroid antiinflammatory agent; olopatadine; oxymetazoline; pemirolast; placebo; prednisolone; pseudoephedrine; rimexolone; tetryzoline; triamcinolone acetonide; unindexed drug; air pollution; allergic disease; allergy; anamnesis; article; atopic keratoconjunctivitis; bitter taste; burning sensation; cataract; clinical trial; closed angle glaucoma; competitive inhibition; conjunctivitis; disease association; disease severity; drug bioavailability; drug contraindication; drug efficacy; drug induced headache; drug potency; drug tolerability; eosinophil; erythema; evidence based medicine; eye allergy; eye burning; eye discomfort; eye irritation; first pass effect; geographic distribution; giant papillary conjunctivitis; health care cost; human; hyperemia; immunotherapy; industrialization; intraocular pressure; lacrimation; lubrication; lymphocyte; mast cell; Medline; mydriasis; nose allergy; nose obstruction; ocular pruritus; pathophysiology; patient compliance; pharyngitis; prevalence; primary medical care; pruritus; rhinitis; rhinoconjunctivitis; risk factor; seasonal variation; side effect; symptom; systematic review; vernal conjunctivitis; acular; alocril; alomide; alrex; lotemax; optivar; patanol; zaditor

Pharmacologic interventions in chronic obstructive pulmonary disease: bronchodilators - Hanania, N.A.; Donohue, J.F. (Proceedings of the American Thoracic Society, 2007)
Chronic obstructive pulmonary disease (COPD) is a treatable disease characterized by progressive airflow limitation. Prevention of disease progression, improvement of symptoms, exercise tolerance, health status, and decrease in exacerbations and in mortality are the main goals of the management of COPD. Bronchodilators play a pivotal role in the treatment of symptomatic patients with COPD. Inhaled short-acting bronchodilators are currently recommended for rescue of symptoms in patients with mild disease, whereas inhaled long-acting bronchodilators are recommended as first-line agents for maintenance therapy in patients with moderate and severe disease and those with daily symptoms. Long-acting bronchodilators improve symptoms, exercise tolerance, and health status, and reduce exacerbations in patients COPD. However, their effects on long-term decline in lung function and mortality are currently under investigation. When symptoms are not sufficiently controlled by the use of one bronchodilator, combining bronchodilators of different classes may be a more effective approach. In fact, recent evidence supports the regular use of a combination of a long-acting β2-adrenoceptor agonist and a long-acting anticholinergic agent in patients with severe COPD. Combining a long-acting β2-adrenoceptor agonist with an inhaled corticosteroid has also been shown to be more effective than the use of either agent alone. The use of theophylline has declined in recent years because of its narrow therapeutic index, and should be reserved as a third-line option in patients with very severe disease. Several novel bronchodilators are now in different stages of development for use alone or in combination with other agents.
Keywords: arformoterol; beta 2 adrenergic receptor stimulating agent; bronchodilating agent; budesonide plus formoterol; carmoterol; cholinergic receptor blocking agent; cilomilast; corticosteroid; fluticasone propionate; fluticasone propionate plus salmeterol; formoterol; glycopyrronium; milveterol; gsk 159802; darotropium bromide; gsk 597901; gsk 656398; gsk 678007; vilanterol; indacaterol; ipratropium bromide; ipratropium bromide plus salbutamol; aclidinium bromide; las 35201; levalbuterol; muscarinic M3 receptor antagonist; phosphodiesterase IV inhibitor; placebo; roflumilast; salbutamol; salmeterol; theophylline; tiotropium bromide; unclassified drug; cardiovascular disease; chronic obstructive lung disease; clinical trial; disease course; disease exacerbation; drug delivery system; drug dose comparison; drug half life; drug mechanism; drug monitoring; exercise tolerance; forced expiratory volume; gastrointestinal symptom; glaucoma; heart arrhythmia; human; metered dose inhaler; monotherapy; nausea; nebulizer; patient compliance; recommended drug dose; review; seizure; single drug dose; tachycardia; tremor; unspecified side effect; urine retention; xerostomia; gsk 159797; gsk 159802; gsk 233705; gsk 597901; gsk 642444; gsk 656398; gsk 678007; las 34273; las 35201

Proposal for juvenile idiopathic arthritis guidance on diagnosis and treatment for primary care pediatricians and nonpediatric rheumatologists (2007) - Yokota, S.; Mori, M.; Imagawa, T.; Takei, S.; Murata, T.; Tomiita, M.; Ito, Y.; Fujikawa, S. (Modern Rheumatology, 2007)
The Pediatric Standing Committee of the Japan College of Rheumatology, in collaboration with the Pediatric Rheumatology Association of Japan, produced guidance on the diagnosis and treatment for juvenile idiopathic arthritis (JIA) for primary care pediatricians and nonpediatric rheumatologists in Japan. This guidance aims to achieve early diagnosis and treatment for JIA, which is similar to adult rheumatoid arthritis (RA), based on recent progress in rheumatology, and to resolve arthritis at an early stage and improve the prognosis of the affected inflammatory joints. It describes clinical symptoms and laboratory findings characteristic to JIA in order to make early diagnosis and treatment possible, and also serves as a triage of patients who are refractory to the treatment protocol described here and need more aggressive interventions. However, because JIA is a complicated and heterogeneous disease and the optimal treatment approach can be diverse and different patient by patient, these guidelines should be viewed as recommendations and be individualized according to the condition of the patient. Finally, we hope that this guidance will trigger exploration for further information by referring to the textbooks and literature listed at the end of these guidelines. © Japan College of Rheumatology 2007.
Keywords: antiemetic agent; tocilizumab; auranofin; aurothiomalate; bucillamine; corticosteroid; cyclooxygenase 2 inhibitor; cyclosporine; disease modifying antirheumatic drug; domperidone; etanercept; folic acid; heparin; hydroxychloroquine; ibuprofen; immunosuppressive agent; infliximab; interleukin 1 receptor blocking agent; methotrexate; methylprednisolone; methylprednisolone sodium succinate; metolate; naproxen; domperidone; nonsteroid antiinflammatory agent; prednisolone; anakinra; rheumatoid factor; salazosulfapyridine; unclassified drug; adrenal cortex insufficiency; agranulocytosis; antiinflammatory activity; aseptic meningitis; bone marrow suppression; cataract; clinical feature; clinical trial; combination chemotherapy; continuous infusion; corticosteroid induced osteoporosis; diabetes mellitus; differential diagnosis; digestive system ulcer; disease classification; disease course; drug dose reduction; drug eruption; drug induced headache; drug megadose; early diagnosis; erythrocyte sedimentation rate; gastrointestinal disease; general practitioner; glaucoma; growth retardation; human; hyperlipidemia; hypertension; impaired glucose tolerance; infection; interstitial nephritis; interstitial pneumonia; Japan; joint contracture; juvenile rheumatoid arthritis; kidney disease; kidney function test; liver disease; liver dysfunction; liver fibrosis; liver function test; low drug dose; lung fibrosis; macrophage activation; monotherapy; moon face; morning dosage; muscle weakness; myalgia; nausea; neutrophil count; obesity; osteoporosis; pancreatitis; patient compliance; pediatric physiotherapy; pediatrician; physical examination; pneumonia; practice guideline; priority journal; prognosis; pruritus; psychosis; range of motion; review; shock; side effect; skin disease

Assessing compliance, acceptance, and tolerability of teriparatide in patients with osteoporosis who fractured while on antiresorptive treatment or were intolerant to previous antiresorptive treatment: An 18-month, multicenter, open-label, prospective study - Adachi, J.D.; Hanley, D.A.; Lorraine, J.K.; Yu, M. (Clinical Therapeutics, 2007)
Background: Teriparatide (parathyroid hormone [1-34] [ribosomal DNA origin]) stimulates new bone formation on trabecular and cortical (periosteal and/or endosteal) bone surfaces by preferential stimulation of osteoblastic activity over osteoclastic activity. It has been found to significantly reduce vertebral fractures by 65%, and nonvertebral fragility fractures by 53% in treatment-naive postmenopausal women who have previously suffered a vertebral fracture. Objective: This study examined the compliance, acceptance, and adherance of SC teriparatide 20 pg QD. Methods: In this 18-month, multicenter, openlabel, prospective study, women with postmenopausal osteoporosis, and men >30 years of age with either idiopathic or hypogonadal osteoporosis (with low bone mass [T-score of -1 or worse] and ≥1 fragility fracture), who had experienced a treatment-related adverse event (AE) or an inadequate response while receiving antiresorptive treatment, and who were willing to receive open-label teriparatide for ≥18 months were eligible. Compliance was defined as self-reported use of ≥80% of study medication. Acceptance of the injection pen was determined by scores obtained from questionnaires and rating scales measuring patients' perception. Patients self-reported on injection discomfort, ease of use, and the overall injection administration. Acceptance was assessed at baseline, and 3, 6, and 18 months. AEs were recorded at each clinical visit from the patients' self-reports. At the 3-month visit, a serum calcium level was drawn ≥16 hours after the previous teriparatide dose. Results: In this study, 116 patients-102 women with postmenopausal osteoporosis and 14 men (12 with idiopathic osteoporosis and 2 with hypogonadal osteoporosis)-were assessed for inclusion in the study. The mean (SD) age was 68.8 (11.1) years (range, 40-89 years) and the mean (SD) weight was 60.5 (11.7) kg (range, 37-87 kg). Seventy-three percent of the patients in this study had baseline spinal T-scores ≤-2.5, and 72% had fractured during treatment with an osteoporosis medication. Reported compliance was 89% at 6 months and 82% at 18 months. At baseline, 42% of patients were concerned about injection discomfort, and 43% were somewhat concerned with daily injections, while 7% were quite concerned. At 6 months, most patients reported much less concern (49%) or no concern (42%). Patient perceptions associated with learning how to use the pen injection, attaching the needle, holding the pen, and injecting the dose, improved during the first 6 months of the study. The most commonly reported AEs were dizziness, 12 (10.3%); nausea, 12 (10.3%); back pain, 9 (7.8%); and muscle cramps, 9 (7.8%). No AEs were believed to be associated with the use of the pen injection or teriparatide. Five patients had mildly elevated serum calcium concentrations (maximum value 2.8 mmol/L) at 3 months. However, all were normal on repeat testing ~4 weeks thereafter. Conclusions: This study found that teriparatide pen injection was well accepted in these patients, and acceptance rates improved during the first 6 months of treatment and, thereafter, improved slightly for ~18 months. Reported compliance remained high throughout the study (82%-89%). Teriparatide pen injection was a viable treatment in these osteopenic or osteoporotic patients with fragility fractures. © 2007 Excerpta Medica, Inc.
Keywords: bisphosphonic acid derivative; calcitonin; parathyroid hormone[1-34]; raloxifene; selective estrogen receptor modulator; vitamin D; abdominal distension; acute coronary syndrome; acute heart infarction; adult; aged; Alzheimer disease; arthralgia; article; backache; bone pain; breast carcinoma; clinical trial; congestive heart failure; controlled study; contusion; coughing; dizziness; drug efficacy; drug safety; falling; fatigue; female; glaucoma; headache; heart arrhythmia; atrial fibrillation; human; hypogonadism; injection site contusion; limb pain; lung disease; major clinical study; male; multicenter study; muscle cramp; musculoskeletal disease; nausea; neck pain; open study; osteoporosis; pain; patient compliance; patient satisfaction; pneumonia; postmenopause osteoporosis; prosthesis infection; rhinopharyngitis; rib fracture; self injection; self report; shoulder dislocation; side effect; sigmoid carcinoma; cerebrovascular accident; subdural hematoma; upper respiratory tract infection; weakness

Gathering Evidence from Claims Data: Caveats - Coleman, A.L. (Ophthalmology, 2007)
Keywords: antiglaucoma agent; prostaglandin derivative; blindness; cataract extraction; clinical practice; diagnostic procedure; disease course; disease severity; editorial; human; open angle glaucoma; optic nerve; patient compliance; priority journal; visual field

Depressive symptomatology, medication persistence, and associated healthcare costs in older adults with glaucoma - Jayawant, S.S.; Bhosle, M.J.; Anderson, R.T.; Balkrishnan, R. (Journal of Glaucoma, 2007)
PURPOSE: Depressive symptoms may impact patients' medication use behavior and utilization of healthcare services. This study examined association between depressive symptoms and Glaucoma medication-related persistence and predictors of associated healthcare charges in older adults with primary open angle Glaucoma. METHODS: This study used a retrospective cohort of older adults with primary open angle Glaucoma who completed health status assessment, used Glaucoma medications, and were enrolled in a Medicare Health Maintenance Organization. Baseline assessment surveyed patients on demographics, healthcare service utilization in year before enrollment, lifestyle, and quality of life. Demographic, clinical, and utilization-related economic variables were retrieved from administrative claims database of patients' Health Maintenance Organization. Survival techniques were used to measure time to discontinuation (persistence) and Center for Epidemiologic Studies Depression Scale a 20-item self-reporting scale assessed depressive symptomatology on a range of 0 to 60. Associations were examined using mixed-model regression approach. Sensitivity analysis that considered log-transformed and untransformed specifications of cost variable tested model appropriateness. RESULTS: In total 268 patients were followed for 2 years (N=536). After controlling for potential confounders and temporal effects, depressive symptomatology was associated with decreased Glaucoma medication-related persistence (P<0.005). Patients who lived alone and had cardiovascular disease showed higher odds of experiencing depressive symptoms (P<0.005). Healthcare charges increased with number of comorbidities and prescriptions (P<0.005). CONCLUSIONS: Presence of depressive symptoms in patients lead to poor Glaucoma medication use behavior. Healthcare expenditures increased for patients with increase in comorbidities. Plan enrollees' risk assessment offers advantage of improving health outcomes and reduces healthcare utilization. © 2007 Lippincott Williams & Wilkins, Inc.
Keywords: antiglaucoma agent; aged; article; Center for Epidemiological Studies Depression Scale; comorbidity; demography; depression; disease association; elderly care; female; health care cost; health care utilization; health maintenance organization; human; lifestyle; major clinical study; male; open angle glaucoma; patient compliance; prescription; priority journal; quality of life; risk assessment; theoretical model; treatment outcome

Does persistency truly equate to compliance? - Best, S.J. (Clinical and Experimental Ophthalmology, 2007)
Keywords: antiglaucoma agent; eye drops; prostaglandin derivative; blindness; diabetic retinopathy; diagnostic error; drug utilization; early diagnosis; editorial; evidence based medicine; glaucoma; human; open angle glaucoma; patient compliance; patient education; practice guideline; prescription; unspecified side effect; visual impairment

Persistency rates for prostaglandin and other hypotensive eyedrops: Population-based study using pharmacy claims data - Rait, J.L.; Adena, M.A. (Clinical and Experimental Ophthalmology, 2007)
Background: Effective management of ocular hypertension requires patients to be persistent with their treatment regimen. We evaluated patients' persistency with hypotensive eyedrops commonly used to treat glaucoma and ocular hypertension. Methods: This large, population-based, retrospective, cohort study used pharmacy claims data for concessional patients from the Australian Pharmaceutical Benefits Scheme (July 1999-June 2005). Resupply rates for prostaglandins, beta-blockers, alpha-agonists and carbonic anhydrase inhibitors were analysed using life tables and Cox regression. Two populations, based on patients' supply histories, were examined: (i) 'new to this eyedrop'-patients who had used other hypotensive eyedrops before (presumably, previously diagnosed with glaucoma or ocular hypertension); and (ii) 'new to any eyedrop'-patients who were using their first hypotensive eyedrop (presumably, newly diagnosed with glaucoma or ocular hypertension). Results: Data were obtained for 14 359 618 supplies of commonly used hypotensive eyedrops to 357 099 concessional patients. For both populations, resupply rates were highest for prostaglandins or the dorzolamide-timolol combination eyedrops, compared with beta-blockers, alpha-agonists or carbonic anhydrase inhibitors. Among the prostaglandins, there was no significant difference in the risk of ceasing supply between latanoprost and bimatoprost, but the risk was significantly higher for travoprost. Conclusions: Based on resupply rates from a national pharmacy claims database, patients supplied with ocular hypotensive eyedrops were most persistent with prostaglandin (bimatoprost, latanoprost and travoprost) and dorzolamide-timolol combination eyedrops. Among the prostaglandins, persistency was highest with, and similar between, bimatoprost and latanoprost. Persistency should be taken into account when selecting the most appropriate eyedrop to treat glaucoma and ocular hypertension. © 2007 The Authors; Journal compilation © 2007 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: alpha adrenergic receptor stimulating agent; antihypertensive agent; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; carbonate dehydratase inhibitor; dorzolamide; dorzolamide plus timolol; eye drops; latanoprost; levobunolol; prostaglandin derivative; timolol; travoprost; article; Australia; cohort analysis; controlled study; drug cost; glaucoma; human; intraocular hypertension; life table; patient compliance; population research; retrospective study

Risk Factors for Noncompliance With Follow-up Among Normal-tension Glaucoma Suspects - Ngan, R.; Lam, D.L.; Mudumbai, R.C.; Chen, P.P. (American Journal of Ophthalmology, 2007)
Purpose: To evaluate noncompliance with follow-up in normal-tension glaucoma (NTG) suspects. Design: Retrospective cohort study. Methods: We reviewed 203 patient charts at a university eye clinic, identified as NTG suspects from a database of optic disk photographs. Noncompliance was defined as less than one year of follow-up and/or fewer than two completed visual field (VF) tests. Results: Twenty-two patients (11%) were excluded because at least two VF tests were not ordered. The 181 patients analyzed included 45 (25%) non-Whites and 16 (9%) non-English speakers. Eighty-three patients (46%) were noncompliant. These patients were significantly younger (50.5 ± 15.0 years vs 55.1 ± 12.8 years; P = .028), were more likely to speak English (P = .023), and were more likely to have no or unknown health insurance (P < .001). Conclusions: Almost half of NTG suspects lacked appropriate follow-up. Lack of health insurance may be a significant barrier to compliance with follow-up in this population. © 2007 Elsevier Inc. All rights reserved.
Keywords: adult; article; controlled study; female; follow up; glaucoma; health insurance; human; intraocular pressure; major clinical study; male; medical record review; optic disk; photography; priority journal; retrospective study; risk factor; visual field

Glaucoma in the United States and Europe: Predicting costs and surgical rates based upon stage of disease - Lee, P.P.; Kelly, S.P.; Mills, R.P.; Traverso, C.E.; Walt, J.G.; Doyle, J.J.; Katz, L.M.; Siegartel, L.R. (Journal of Glaucoma, 2007)
PURPOSE: Primary open-angle glaucoma is a significant health-economic burden in both the United States and Europe that is likely to increase. This study compared treatment patterns and cost among patients with primary open-angle glaucoma in these locations. METHODS: Retrospective medical chart reviews were conducted in the United States (1990 to 2002) and Europe (1995 to 2003). A total sample of 151 US charts and 194 European charts was studied, and patients were assigned a baseline intraocular pressure (IOP) and baseline stage, using a 6-stage visual functional glaucoma staging algorithm. Resource utilization and direct costs were assessed by stage of disease using publicly available United States and European costs. Cox Proportional Hazards modeling were used to examine covariates predicting glaucoma surgery. Total cost was predicted, adjusting for covariates using Generalized Linear Models, with baseline stage as the independent variable. RESULTS: Glaucoma surgery requirement was highly associated with baseline disease stage and IOP increase before surgery in the United States and somewhat associated with these factors in Europe. Within both locations, baseline IOP was highly associated with glaucoma surgery requirement. Controlling for covariates, patients at higher baseline stages incurred greater costs in the United States (P=0.0017) and Europe (P=0.0715). Surgery and medication were also highly predictive of increased cost (P<0.0001). Cost of care differed greatly between the European countries, with costs lowest in Italy. CONCLUSIONS: Increases in annual cost were related to higher baseline IOP, higher baseline stage, medication, and surgery. Thus, significant potential savings and reductions in annual healthcare burden are possible if patients are diagnosed and treated at earlier stages of glaucoma. © 2007 Lippincott Williams & Wilkins, Inc.
Keywords: article; controlled study; disease course; Europe; female; health care cost; health care utilization; human; intraocular pressure; major clinical study; male; open angle glaucoma; priority journal; trabeculectomy; United States; visual field

Key barriers to optimal management of adult asthma in Australia: Physician and patient perspectives - Heiner, M.M. (Current Medical Research and Opinion, 2007)
Objective: Despite recent advances in asthma treatment, its management in many patients remains sub-optimal. The aim of the Global Asthma Physicians and Patient (GAPP) survey was to identify barriers to optimal asthma management and to explore the content and dynamics of physician-patient communications. Here we present the key findings for adults with asthma in Australia. Research design and methods: Patients with asthma aged ≥ years and physicians who treat adults (generalists; specialists) participated in telephone interviews conducted in May-June 2005, using close-end questionnaires. The survey examined physicians' beliefs and prescribing habits; patients' experiences with asthma; doctor-patient communication; satisfaction with asthma medications and interest in new asthma treatment. Results: A total of 101 adults with asthma and 100 physicians treating asthma patients in Australia completed the survey. Overall, key barriers to optimal asthma management included medication side effects, treatment compliance and patient education. These barriers may be exacerbated by poor patient-physician communication that fails to address patients concerns regarding side effects and may lead to poor treatment compliance. Both physicians and patients expressed safety concerns regarding the long-term use of inhaled corticosteroid and both groups would welcome new treatment options with improved safety profiles, efficacy and once-daily dosing. Conclusion: From both a physician and patient perspective, the safety profile of asthma medication constitutes a key factor in promoting treatment compliance and, ultimately, treatment outcomes. The results highlight discrepancies in perceived patient-physician communication and a need for improved patient education in asthma management. © 2007 Librapharm Limited.
Keywords: antiasthmatic agent; beta 2 adrenergic receptor stimulating agent; cholinergic receptor blocking agent; corticosteroid; adult; aged; asthma; Australia; cataract; combination chemotherapy; controlled study; disease severity; doctor patient relationship; drug safety; female; glaucoma; health survey; hoarseness; human; interview; major clinical study; male; monotherapy; osteoporosis; patient compliance; patient education; patient satisfaction; pharyngitis; prescription; review; side effect; structured questionnaire; thrush; unspecified side effect

Medical costs of glaucoma and ocular hypertension in Italian referral centres: A prospective study - Koleva, D.; Motterlini, N.; Schiavone, M.; Garattini, L. (Ophthalmologica, 2007)
Aim: This study analyzes the resource utilization and costs of ocular hypertension and glaucoma (staged by severity) in Italian ophthalmology departments. Methods: The project was a multi-centre observational study conducted in 17 Italian ophthalmology departments throughout the country. A total of 659 patients were recruited and followed prospectively for 1 year. For the purpose of analysis, the patients were divided into 3 groups according to the severity at onset: ocular hypertension, glaucoma and advanced glaucoma. Results:The subgroups differed significantly in the main demographic and clinical variables. As expected, greater severity was associated with older mean age and worse visual acuity, and with higher resource consumption and costs. The annual average cost per patient was EUR 788.7 and rose significantly with disease severity (EUR 572.0 for ocular hypertension, EUR 734.3 for glaucoma and EUR 1,054.9 for advanced glaucoma). Drugs and specialist consultations were by far the largest cost components. Conclusions: This study offers some information on the medical costs of glaucoma in Italy potentially useful for decision-making in the health care services. Health care resources and costs increased with disease severity. Copyright © 2007 S. Karger AG.
Keywords: beta adrenergic receptor blocking agent; prostaglandin derivative; aged; article; clinical trial; controlled clinical trial; controlled study; diagnostic procedure; disease severity; drug cost; female; glaucoma; health care utilization; health service; human; intraocular hypertension; major clinical study; male; multicenter study; visual acuity

Medication noncompliance and its implications in transplant recipients - Morrissey, P.E.; Flynn, M.L.; Lin, S. (Drugs, 2007)
The transplant patient's therapeutic regimen consists of a lifelong drug therapy, including immunosuppressive drugs, prophylactic antimicrobials and often medications for the treatment of hypertension, diabetes mellitus and other comorbid diseases. Regular clinic appointments are required to monitor for signs and symptoms of immunological injury, recurrent disease and adverse drug effects. Patients are instructed to avoid risk factors for cardiovascular disease and cancer (e.g. diet, exercise, sun protection and not smoking). Noncompliance with all aspects of this regimen is substantial. Medication noncompliance leads to an increased incidence of acute rejection, chronic rejection and graft loss. Undoubtedly, many practitioners fail to appreciate the extent of noncompliance as the signs are often subtle and most patients are unwilling to disclose deliberate or widespread disregard for medication use. Newer immunosuppressive agents, particularly once-daily medications and long-acting antibody preparations offer convenience and monitoring that may improve compliance. This review focuses on the prevalence, correlates and consequences of medication nonadherence after organ transplantation. Current recommendations to enhance adherence are discussed. © 2007 Adis Data Information BV. All rights reserved.
Keywords: antiinfective agent; azathioprine; corticosteroid; cyclosporine; daclizumab; immunosuppressive agent; methylprednisolone sodium succinate; mycophenolate mofetil; prednisone; rapamycin; sunscreen; tacrolimus; acne; amenorrhea; anemia; aphthous stomatitis; arthralgia; avascular necrosis; bone marrow suppression; bone pain; malignant neoplasm; cardiovascular disease; cataract; comorbidity; Cushingoid syndrome; diabetes mellitus; diarrhea; diet; ecchymosis; edema; exercise; fluid retention; gastritis; gastrointestinal symptom; gingiva hyperplasia; glaucoma; glucose intolerance; graft failure; graft recipient; graft survival; growth retardation; headache; hirsutism; human; hyperkalemia; hyperlipidemia; hypertension; hyperuricemia; hypomagnesemia; incidence; kidney allograft; kidney disease; kidney graft rejection; kidney transplantation; leukopenia; lymphocele; mental instability; microelectromechanical system; muscle weakness; nephrotoxicity; neurotoxicity; organ transplantation; osteopenia; paresthesia; patient compliance; patient monitoring; petechia; physical disease by body function; physician; pneumonia; psychosis; questionnaire; recurrent disease; review; risk factor; side effect; sodium retention; sweating; thrombocytopenia; tremor; wound healing

Ocular carteolol: A review of its use in the management of glaucoma and ocular hypertension - Henness, S.; Harrison, T.S.; Keating, G.M. (Drugs and Aging, 2007)
Ocular carteolol (Mikelan®, Teoptic®, Ocupress®) is a nonselective β-adrenoceptor antagonist with intrinsic sympathomimetic activity (ISA). Ocular carteolol effectively reduces intraocular pressure (IOP) in patients with open-angle glaucoma (OAG) or ocular hypertension (OH). Twice-daily administration of standard carteolol has generally similar IOP-lowering efficacy to other ocular β-adrenoceptor antagonists such as timolol, betaxolol and metipranolol in patients with OAG or OH. In addition, long-term treatment with carteolol has similar efficacy to timolol and betaxolol in terms of reducing IOP and maintaining visual fields in patients with newly diagnosed primary OAG (POAG). The new long-acting formulation of once-daily carteolol has equivalent efficacy to the standard formulation of carteolol administered twice daily in patients with OAG or OH. Both the standard and long-acting formulations of ocular carteolol are generally well tolerated in terms of topical adverse effects involving the eyes or systemic adverse effects involving the cardiovascular system. Thus, twice-daily carteolol is a well established option in the treatment of glaucoma and OH, and the new oncedaily formulation of long-acting carteolol offers similar efficacy and tolerability with a potential for improved patient adherence. Pharmacological Properties: Carteolol is a nonselective β-adrenoceptor antagonist with properties unlike those of other β-adrenoceptor antagonists (i.e. ISA and minimal local anaesthetic activity). Ocular carteolol significantly reduced IOP in healthy volunteers. In addition, significant reductions in aqueous humour production were seen with carteolol in patients with POAG; it did not alter corneal sensitivity, tear secretion or pupil diameter. Unlike timolol or betaxolol, carteolol also appeared to improve perfusion of the optic nerve head. Ocular carteolol did not affect respiratory function in healthy volunteers, although bronchoconstriction was seen in patients with asthma. Although carteolol had similar cardiovascular effects to other ocular β-adrenoceptor antagonists in healthy volunteers and patients with asthma, unlike timolol, it did not have a deleterious effect on the lipid profile in patients with POAG or OH. Plasma carteolol concentrations were significantly lower with the long-acting formulation of ocular carteolol than with the standard formulation. In animal models, the precorneal residence time of carteolol was increased with the long-acting versus the standard formulation, allowing for prolonged ocular delivery. Moreover, compared with standard carteolol, a single dose of long-acting carteolol resulted in significantly higher carteolol concentrations at certain timepoints in the iris and ciliary body, indicating enhanced ocular penetration. Therapeutic Efficacy: The results of numerous trials showed that the ocular hypotensive efficacy of standard carteolol 1% or 2% twice daily was similar to that of timolol 0.25% or 0.5% twice daily, betaxolol 0.5% twice daily or metipranolol 0.3% twice daily in patients with POAG, OAG or OH after 1-12 months of treatment. However, 3 months of treatment with levobunolol 0.5% twice daily resulted in a significantly greater reduction in IOP than carteolol 2% twice daily in patients with OAG or OH. A significant reduction from baseline in IOP was seen with carteolol in most studies. Long-term treatment (for up to 7 years) with carteolol 1% twice daily had similar efficacy to timolol 0.25% twice daily and betaxolol 0.5% twice daily in terms of reducing IOP and maintaining visual fields in patients with newly diagnosed POAG. Combination therapy with carteolol plus latanoprost reduced IOP to a significantly greater extent than monotherapy with latanoprost or combination therapy with nipradilol plus latanoprost in patients with POAG or normal-tension glaucoma. The ocular hypotensive efficacy of long-acting carteolol administered once daily was equivalent to that of the standard formulation of carteolol administered twice daily in two well designed trials in patients with OAG or OH. In addition, data from a third trial revealed significant reductions from baseline in IOP with both the long-acting and standard formulations of carteolol in patients with PAOG or OH. Tolerability: Ocular administration of standard or long-acting carteolol was generally well tolerated in patients with POAG, OAG or OH. In general, there were no significant differences in the incidence of ocular symptoms (e.g. burning/stinging at instillation, tearing, ocular pain, blurred vision, itching, conjunctival hyperaemia) between patients receiving carteolol and those receiving comparators such as timolol, metipranolol or levobunolol. However, several studies reported better ocular tolerability of carteolol versus timolol for certain endpoints (e.g. fewer ocular symptoms overall and less burning and eye pain). The long-acting formulation of carteolol was associated with a low incidence of blurred vision (≤2% of patients). Few differences emerged between carteolol and other β-adrenoceptor antagonists in terms of cardiovascular effects (i.e. effects on heart rate and blood pressure) in patients with POAG, OAG or OH. However, one study found a significantly lower incidence of cardiovascular adverse events overall and a significantly lower incidence of bradycardia with carteolol than with timolol; in particular, carteolol seemed less likely to induce nocturnal bradycardia. © 2007 Adis Data Information BV. All rights reserved.
Keywords: beta adrenergic receptor blocking agent; betaxolol; carteolol; dorzolamide; latanoprost; levobunolol; metipranolol; nipradilol; pilocarpine; timolol; aqueous humor; asthma; blurred vision; bradycardia; burning sensation; cataract; ciliary body; clinical trial; combination chemotherapy; conjunctival hyperemia; data base; dosage schedule comparison; drug absorption; drug blood level; drug delivery system; drug distribution; drug efficacy; drug excretion; drug formulation; drug half life; drug mechanism; drug metabolism; drug tolerability; dry eye; Embase; epiphora; eye pain; eyelid erythema; glaucoma; heart rate; heart rate variability; human; hypertension; intraocular pressure; iris; keratitis; lacrimation; medical literature; Medline; methodology; monotherapy; nonhuman; ocular pruritus; optic nerve; patient compliance; priority journal; Leporidae; rat strain; review; side effect; single drug dose; statistical significance; symptom; visual field; vitreous disease; mikelan; ocupress; teoptic

Compliance therapy with antinflammatory antiasthmatic drugs: Inhaled corticosteroids and leukotriene receptor antagonists - Riccioni, G.; Bucciarelli, T.; Mancini, B.; Di Ilio, E.; Palumbo, G.; D'Orazio, N. (Clinica Terapeutica, 2007)
Bronchial asthma represents the commonest chronic respiratory disease in industrialized countries and its prevalence is increasing throughout the world. This is a chronic inflammatory disease in which the inflammation constitutes an important predisposing condition for airway remodelling and secondary irreversible airflow obstruction. The current approach for the treatment involves many classes of drugs, particularly anti-inflammatory such inhaled and oral corticosteroids and cysteinyl-leukotriene receptor antagonist. The pharmacology of drugs used in asthma represents an important factor that conditioning the effectiveness of therapy. In fact, many studies have demonstrated that some asthmatic patients have particular problems that deserve special treatment. Another important factor of asthma treatment is represented by delivery devices for the inhalation of medications and their correct use because, at the present, it is estimated that compliance to controller anti-asthmatic therapy is no more than 50%. The aim of this review is to focus on the compliance in the treatment of asthma and the use of anti-inflammatory therapies with inhaled corticosteroids and leukotriene receptor antagonist drugs.
Keywords: antiasthmatic agent; antiinflammatory agent; beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; corticosteroid; leukotriene receptor blocking agent; montelukast; pranlukast; zafirlukast; zileuton; antiinflammatory activity; asthma; bronchodilating activity; cataract; clinical trial; coughing; dosage schedule comparison; dose response; drug delivery system; drug efficacy; drug mechanism; drug tolerability; dysphonia; glaucoma; growth inhibition; hoarseness; hormone release; human; metabolic disorder; metered dose inhaler; oropharynx candidiasis; osteoporosis; particle size; patient compliance; quality of life; review; side effect; skin fragility; throat irritation; treatment outcome; unspecified side effect

Keep an eye out for glaucoma. - Kowing, D.; Kester, E. (The Nurse practitioner, 2007)
Keywords: antihypertensive agent; eye drops; glaucoma; human; pathophysiology; patient compliance; review

Therapeutic options for glaucoma - Nakhla, E. (U.S. Pharmacist, 2007)
Keywords: acetazolamide; epinephrine; adrenergic receptor stimulating agent; brimonidine; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbachol; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; dipivefrine; dorzolamide; dorzolamide plus timolol; ecothiopate iodide; eye drops; latanoprost; levobunolol; methazolamide; metipranolol; pilocarpine; pilocarpine plus timolol; pilocarpine; potassium; timolol; timolol maleate; timoptic gfs; travoprost; unindexed drug; unoprostone isopropyl ester; adjuvant therapy; age distribution; airway obstruction; allergic conjunctivitis; appetite; article; bedtime dosage; bitter taste; blepharoconjunctivitis; blepharoconjunctivitis; blood pressure; blurred vision; burning sensation; cataract; clinical trial; combination chemotherapy; conjunctiva disease; conjunctival hyperemia; cornea disease; diarrhea; drug contraindication; drug efficacy; drug half life; drug hypersensitivity; drug mechanism; drug penetration; drug potency; drug safety; drug tolerability; drug withdrawal; dry eye; dyspnea; electrolyte disturbance; exercise tolerance; eye discharge; eye disease; eye irritation; eye pain; eyebrow disease; eyebrow disease; eyebrow pain; eyebrow pain; eyelash; eyelid disease; fatigue; glaucoma; gonioscopy; headache; heart palpitation; heart rate; human; hypotension; insomnia; intracranial hypertension; intraocular pressure; iris disease; lacrimation; lethargy; lung disease; malaise; metabolic acidosis; monotherapy; muscle spasm; muscle twitch; mydriasis; myopia; nausea

Bimatoprost, a novel efficacious ocular hypotensive drug now recognized as a member of a new class of agents called prostamides - Burk, R.M.; Woodward, D.F. (Drug Development Research, 2007)
Pursuit of a new FP-agonist prodrug led to the identification of an interesting series of neutral C1-substituted prostaglandin F2α analogues. Although these initial analogues were devoid of any inherent pharmacological activity at the FP-receptor, two compounds AGN-190910 and AGN-191129, were found to have pronounced effects in lowering intraocular pressure (IOP) in normotensive dogs and monkeys. The cat iris sphincter assay was quickly developed as a primary screen for these analogues, leading to rapid identification of AGN-192024 (17-phenyl PGF2α ethyl amide, bimatoprost). While bimatoprost is structurally similar to naturally occurring mammalian hormones of the prostanoid family, surprisingly it demonstrates no significant activity at any of the known prostanoid receptors. Furthermore, results of considerable additional pharmacological studies provide evidence that it may indeed act through a unique receptor yet to be identified. The effect of Bimatoprost on lowering IOP has also been found to be unique in comparison to prostanoids. Bimatoprost reduces human IOP by increasing aqueous humor outflow through a dual mechanism of action where it improves both pressure-dependent and pressure-independent outflow pathways. First introduced to the market in 2002, bimatoprost is currently the most potent single therapy available for control of ocular hypertension. ©2007 Wiley-Liss, Inc.
Keywords: 11 fluoro 9,15 dihydroxy 15 (2 indanyl) 16,17,18,19,20 pentanorprosta 5,13 dienoic acid; 11 pivaloylprostaglandin F2 alpha; 11,15 dipivaloylprostaglandin F2 alpha; agn 190910; agn 190911; agn 190988; agn 191045; agn 191129; agn 204396; AGN 211334; bimatoprost; latanoprost; prostaglandin F2 alpha; prostamide; prostanoid; unclassified drug; antihypertensive activity; aqueous humor flow; drug research; drug screening; drug structure; glaucoma; human; hyperemia; intraocular hypertension; intraocular pressure; nonhuman; patient compliance; review; sphincter pupillae muscle; agn 190910; agn 190911; agn 190988; agn 191045; agn 192024; agn 204396; AGN 211334; al 8810

Use of eyedrops in glaucoma: How can we help to reduce non-compliance? [6] - Chawla, A.; Mcgalliard, J.N.; Batterbury, M. (Acta Ophthalmologica Scandinavica, 2007)
Keywords: antiglaucoma agent; eye drops; blindness; doctor patient relationship; dosage schedule comparison; family history; glaucoma; health survey; human; intraocular pressure; letter; major clinical study; patient attitude; patient compliance; patient education; patient participation; pressure measurement; priority journal; treatment duration; unspecified side effect

Urticaria: Current and future treatments - Borzova, E.; Grattan, C. (Expert Review of Dermatology, 2007)
Urticaria is a common disorder with diverse clinical presentations. Correct recognition of the different clinical patterns promotes more effective treatment. Management involves treatment of any identifiable external causes, including infection, avoidance drug, food and physical triggers and the appropriate use of pharmacological therapies. These can be divided into first-, second- and third-line approaches. The-choice of treatment will be influenced by many factors, including drug licensing, safety, pattern of disease, disease severity, pharmacoeconomic considerations and patient preference. H1 antihistamines are the mainstay of treatment of most patterns of urticaria and are effective in the majority of patients with mast cell-mediated disease. Second-generation antihistamines have a better therapeutic index and improved pharmacodynamic properties compared with older' classic' antihistamines and should be prescribed preferentially for chronic urticaria. Patients who are unresponsive to H1 antihistamines at full dose may require short-term treatment with oral corticosteroids but their long-term use for urticaria should be avoided whenever possible on account of the risk of serious adverse effects. Antileukotrienes and alternative second-line agents, prescribed off licence, can be helpful for patients who respond poorly to antihistamines when taken in conjunction but a better evidence base is needed to guide prescribing. Third-line immunosuppressive therapies can be considered for debilitating urticaria, especially for patients with corticosteroid-dependent chronic disease, and may have some potential to modify the natural course of the illness. Possible new therapeutic approaches on the horizon include new H1 antihistamines, H4 receptor antagonists, a histidine decarboxylase inhibitor under development and biological agents that target histamine-releasing autoantibody production and function. © 2007 Future Drugs Ltd.
Keywords: acetylsalicylic acid; acrivastine; antihistaminic agent; antithyroid agent; autoantibody; biological product; cetirizine; chlorpheniramine; codeine; corticosteroid; cyclosporine; decarboxylase inhibitor; desloratadine; dipeptidyl carboxypeptidase inhibitor; diphenhydramine; ebastine; fexofenadine; histamine H1 receptor antagonist; histamine H4 receptor; histidine decarboxylase; hydroxyzine; leukotriene receptor blocking agent; levocetirizine; levothyroxine; loratadine; menthol; mizolastine; nonsteroid antiinflammatory agent; penicillin G; placebo; unindexed drug; add on therapy; agitation; angioneurotic edema; antibody production; anticholinergic effect; aseptic necrosis; blood brain barrier; blurred vision; car driving; clinical feature; clinical trial; cognitive defect; convulsion; Cushingoid syndrome; diabetes mellitus; diagnostic accuracy; disease association; disease course; disease severity; drug absorption; drug blood level; drug dependence; drug distribution; drug dose comparison; drug dose increase; drug dose reduction; drug efficacy; drug half life; drug megadose; drug metabolism; drug penetration; drug protein binding; drug safety; drug use; evidence based medicine; heart palpitation; histamine release; human; hyperactivity; hypertension; hypothyroidism; increased appetite; infection; intraocular hypertension; irritability; licensing; long term care; mast cell; medical decision making; monotherapy; mydriasis; nervousness; optimal drug dose; patient compliance; performance; pharmacoeconomics; prescription; priority journal; protein function; psychomotor performance; recommended drug dose; respiration depression; review; sedation; short course therapy; side effect; sleep disordered breathing; thyrotoxicosis; time to maximum plasma concentration

Risk factors and open-angle glaucoma: Classification and application - Boland, M.V.; Quigley, H.A. (Journal of Glaucoma, 2007)
Decades of epidemiologic research into open-angle glaucoma have elucidated several risk factors related in some way to the disease. As more and more risk factors are identified, however, assessing their individual and collective contributions in a particular patient is becoming increasingly complicated. To help organize our knowledge of risk in glaucoma we first review some concepts of risk and then propose a scheme that places known risk factors into categories (state of the individual, ocular anatomy and physiology, signs of disease, nonglaucoma medications, and personal behaviors) and also indicates how each factor interacts with disease (incidence, prevalence, progression, therapy.) We also describe methods for using risk factors in clinical practice and describe ways that a large and complex body of knowledge can be applied to individual patients. © 2007 Lippincott Williams & Wilkins, Inc.
Keywords: epinephrine; alcohol; antiglaucoma agent; antilipemic agent; beta adrenergic receptor blocking agent; betaxolol; caffeine; calcium channel blocking agent; corticosteroid; fat; fluorouracil; pilocarpine; prostaglandin; age; alcohol consumption; anatomy; behavior; bleeding; body mass; cardiovascular disease; causal attribution; choroid; cigarette smoking; classification; clinical practice; cornea thickness; diabetes mellitus; dietary intake; disease course; disease severity; epidemiological data; ethnicity; exercise; pseudoexfoliation; eye surgery; family history; fat intake; human; hypertension; incidence; intraocular pressure; laser surgery; migraine; myopia; open angle glaucoma; optic disk; patient compliance; physician attitude; physiology; pigmentation; priority journal; Raynaud phenomenon; review; risk assessment; risk factor; sex difference; side effect; sleep disordered breathing; symptomatology; systemic disease; therapy effect; thickness; thyroid disease; trabeculectomy; treatment response; venous pressure

Medication adherence and health care costs with the introduction of latanoprost therapy for glaucoma in a medicare managed care population - Bhosle, M.J.; Reardon, G.; Camacho, F.T.; Anderson, R.T.; Balkrishnan, R. (American Journal Geriatric Pharmacotherapy, 2007)
Abstract. Background: Latanoprost, a prostaglandin inhibitor, is inercasingly being used in the therapcutic management of glaucoma. However, there is scant literature examining the cost and outcome ramifications of latanoprost. Objectives: This study examined the medication use behavior (medication-related persistence and adherence rates) and costs associated with the introduction of latanoprost therapy in a treatment-naive older population (aged ≥65 years) enrolled in Medicare. Methods: The study employed a retrospective observational cohort design and used administrative claims data from a Medicare health maintenance organization (HMO), which offered complete coverage to enrollees, including prescription benefits. The case group consisted of patients with glaucoma who began latanoprost therapy. The control group consisted of enrollees with glaucoma who started any therapy other than latanoprost. Both groups were followed up for 1 year before and after initiation of therapy. Bivariate and multivariate techniques incorporating health care utilization in the year before the start of new therapy were used to determine the study outcomes. Results: The case group comprised 101 patients (mean age, 77.60 years), while the control group included 168 patients (mean age, 77.59 years). There were no significant differences across the 2 groups with respect to age, sex, general health scores on the 12 item Short-Form Health Survey, severity of comorbidity, or the proportion of respondents with perception of worsened health. Introduction of latanoprost therapy was associated with higher medication persistence (hazard ratio, 0.90; 95% CI, 0.68-0.98) and adherence rates (mean [SD], 0.51 [0.26] vs 0.40 [0.25]; P < 0.001) compared with patients starting other glaucoma medication. Furthermore, there were no additional increases in total health care costs in the entire population associated with the introduction of latanoprost therapy, after adjusting for group and time effects, as well as other confounders (mean [SD], $4718.24 [$8982.92] vs $4046.55 [$6505.39]). Conclusions: Latanoprost therapy offered improved medication use behavior in these older adults enrolled in a Medicare HMO. There were no significant additional increases in overall health care costs as a result of introduction of latanoprost therapy, after adjusting for group and time effects, as well as other baseline confounders in this study cohort. © 2007 Excerpta Medica. Inc.
Keywords: antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; brinzolamide; carteolol; dipivefrine; dorzolamide; dorzolamide plus timolol; latanoprost; levobunolol; metipranolol; timolol maleate; travoprost; unoprostone isopropyl ester; aged; article; bivariate analysis; cohort analysis; comorbidity; confidence interval; controlled study; drug cost; drug exposure; drug use; elderly care; female; follow up; hazard ratio; health care utilization; human; major clinical study; male; managed care; medicare; multivariate analysis; observational study; open angle glaucoma; patient compliance; priority journal; retrospective study; statistical significance; treatment outcome

Increasing compliance in glaucoma patients through education - Cochereau, I. (Journal français d'ophtalmologie, 2007)
Compliance is a major issue in glaucoma, a chronic and asymptomatic disease. The management of the disease by the patient himself is a key point in the prognosis of glaucoma. Ophthalmologists can increase glaucoma patient compliance through education and medicopsychological assistance.
Keywords: article; glaucoma; human; patient compliance; patient education; psychological aspect; quality of life

Microbial keratitis in orthokeratology: The Australian experience - Watt, K.G.; Boneham, G.C.; Swarbrick, H.A. (Clinical and Experimental Optometry, 2007)
Background: This study was conducted to investigate the demographics of orthokeratology (OK) practice in Australia, to uncover any previously undocumented cases of serious adverse responses in OK, including microbial keratitis (MK), and to review the demographics of MK in OK in Australia. Methods: A questionnaire was sent to the 62 members of the Orthokeratology Society of Australia (OSA). Questions related to aspects of their OK practice, demographics of their OK patient base and any adverse responses to OK lens wear that they had encountered. Results: Thirty-three questionnaires (53 per cent) were returned. OSA members have been fitting OK lenses for a median of 7.5 years. OK patients were predominantly female, Caucasian, aged between 15 and 39 years and wearing lenses in an overnight modality. In addition to two cases reported previously, the survey uncovered seven further cases of MK in OK patients over an eight-year period. The infecting organism was Pseudomonas aeruginosa in four cases, Acanthamoeba spp. in two cases and unknown in three cases. There was no loss of visual acuity in seven cases. One case resulted in vision of counting fingers at one metre and another case resolved with 6/12 visual acuity. Non-compliance with instructions on lens care and after-care was reported in seven of nine cases of MK. Conclusion: Overall, OSA members who responded to the survey have many years of experience in OK. The typical Australian OK patient is in young adulthood, female and Caucasian. A total of nine cases of presumed MK associated with OK have been reported in Australia over an eight-year period and seven of these were new cases uncovered by this survey. Our analysis suggests that the demographics of MK cases in OK reflect the demographics of the OK lens-wearing population. © 2007 Optometrists Association Australia.
Keywords: contact lens solution; Acanthamoeba keratitis; adolescent; adult; aged; article; Australia; bacterial infection; contact lens; demography; female; Gram negative infection; human; incidence; keratitis; male; methodology; microbiology; middle aged; myopia; optometry; patient compliance; Pseudomonas aeruginosa

Lifetime visual disability in open-angle glaucoma and ocular hypertension - Forsman, E.; Kivelä, T.; Vesti, E. (Journal of Glaucoma, 2007)
PURPOSE: To study how many of the patients with treated glaucoma or ocular hypertension go blind during their lifetime and which factors are associated with blindness. PATIENTS: The data on 106 consecutive patients who had died between 1991 and 2002 was retrospectively evaluated. At diagnosis 39 patients had primary open-angle glaucoma, 27 had exfoliation glaucoma, and 40 had ocular hypertension. METHODS: Clinical records and causes of death were reviewed. Visual disability at the last visit before death was evaluated. Outcome measures were visual handicap and blindness based on visual acuity and/or visual fields. RESULTS: At the last visit, 17 patients [16%, 95% confidence interval (CI) 9-23] were visually handicapped. Thirteen patients (14%) were bilaterally blind. Glaucoma was the cause of blindness in one or both eyes in 16 patients (15%, 95% CI 8-22) and in both eyes in 6 patients (6%, 95% CI 1-10). In the analysis of only 1 eye of each patient, the cumulative incidence of glaucoma-caused blindness was 6% (95% CI 2-11) at 5 years, 9% (95% CI 4-15) at 10 years, and 15% (95% CI 9-23) at 15 years. An advanced stage of glaucoma at diagnosis, fluctuation in intraocular pressure during treatment, the presence of exfoliation syndrome, and poor patient compliance increased the occurrence of blindness. Positive family history of glaucoma and vascular causes of death had no effect on visual outcome. CONCLUSIONS: Glaucoma-caused blindness was associated with an advanced stage of glaucoma at diagnosis, fluctuation of intraocular pressure during treatment, the presence of exfoliation syndrome, and poor patient compliance. The risk of going blind from glaucoma in both eyes was 6%. © 2007 Lippincott Williams & Wilkins, Inc.
Keywords: adult; aged; article; blindness; controlled study; data analysis; pseudoexfoliation; female; human; intraocular hypertension; intraocular pressure; lifespan; major clinical study; male; open angle glaucoma; outcome assessment; patient compliance; priority journal; risk factor; visual acuity; visual disorder; visual field; visual impairment

The future of acute care and prevention in headache - Krymchantowski, A.V.; Rapoport, A.M.; Jevoux, C.C. (Neurological Sciences, 2007)
Migraine is a chronic neurological disease with heterogeneous characteristics resulting in a range of symptom profiles, burden and disability. It affects nearly 12% of the adult population in Western countries and up to 22% of the Brazilian population, imposing considerable suffering as well as personal, economic and social losses. The pharmacological treatment of migraine is divided into preventive and acute treatment. A better comprehension of migraine pathophysiology, as well as the finding of novel molecular targets, has led to a growing number of upcoming therapeutic opportunities. The same is true of cluster headache, which affects only about 0.07%-0.4% of most populations. This review focuses on current and emerging agents and procedures for the treatment of migraine and cluster headache. © Springer-VerlagItalia 2007.
Keywords: 5 (4 fluorobenzamido) 3 (1 methyl 4 piperidinyl) 1h indole fumarate; 6 n (2 hydroxycyclopentyl)adenosine; acetylsalicylic acid; anticonvulsive agent; antiemetic agent; botulinum toxin A; carvedilol; cis capsaicin; tezampanel; dihydroergotamine; ergotamine; etiracetam; frovatriptan; narcotic analgesic agent; nitric oxide synthase inhibitor; nonsteroid antiinflammatory agent; olcegepant; paracetamol; Petasites hybridus extract; placebo; quetiapine; rizatriptan; tiagabine; tizanidine; topiramate; triptan derivative; unindexed drug; valproate semisodium; verapamil; zonisamide; abdominal pain; add on therapy; agitation; amnesia; analgesic activity; anhidrosis; anorexia; anxiety; aphasia; asthenia; ataxia; burning sensation; carcinogenicity; chronic daily headache; clinical trial; cluster headache; common cold; concentration loss; confusion; decreased appetite; delusion; depression; diarrhea; diplopia; dizziness; dose response; drug absorption; drug approval; drug blood level; drug choice; drug competition; drug dose comparison; drug dose increase; drug dose reduction; drug dose titration; drug efficacy; drug metabolism; drug safety; drug targeting; drug tolerability; drug withdrawal; dysphoria; economic aspect; enzyme inhibition; eructation; extrapyramidal symptom; fatigue; human; injection site reaction; insomnia; intraocular hypertension; lacrimation; lethargy; leukopenia; low drug dose; migraine; migraine with aura; migraine without aura; muscle weakness; myalgia; nausea; nephrolithiasis; nervousness; nonhuman; orthostatic hypotension; paresthesia; patient compliance; primary prevention; ptosis (eyelid); review

Examination of first-degree relatives of patients with glaucoma: A randomized trial of strategies to increase use in an eye hospital in Africa - Munachonga, E.M.; Hall, A.B.; Courtright, P. (Ophthalmic Epidemiology, 2007)
Objective: To determine the best approach to examine first-degree relatives (FDR) of glaucoma patients in a rural African setting. Methods: Randomized controlled trial of FDR aged 40 years and older of (index) open angle glaucoma patients who presented to KCMC Hospital. Two strategies of uptake were tested. The main outcome measure was FDR presentation for examination for glaucoma. Results: From 182 index cases, 484 FDR were enrolled in the study, 256 randomized to free examination, and 228 randomized to standard (pay) examination. Overall, 8.1% (95% CI: 5.7-10.5) came for examination. FDR who were offered examination free of charge were 1.87 times (95% CI: 0.94-3.73) more likely to present than those offered standard examination. Among those offered free examination, living near the hospital was associated with presentation (OR = 2.85; 95% CI: 1.10-7.36) whereas among those offered standard examination the association with residence was weak (OR = 2.27; 95% CI: 0.72-7.15). Conclusions: Providing good quality counseling of index cases and offering glaucoma examination free of charge is not sufficient to reach those at risk of glaucoma, suggesting that the indirect costs of accessing services are significant barriers to use of examination services. Other means of encouraging FDR to come for glaucoma examination should be investigated. Copyright © 2007 Informa Healthcare.
Keywords: adult; Africa; aged; article; confidence interval; controlled study; cost; eye care; eye examination; female; health care access; health care utilization; high risk population; hospital; human; major clinical study; male; open angle glaucoma; priority journal; randomization; relative; rural area; standard

Changes in eye care utilization following an eye health promotion campaign - Müller, A.; Keeffe, J.E.; Taylor, H.R. (Clinical and Experimental Ophthalmology, 2007)
Background: The Vision Initiative is a public health campaign that promotes the early detection of the main causes of vision loss through regular eye examinations. Target groups are people over 50 years, with diabetes, a family history of glaucoma or age-related macular degeneration and those who have noted a change in vision. Methods: In 2005, a range of initiatives promoted the main campaign messages using metropolitan and regional television, radio and newspapers. Campaign outcomes such as last visits to an eye specialist were evaluated comparing pre- and post-campaign data. Participation was volunteer based from randomly selected Melbourne suburbs. Recruitment was by mail. Participants were between 70 and 79years of age. A questionnaire collected information about demographics, utilization of eye care services, general health and lifestyle. Key features of the five main eye diseases that cause vision loss in Australia were assessed. Results: The percentage of people that reported to have visited an eye specialist within the last year increased significantly from 61% to 70% (P <0.001). Also the percentage of people with diabetes that reported to have a dilated fundus examination within the last 2years increased significantly from 52% to 70% (P <0.001) and the percentage of people reporting to always wear sunglasses when going out in the sun increased significantly from 33% to 39% (P <0.001). Conclusions: Following the campaign, there was an improvement in the utilization of eye care services, especially by people with diabetes. However, other Australian public campaigns may contribute to the increased awareness of the effect of diabetes on eye health. © 2007 The Authors; Journal compilation © 2007 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: aged; aging; article; Australia; awareness; comorbidity; diabetes mellitus; diabetic retinopathy; early diagnosis; eye care; eye examination; eye protection; family history; female; follow up; glaucoma; health care utilization; health program; health promotion; health service; health status; high risk population; human; lifestyle; major clinical study; male; mass medium; public health; questionnaire; age related macular degeneration; visual impairment

Criteria for choosing clinically effective glaucoma treatment: A discussion panel consensus - Thygesen, J.; Burk, R.; Carassa, R.; Crichton, A.; Goñi, F.J.; Menage, M.; Miglior, S.; Montgomery, D.; Nordmann, J.-P.; Roberts, T.; Singh, K. (Current Therapeutic Research - Clinical and Experimental, 2007)
Abstract. Background: In the clinical management of patients at risk for or diagnosed with primary open-angle glaucoma (POAG), the aim of medical treatment is to reduce intraocular pressure (IOP) and then maintain it over time at a level that preserves both the structure and function of the optic nerve. Objective: The objective of this report was to establish a consensus on the criteria that should be used to determine the characteristics of IOP-lowering medication. Methods: Discussion was held among a panel of 12 physicians considered to be experts in glaucoma to develop a consensus on the criteria used by them to determine the characteristics of the IOP-lowering medication chosen for initial monotherapy and adjunctive treatment of ocular hypertension (OHT) or POAG. Consensus development combined available evidence and the impressions of these physicians regarding the clinical effectiveness of IOP-lowering medication for OHT and POAG. Once the panel identified the criteria, the order of priority and the relative importance of these criteria were then established in the setting of 3 risk categories (low, medium, and high) for a patient to experience significant visual disability from glaucoma over their expected life span. Results: The panel identified 5 criteria to determine the characteristics of IOP-lowering medication for OHT and POAG: IOP-lowering effect, systemic adverse events (AEs), ocular tolerability, compliance/administration, and cost of treatment. IOP-lowering effect was consistently ranked as the highest priority and cost as the lowest. The priority of compliance/administration did not vary by clinical situation. Systemic AEs and ocular tolerability were ranked as higher priorities in initial monotherapy than in adjunctive treatment and ranked lower as the risk for visual disability increased. The priority given to the criteria used to determine clinical effectiveness varied both with the risk for functional vision loss from glaucoma and whether initial monotherapy or adjunctive treatment was being considered. Conclusion: Glaucoma treatment should be assessed with regard to the need not only to lower IOP but also to minimize systemic and ocular AEs, promote patient compliance, and minimize cost. The order of priority and relative importance given to these treatment criteria will vary as part of individualizing patient care. © 2007 Excerpta Medica, Inc. All rights reserved.
Keywords: alpha adrenergic receptor stimulating agent; apraclonidine; bimatoprost; brimonidine; brinzolamide; carbachol; carbonate dehydratase inhibitor; clonidine; dorzolamide; latanoprost; pilocarpine; prostaglandin derivative; travoprost; article; consensus development; drug efficacy; drug tolerability; glaucoma; human; intraocular hypertension; intraocular pressure; open angle glaucoma; optic nerve; patient compliance; priority journal

The variant N363S of glucocorticoid receptor in steroid-induced ocular hypertension in Hungarian patients treated with photorefractive keratectomy - Szabó, V.; Borgulya, G.; Filkorn, T.; Majnik, J.; Bányász, I.; Nagy, Z.Z. (Molecular Vision, 2007)
Purpose: Variation in sensitivity to glucocorticoids observed in healthy population is influenced by genetic polymorphisms of the glucocorticoid receptor gene (NR3C1). N363S, ER22/23EK, and Bcl I have been previously described as glucocorticoid-sensitivity modulating polymorphisms. We investigated whether these variants may contribute to steroid-induced ocular hypertension and if they play a role as protective or risk factors during exogenous glucocorticoid administration. Methods: We examined 102 patients who underwent photorefractive keratectomy and received topical steroids (either fluorometholone 0.1% or prednisolone acetate 0.5% alone or combined) as part of postoperative therapy. The choice of steroid depended on course of wound healing and regression. Variations in intraocular pressure (IOP) levels in response to steroid therapy were observed. To genotype DNA, allele-specific PCR amplification was applied for the N363S polymorphism, and PCR-based restriction fragment length polymorphism analysis was performed to examine the Bcl I and the ER22/23EK polymorphisms. We separately analyzed data from three groups of patients: those who received fluorometholone only; those who were initially given fluorometholone then later switched to prednisolone acetate; and those who received prednisolone acetate only. Covariance analysis with forward stepwise variable selection was carried out. Results: In cases where prednisolone acetate was administered, we found a significant correlation between N363S heterozygosity and steroid-induced ocular hypertension. ER22/23EK and Bcl I polymorphisms do not have a major influence on the risk of developing steroid-induced ocular hypertension. Conclusions: Genotyping of high risk steroid responders may allow an individual therapy to avoid steroid-induced ocular hypertension. The N363S polymorphism may have a clinical significance in the future. © 2007 Molecular Vision.
Keywords: DNA; fluorometholone; glucocorticoid receptor; prednisolone acetate; tobramycin; adult; analysis of covariance; article; controlled study; correlation analysis; drug choice; drug substitution; drug withdrawal; female; gene amplification; genetic polymorphism; genetic risk; genetic variability; genotype; heterozygosity; human; Hungary; individualization; intraocular hypertension; intraocular pressure; major clinical study; male; patient care; patient compliance; photorefractive keratectomy; polymerase chain reaction; postoperative complication; priority journal; refraction error; treatment outcome; wound healing

The TRAVATAN Dosing Aid Accurately Records When Drops Are Taken - Friedman, D.S.; Jampel, H.D.; Congdon, N.G.; Miller, R.; Quigley, H.A. (American Journal of Ophthalmology, 2007)
Purpose: To assess the accuracy of Travatan Dosing Aid recordings. Design: Prospective evaluation of drop-recording accuracy. Methods: Physicians and patients used the Dosing Aid, and logs of usage were compared to the data obtained from the Dosing Aid. Results: Five physicians and 20 patients participated. Devices used by physicians recorded all drops dispensed. Extra readings were recorded when physicians carried the devices during the day. For patients, 93% of all drops were recorded, with 18 of 20 subjects having over 85% of the drops recorded. Seventy percent of patients would continue using the device. Conclusions: The Dosing Aid accurately recorded most eyedrops administered by patients and physicians. Given recent documentation of widespread undercompliance with medical therapy, the Dosing Aid could be a useful addition to clinical practice and research. © 2007 Elsevier Inc. All rights reserved.
Keywords: eye drops; travoprost; adult; aged; article; clinical article; clinical practice; diagnostic accuracy; dose calculation; drug administration route; drug delivery system; drug dosing aid; female; glaucoma; human; male; patient compliance; priority journal; prospective study; technical aid; travatan; Travatan Dosing Aid

Accounting for Restart Rates in Evaluating Persistence with Ocular Hypotensives - Schwartz, G.F.; Platt, R.; Reardon, G.; Mychaskiw, M.A. (Ophthalmology, 2007)
Purpose: Persistence with ocular hypotensive medication is important as a long-term outcome, and rates of persistence typically are low. This study assessed restart rates for 3 prostaglandin analogs by determining the percentage of patients who discontinued and then restarted therapy. Design: Retrospective cohort study of pharmacy claims submitted to a large national administrative claims database. Participants: In all, 4356 patients initiating prostaglandin therapy were identified. Methods: Claims for 3 prostaglandin analogs (bimatoprost, latanoprost, travoprost [index prostaglandin]) submitted between 2001 and 2002 were analyzed. Patients were excluded if they did not have coverage in the plan for the preceding 180 days or had been prescribed any ocular prostaglandin in the prior 180 days. Main Outcome Measures: Persistence was defined as neither discontinuing nor changing the index prostaglandin. The number of current users of the index prostaglandin at day 180 was the sum of patients who persisted with the index prostaglandin plus patients who restarted the index prostaglandin after a discontinuation. Results: Of the 4356 patients initiating prostaglandin therapy, 2503 (57%) were potential current users (were still plan members and had not switched ocular hypotensive therapies after 180 days). Just over half, (1356/2503 [54%]) were current users, including 879 (35%) who persisted with their index prostaglandin and 477 (19%) who restarted their index prostaglandin. Of patients discontinuing their index prostaglandin, more than half failed to restart any topical therapy (827/1624 [51%]). Conclusions: Previous studies showing low persistence rates for glaucoma therapy failed to evaluate restarts. Restart analyses are crucial for assessing long-term treatment of chronic diseases such as glaucoma. In general, persistence remains a challenge, and our findings demonstrate the importance of clinicians' identifying patients who are not persistent and encouraging them either to restart or to initiate treatment with an alternative therapy. © 2007 American Academy of Ophthalmology.
Keywords: bimatoprost; latanoprost; prostaglandin; travoprost; adult; aged; article; cohort analysis; drug use; drug withdrawal; female; glaucoma; human; intraocular hypotension; major clinical study; male; patient compliance; priority journal; retrospective study; treatment response

Risk factors for ill-health in old age - Warnes, A.M. (British Journal of General Practice, 2007)
Keywords: aged; amnesia; arthritis; case finding; chronic disease; depression; editorial; evidence based medicine; general practice; geriatric assessment; geriatric care; glaucoma; health behavior; health care delivery; health care distribution; health care utilization; health status; high risk population; human; mass screening; patient monitoring; patient satisfaction; primary medical care; psychosocial care; quality of life; resource allocation; rheumatic disease; risk factor; social change; social isolation; social status; vulnerable population

Health risk appraisal in older people 1: Are older people living alone an 'at-risk' group? - Kharicha, K.; Iliffe, S.; Harari, D.; Swift, C.; Gillmann, G.; Stuck, A.E. (British Journal of General Practice, 2007)
Background: In the UK, population screening for unmet need has failed to improve the health of older people. Attention is turning to interventions targeted at 'at-risk' groups. Living alone in later life is seen as a potential health risk, and older people living alone are thought to be an at-risk group worthy of further intervention. Aim: To explore the clinical significance of living alone and the epidemiology of lone status as an at-risk category, by investigating associations between lone status and health behaviours, health status, and service use, in non-disabled older people. Design of study: Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal in older people. Setting: Four group practices in suburban London. Method: Sixty per cent of 2641 community-dwelling non-disabled people aged 65 years and over registered at a practice agreed to participate in the study; 84% of these returned completed questionnaires. A third of this group, (n = 860, 33.1 %) lived alone and two-thirds (n = 1741, 66.9%) lived with someone else. Results: Those living alone were more likely to report fair or poor health, poor vision, difficulties in instrumental and basic activities of daily living, worse memory and mood, lower physical activity, poorer diet, worsening function, risk of social isolation, hazardous alcohol use, having no emergency carer, and multiple falls in the previous 12 months. After adjustment for age, sex, income, and educational attainment, living alone remained associated with multiple falls, functional impairment, poor diet, smoking status, risk of social isolation, and three self-reported chronic conditions: arthritis and/or rheumatism, glaucoma, and cataracts. Conclusion: Clinicians working with independently-living older people living alone should anticipate higher levels of disease and disability in these patients, and higher health and social risks, much of which will be due to older age, lower educational status, and female sex. Living alone itself appears to be associated with higher risks of falling, and constellations of pathologies, including visual loss and joint disorders. Targeted population screening using lone status may be useful in identifying older individuals at high risk of failing. © British Journal of General Practice 2007.
Keywords: age distribution; aged; alcohol consumption; arthritis; arthropathy; article; cataract; chronic disease; community living; daily life activity; educational status; falling; female; functional status; gender bias; geriatric care; geriatric nutrition; glaucoma; health behavior; health care utilization; health hazard; health status; high risk population; human; major clinical study; male; mass screening; memory disorder; mood disorder; physical activity; physical disability; rheumatic disease; risk assessment; smoking; social isolation; United Kingdom; visual disorder; vulnerable population

Accuracy and performance of a commercially available Dosing Aid - Cronin, T.H.; Kahook, M.Y.; Lathrop, K.L.; Noecker, R.J. (British Journal of Ophthalmology, 2007)
Aim: To evaluate the recently introduced Travatan Dosing Aid (TDA) for its accuracy in recording and dispensing eyedrops. Methods: The number of eyedrops dispensed with each lever depression and agreement of total number of drops dispensed with that recorded by the device was evaluated in a controlled setting. Results: The TDA correctly recorded a drop being dispensed 100% of the time with full TDA lever depression for <3 s. Under these conditions, agreement between numbers of drops dispensed and recorded was 99%. However, failure to fully depress the lever or prolonged lever depression for >4 s resulted in unreliable TDA recording. Conclusion: Eyedrops were reliably recorded by the TDA after each full lever depression. However, patients need to be instructed about optimal technique so that evaluation of compliance is not confounded by mechanical factors.
Keywords: antiglaucoma agent; eye drops; article; devices; drug delivery system; drug dose regimen; glaucoma; human; patient compliance; priority journal; travatan

The role of non-penetrating filtering procedures in glaucoma surgery - Drolsum, L. (Acta Ophthalmologica Scandinavica, 2007)
Keywords: antiglaucoma agent; antimetabolite; poly(methyl methacrylate); aqueous humor; developing country; drug use; editorial; filtering operation; glaucoma; glaucoma drainage implant; glaucoma surgery; health care cost; human; intermethod comparison; intraocular pressure; laser surgery; medical research; patient compliance; patient safety; postoperative complication; postoperative hemorrhage; priority journal; pseudoexfoliation; sclerotomy; Sturge Weber syndrome; surgical technique; suture technique; trabeculectomy; treatment outcome; viscocanalostomy; visual acuity

The treatment of lupus nephritis in children involves corticosteroids and cytotoxic agents (Drugs and Therapy Perspectives, 2007)
Lupus nephritis is one of the main causes of morbidity and mortality in children with systemic lupus erythematosus. Although the first-line of treatment is corticosteroids, it is important to minimise their dosage because of their extensive adverse event profile. Antimalarials are often added as corticosteroid-sparing agents in patients with mild disease. For patients with more active disease, early cytotoxic therapy with cyclophosphamide is the standard of care for inducing remission. © 2007 Adis Data Information BV. All rights reserved.
Keywords: angiotensin receptor antagonist; antihistaminic agent; antimalarial agent; azathioprine; blys monoclonal antibody; calcium; complement component c5b monoclonal antibody; corticosteroid; cyclophosphamide; cyclosporine; cyclosporine; cytotoxic agent; dipeptidyl carboxypeptidase inhibitor; diphenhydramine; diuretic agent; hydroxychloroquine; hydroxymethylglutaryl coenzyme A reductase inhibitor; interleukin 10 antibody; methotrexate; methylprednisolone; monoclonal antibody; mycophenolate mofetil; nucleoside derivative; prednisolone; rituximab; tumor necrosis factor antibody; unclassified drug; vitamin D; acne; add on therapy; alopecia; amenorrhea; antiinflammatory activity; atherosclerosis; avascular necrosis; cardiovascular disease; cataract; cause of death; clinical trial; cognitive defect; combination chemotherapy; corticosteroid induced osteoporosis; corticosteroid therapy; Cushing syndrome; diabetes mellitus; disease classification; disease course; disease severity; drug dose escalation; drug dose reduction; drug efficacy; drug fever; drug mechanism; face erythema; gastrointestinal symptom; glaucoma; glomerulus filtration rate; growth retardation; hemorrhagic cystitis; hirsutism; human; hyperlipidemia; hypertension; immunosuppressive treatment; induced hypotension; infection; infertility; kidney disease; kidney function; kidney transplantation; leukopenia; long term care; low drug dose; lupus erythematosus nephritis; metastasis; monotherapy; morbidity; nausea; nephrotic syndrome; nephrotoxicity; patient compliance; proliferative glomerulonephritis; proteinuria; pruritus; psychosis; renovascular hypertension; review; rigor; side effect; standard; stria; systemic lupus erythematosus; unspecified side effect; vomiting; World Health Organization; wound healing impairment

Management of painful neuropathies - Gould III, H.J. (Current Treatment Options in Neurology, 2007)
Inadequately assessed and poorly managed pain contributes both to high general medical cost and to increasing numbers of societal problems. A large determining factor of inadequate pain care is the lack of understanding about the complex nature of pain and of a rational approach to its assessment and treatment. The less than adequate assessment of neuropathic pain and its relatively poor response to typical analgesic medications are major determinants to the undertreatment of pain. Other than the important management concept of treating the underlying cause, current approaches to the treatment of pain in general, and neuropathic pain in particular, have shifted away from treatment of individual syndromes toward the identification and management of common symptoms and the mechanisms upon which such symptoms are presumed to be based. This article summarizes the features of neuropathic pain that commonly appear in most peripheral neuropathies, regardless of the mechanism of injury, and provides an approach for the selection of treatment. Copyright © 2007 by Current Medicine Group LLC.
Keywords: analgesic agent; antiarrhythmic agent; anticonvulsive agent; antihypertensive agent; baclofen; carbamazepine; duloxetine; etiracetam; gabapentin; imipramine; lamotrigine; local anesthetic agent; monoamine oxidase inhibitor; nonsteroid antiinflammatory agent; nortriptyline; opiate; oxcarbazepine; phenytoin; placebo; pregabalin; sedative agent; tiagabine; tizanidine; topical agent; topiramate; tricyclic antidepressant agent; unindexed drug; valproic acid; venlafaxine; zonisamide; alopecia; behavior modification; cardiotoxicity; clinical trial; closed angle glaucoma; cognitive therapy; cryotherapy; dietary intake; drowsiness; drug clearance; drug cost; drug dependence; drug eruption; drug half life; drug hypersensitivity; drug mechanism; drug potentiation; drug withdrawal; electrotherapy; evidence based medicine; health care cost; human; hypnosis; hyponatremia; liver toxicity; nephrolithiasis; neuropathic pain; neurosurgery; occupational therapy; orthosis; pain assessment; patient compliance; peripheral neuropathy; physiotherapy; protective equipment; QT prolongation; review; serotonin syndrome; side effect; social problem; symptomatology; treatment planning; unspecified side effect; body weight gain; body weight loss; xerostomia

Access to eye care: Response of the American Academy of Ophthalmology and its members to societal needs now and in the future - Lee, P.P.; Hoskins Jr., H.D.; Smith, R.E.; Hutchinson, B.T.; Wong, B.A. (Archives of Ophthalmology, 2007)
Access to health care has been traditionally viewed as the ability to see a physician or to be hospitalized if necessary in the presence of a health state that may benefit from care in prevention, treatment, amelioration, or palliation. Information from national databases such as the National Ambulatory Care Medical Survey reporting on samples of visits from physician offices around the United States1,2 or from the Medicare claims data3 provides valuable insight about the status of eye care use in the United States, particularly for adults. National Ambulatory Care Medical Survey data from 2004 (the most recent year available) show that there were 47.3 million visits (SE of estimate, ±7.0 million visits) across all age groups to ophthalmologists' nonhospital-based offices, constituting 5.2% of all such visits and a rate of 16.4 visits per 100 persons in 2004.1 There were a total of 43.6 million visits for eye and ear symptoms, with 11.1 million (SE, ±2.2 million) referable to vision dysfunction symptoms. As might be expected, visit rates are traditionally higher for elderly persons, with nearly 50% of those aged 65 years and older having at least 1 eye visit in any given year in Medicare.3 In comparison, annual rates of eye care use have been estimated from the National Health Interview Survey to be 7.3% (95% confidence interval, 6.0%-8.6%) of those aged 0 to 5 years and 24.8% (95% confidence interval, 23.5%-26.2%) among those aged 6 to 17 years.4 Across all age groups,1-4 female sex was associated with greater use or likelihood of use of eye care services. ©2007 American Medical Association. All rights reserved.
Keywords: ambulatory care; article; blindness; clinical feature; data base; eye care; glaucoma; health care access; health care utilization; health service; health survey; high risk population; hospitalization; human; medical information; medical society; medical specialist; medicare; physician; priority journal; screening test; sex difference; United States; visual disorder; visual impairment

Developments in dosing aids and adherence devices for glaucoma therapy: Current and future perspectives - Kahook, M.Y. (Expert Review of Medical Devices, 2007)
Glaucoma is a leading cause of blindness worldwide. Currently, topical drops are the mainstay of treatment for patients who suffer from this chronic disease. Adherence to topical therapy is known to be affected by forgetfulness, frequent dosing requirements and physical limitations. Dosing and adherence aids are designed to help patients adhere to their prescribed therapeutic regimens. This review discusses commonly used dosing and adherence aids, and offers opinions on how future devices may improve on currently available technology.
Keywords: antiglaucoma agent; eye drops; latanoprost; pilocarpine; timolol; travoprost; assistive technology device; blurred vision; clinical trial; drug instillation; electronics; eye irritation; glaucoma; human; intraocular pressure; patient compliance; patient education; questionnaire; reminder system; review; self report; ocusert; pilogel; travatan; xalatan; Auto-drop; Drop Zone; Easidrop; Lumigan; Opticare; Prescript Time-Cap; Travatan Dosing Aid; Xal-Ease

Safety of inhaled corticosteroids: Room for improvement - Rossi, G.A.; Cerasoli, F.; Cazzola, M. (Pulmonary Pharmacology and Therapeutics, 2007)
Inhaled corticosteroids (ICS) are the standard of care in asthma and are widely used in the treatment of patients with chronic obstructive pulmonary disease. High-dose regimens and long-term use of ICS in predisposed individuals may be associated with a variety of side effects, similar to those observed with systemic corticosteroid therapy. Side effects associated with long-term ICS use include reduction in growth velocity, cataracts, glaucoma, osteoporosis, and fractures. Fear of unwanted complications may be of concern in all patients using ICS, particularly in age- and gender-specific populations that are more prone to develop side effects or to reduce treatment adherence because of physical, behavioral, or psychological problems. In addition to concerns about ICS safety, dosing regimens that are difficult to follow may further reduce a patient's ability to comply with treatment. Ciclesonide, a new-generation ICS with unique pharmacokinetic properties, was developed to provide effective anti-inflammatory control for asthma with once-daily administration to improve patient adherence and a high safety profile to reduce the occurrence of local and systemic side effects. © 2005 Elsevier Ltd. All rights reserved.
Keywords: beclomethasone dipropionate; budesonide; ciclesonide; corticosteroid; flunisolide; fluticasone propionate; influenza vaccine; mometasone furoate; nedocromil; triamcinolone; adrenal cortex insufficiency; antiinflammatory activity; article; aspergillosis; asthma; bone density; cataract; chronic obstructive lung disease; clinical trial; corticosteroid therapy; drug absorption; drug megadose; drug safety; fracture; glaucoma; growth retardation; high risk patient; hoarseness; human; hypothalamus hypophysis adrenal system; lung aspergillosis; lung infection; mycosis; osteoporosis; particle size; patient compliance; pharyngitis; physical chemistry; priority journal; skin contusion; skin manifestation; skin thinning; skinfold thickness; thrush

Patients prefer once-daily glaucoma drops - Buller, A.J.; Morgan, L.H.; Hercules, B.L. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2007)
Background: The relationship between complexity of eye drop regime and compliance is not straightforward, i.e. fewer drops may not mean better compliance. We investigated the level of inconvenience different eye drop regimes incurred in comparison with a once-daily (OD) regime for patients experienced with using topical anti-glaucoma medication. Methods: Patients indicated the level of inconvenience from drop regimes of 1,2,3 or 4 times daily on 10-cm visual analogue scales. The score for the OD regime was then compared with the scores for the other regimes using paired t-tests with Bonferroni correction. Results: At a significance limit of p=0.05, five of six subgroups indicated once-a-day drops were significantly more convenient than other regimes. Patients who had used the OD regime considered this difference greater than those who had not. Conclusions: This study's results offer some pragmatic guidance on choice of therapy and on counselling patients about compliance. We would suggest starting patients on OD drops in preference to alternatives to promote compliance. © Springer-Verlag 2006.
Keywords: antiglaucoma agent; article; dosage schedule comparison; drug dose regimen; glaucoma; human; major clinical study; patient attitude; patient compliance; priority journal; questionnaire; statistical significance; Student t test; visual analog scale

Simplification of eye drop regimes helps reduce involuntary non-compliance with glaucoma treatment [1] - Buchan, J.C.; Siddiqui, S.; Gilmour, D. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2007)
Keywords: antiglaucoma agent; consultation; general practitioner; glaucoma; human; intraocular pressure; letter; medical specialist; medication error; patient attitude; patient compliance; prescription; priority journal; questionnaire

Retinal vein occlusions in patients treated with anticoagulant and/or platelet aggregation inhibitors. Five case studies - Ducos De Lahitte, G.; Quintyn, J.C.; Leparmentier, A.; Mathis, A. (Journal Francais d'Ophtalmologie, 2007)
Introduction: Retinal vein occlusions (RVOs) are a common cause of severe or total loss of vision. Although the disease entity has long been known, its management is still controversial. We report five patients (six eyes) who experienced RVO even though they were taking anticoagulants or antiplatelet agents. Case reports: Two patients developed a central retinal vein occlusion (two eyes), two patients a branch retinal vein occlusion (two eyes), and one patient a bilateral central retinal vein occlusion (two eyes). Three patients were treated with anticoagulants, two for hemostatic pathologies and one for cardiopathy; two patients were treated with antiplatelet agents, one for auricular fibrillation and one for a cardiac graft. Retinal photocoagulation was performed in all cases to treat retinal ischemia. Neovascular glaucoma occurred in a single eye. Discussion: Treatments for thromboembolic disorders are more and more commonly used for various indications. Nevertheless, many patients develop RVO while taking such treatments, even though the International Normalized Ratio (INR) shows good patient compliance. Many case reports and small case series illustrate the occurrence of RVO with such treatments. These examples seem to illustrate the lack of efficacy of anticoagulants and platelet aggregation inhibitors in preventing vascular complications in the retinal venous circulation. Conclusion: Anticoagulants and platelet aggregation inhibitors must only be used to treat systemic factors or thromboembolic disorders associated with RVO. These five case reports illustrate that anticoagulants and platelet aggregation inhibitors cannot guarantee that a severe RVO will not occur. A prospective study would be useful to analyze their advantages in RVO management. © 2007. Elsevier Masson SAS.
Keywords: anticoagulant agent; antithrombocytic agent; adult; aged; article; case report; human; international normalized ratio; male; middle aged; patient compliance; retina vein occlusion; treatment outcome

Pharmacotherapy in children should become safer - Frobel, A.-K.; Hsien, L.; Breddemann, A.; Läer, S. (Deutsche Apotheker Zeitung, 2007)
Keywords: epinephrine; captopril; carboplatin; carmustine; carvedilol; cephalosporin; chloral hydrate; ciprofloxacin; cisplatin; clonidine; digoxin; foscarnet; furosemide; hydrochlorothiazide; hydroxyurea; indometacin; lomustine; loracarbef; meropenem; metoprolol succinate; prazosin; propranolol; ramipril; spironolactone; steroid; thalidomide; topiramate; tramadol; unindexed drug; vincristine; article; asthma; atopic dermatitis; drug absorption; drug elimination; drug metabolism; drug safety; epilepsy; esophagitis; Food and Drug Administration; gastroesophageal reflux; glaucoma; human; Human immunodeficiency virus infection; hydrophilicity; medicinal plant; meningitis; migraine; muscle hypertonia; otitis media; patient compliance; psychosis; sinusitis; contergan

Pharmacist-specific summary of adult asthma guidelines - Chong, E. (Canadian Pharmacists Journal, 2007)
Keywords: acetylsalicylic acid; aminophylline; beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; budesonide; budesonide plus formoterol; carbamazepine; choline theophyllinate; ciclesonide; corticosteroid; erythromycin; fenoterol; fenoterol plus ipratropium bromide; fluticasone; fluticasone propionate; fluticasone propionate plus salmeterol; formoterol; formoterol fumarate; ipratropium bromide; ipratropium bromide plus salbutamol; leukotriene receptor blocking agent; montelukast; omalizumab; enprofylline; phenobarbital; phenytoin; prednisolone; rifampicin; salbutamol; salbutamol sulfate; salmeterol; salmeterol xinafoate; terbutaline; theophylline; tiotropium bromide; unclassified drug; unindexed drug; warfarin; zafirlukast; add on therapy; asthma; bronchospasm; cigarette smoking; clinical practice; clinical trial; combination chemotherapy; coughing; disease control; disease exacerbation; disease severity; drug blood level; drug dose increase; drug inhibition; drug mechanism; drug megadose; drug potentiation; drug substitution; drug withdrawal; dust; evidence based medicine; exercise; glaucoma; heart palpitation; human; hypokalemia; inhaler; low drug dose; lung function; metallic taste; metered dose inhaler; monotherapy; multiple cycle treatment; mydriasis; nervousness; patient assessment; patient compliance; patient counseling; patient education; pollen; practice guideline; review; side effect; smoking cessation; tachycardia; taste disorder; tremor; unspecified side effect; urine retention; wheezing; xerostomia; accolate; advair; airomir; alvesco; atrovent; berotec; bricanyl; choledyl; combivent; duovent

An information session for glaucoma patients - Blondeau, P.; Esper, P.; Mazerolle, É. (Canadian Journal of Ophthalmology, 2007)
Background: A 2-hour information session to improve understanding and compliance was offered to glaucoma patients. Three studies are presented regarding the participants, their satisfaction with the presentation, and their retention of information. Methods: One hundred consecutive patients were invited to participate. Age, sex, race, travelling distance, type of glaucoma, number of medications, duration of glaucoma, laser trabeculoplasty, trabeculectomy, medical conditions, visual acuity, visual field mean deviation, and pattern standard deviation (PSD) were documented. At the conclusion of the session, patient satisfaction was determined using a questionnaire. Responses to 6 glaucoma-related questions were requested prior to the session and again at 1, 4, and 10 months afterwards. The effects of age, sex, duration of glaucoma, drops applied, and compliance were analysed. Results: The invitation was accepted by 65.2% of all subjects, including 93.4% of those who had been undergoing therapy for less than 1 year. Factors identified in nonparticipation were advanced age, a longer duration of glaucoma, coronary heart disease, and worse PSD in the worse eye. Transportation was the main reason for nonparticipation. Patient satisfaction was excellent, and 99% indicated that they would recommend the clinic to friends with glaucoma. Patient knowledge increased and persisted throughout the 10 months. Older participants had lower scores. Interpretation: Most patients wanted to participate in the information session. Participants subjectively felt that the session was useful. It improved their knowledge of glaucoma, and has the potential to increase patient compliance.
Keywords: antiglaucoma agent; age distribution; article; disease duration; female; glaucoma; human; ischemic heart disease; major clinical study; male; patient compliance; patient education; patient satisfaction; patient transport; questionnaire; race difference; sex difference; visual acuity; visual field

Management of Patients With Ocular Hypertension: A Cost-Effectiveness Approach From the Ocular Hypertension Treatment Study - Rosenbaum, L.J. (American Journal of Ophthalmology, 2007)
Keywords: beta adrenergic receptor blocking agent; timolol; cost effectiveness analysis; drug cost; follow up; glaucoma; human; intraocular hypertension; intraocular pressure; letter; medicare; ophthalmoscopy; patient compliance; priority journal; remission; reproducibility; trabeculoplasty; treatment indication; visual field

Drugs for some common eye disorders. (Treatment guidelines from the Medical Letter, 2007)
Keywords: alpha adrenergic receptor stimulating agent; angiogenesis inhibitor; antiinfective agent; antioxidant; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; cyclosporine; eye drops; glucocorticoid; immunosuppressive agent; osmotic diuretic agent; prostaglandin; triamcinolone acetonide; vasculotropin A; zinc; allergic conjunctivitis; conjunctivitis; drug antagonism; dry eye; eye disease; glaucoma; human; patient compliance; patient selection; photochemotherapy; macular degeneration; review; treatment outcome

Into the Looking Glass: Factors and Opportunities to Reshape Eye Care in the Next 25 Years - Lee, P. (Ophthalmology, 2007)
Keywords: clinical practice; demography; diabetic retinopathy; editorial; eye care; eye disease; eye examination; glaucoma; government regulation; health care; health care access; health care cost; health care policy; health care quality; human; politics; practice guideline; priority journal; macular degeneration; surgical technique

Statins and the risk of lung, breast, and colorectal cancer in the elderly - Setoguchi, S.; Glynn, R.J.; Avorn, J.; Mogun, H.; Schneeweiss, S. (Circulation, 2007)
BACKGROUND - Although most randomized trials and meta-analyses suggest a slight or no increase in the risk of cancer in statin users, results from observational studies have been conflicting, and some have even suggested a large protective effect of statins on certain cancers. Long-term statin users tend to be healthier, less frail, and more adherent to therapy than nonusers, however. This could explain such apparent "protective" effects. METHODS AND RESULTS - We conducted the present cohort study by linking data from a large state drug benefit program with cancer registry data and Medicare healthcare utilization data. We identified all initiators of statins; initiators of glaucoma medications, another preventive drug, served as a comparison group. Outcomes included all registry-identified cases of colorectal, lung, and breast cancer. Multivariable Cox proportional models were used to adjust for confounding. Patient characteristics were similar in both groups, but statin initiators (n=24 439) were slightly younger and used some services more frequently than glaucoma drug initiators (n=7284). The mean follow-up was 2.9 years, with the longest follow-up being 8.4 years. Incidence rates of colorectal, lung, and breast cancers in both groups were very similar to rates in the general population. Adjusted hazard ratios were 0.96 (95% CI, 0.70 to 1.31) for colorectal cancer, 1.11 (95% CI, 0.77 to 1.60) for lung cancer, and 0.99 (95% CI, 0.74 to 1.33) for breast cancer. CONCLUSIONS - These data from a large population of typical older patients who began using statins indicate that it is unlikely that statins confer a clinically important decrease or increase in the risk of colorectal, lung, or breast cancer over the durations studied. © 2007 American Heart Association, Inc.
Keywords: acetylsalicylic acid; antiglaucoma agent; atorvastatin; estrogen; fluindostatin; hydroxymethylglutaryl coenzyme A reductase inhibitor; mevinolin; nonsteroid antiinflammatory agent; pravastatin; simvastatin; aged; aging; article; breast cancer; cancer incidence; cancer prevention; cancer registry; cancer risk; cohort analysis; colorectal cancer; comparative study; confidence interval; control group; controlled study; drug effect; female; follow up; glaucoma; groups by age; hazard ratio; health care utilization; human; lung cancer; major clinical study; male; medicare; multivariate analysis; priority journal; proportional hazards model; side effect; aspirin

Targeted interventions for difficult-to-treat asthma - Chipps, B.E.; Harder, J.M. (Expert Opinion on Therapeutic Targets, 2007)
Chronic persistent asthma has a significant burden in terms of healthcare-related expenses, decreased productivity and reduced quality of life for patients. Currently available guideline-directed therapy can control the majority of patients, but roughly one-third of patients will require additional care. This article reviews the barriers that hinder the ability of practitioners and patients to gain and maintain control of asthma, including inaccurate assessment measures, variability in patient response, and poor adherence. Strategies aimed at controlling difficult-to-treat disease, such as the use of biomarkers to assess control, are discussed. Newer and developing therapies that cater to specific types of asthmatic patients and may lead to improved outcomes in those patients for whom standard care is insufficient are also looked at. © 2007 Informa UK Ltd.
Keywords: arformoterol; beclometasone; beta 2 adrenergic receptor stimulating agent; biological marker; budesonide; carmoterol; ciclesonide; corticosteroid; etanercept; fluticasone; fluticasone propionate; fluticasone propionate plus salmeterol; milveterol; gsk 597901; indacaterol; leukotriene receptor blocking agent; long acting drug; montelukast; omalizumab; phosphodiesterase IV inhibitor; placebo; roflumilast; suplatast tosylate; tumor necrosis factor inhibitor; unclassified drug; adrenal suppression; asthma; cataract; chronic obstructive lung disease; clinical protocol; clinical trial; cytokine production; diagnostic accuracy; disease control; drug bioavailability; drug dose increase; drug dose reduction; drug dose titration; drug half life; drug induced headache; drug mechanism; drug megadose; drug protein binding; drug targeting; dysphonia; fracture; glaucoma; glucose intolerance; growth retardation; human; hydrocortisone release; low drug dose; monotherapy; nausea; patient care; patient compliance; pharyngitis; review; side effect; skin disease; systematic review; thrush; treatment response; gsk 159797; gsk 597901

Currently Available Antiepileptic Drugs - Schachter, S.C. (Neurotherapeutics, 2007)
Many new antiepileptic drugs (AEDs) have become available over the past 15 years. At the same time, the emphasis on treating patients with epilepsy has grown from stopping seizures to avoiding side effects and maximizing quality of life. This review summarizes currently available AEDs, and presents general treatment principles and guidelines for AED selection. Unfortunately, despite the increased treatment options of today, seizure freedom without side effects remains unattainable for too many patients with epilepsy. Consequently, there remains a significant need for further development of new therapies. © 2007 The American Society for Experimental NeuroTherapeutics, Inc.
Keywords: anticonvulsive agent; carbamazepine; carbamazepine 10,11 oxide; cimetidine; contraceptive agent; dextropropoxyphene; diltiazem; erythromycin; ethosuximide; etiracetam; felbamate; fluoxetine; gabapentin; isoniazid; lamotrigine; oxcarbazepine; phenobarbital; phenytoin; phenytoin; pregabalin; primidone; tiagabine; topiramate; unclassified drug; valproate semisodium; valproic acid; verapamil; viloxazine; zonisamide; abdominal pain; absence; acne; aggression; agitation; agranulocytosis; anhidrosis; anorexia; anxiety; aplastic anemia; appetite; article; asthenia; ataxia; behavior change; blurred vision; bone marrow suppression; capillary resistance; cerebellum atrophy; closed angle glaucoma; cognitive defect; confusion; depression; dermatitis; diarrhea; diplopia; disease exacerbation; dizziness; dose response; drowsiness; drug clearance; drug dependence; drug dose increase; drug dose titration; drug efficacy; drug eruption; drug half life; drug hypersensitivity; drug induced headache; drug mechanism; drug metabolism; drug safety; dysarthria; dysphasia; epilepsy; erythema multiforme; face coarsening; face coarsening; face disorder; fatigue; fetus disease; flapping tremor; fluid retention; folic acid deficiency; gingiva hyperplasia; hair loss; hepatitis; hiccup; hirsutism; human; hyperactivity; hyperthermia; hyponatremia; insomnia; kidney failure; Lennox Gastaut syndrome; lethargy; libido disorder; liver failure; liver metabolism; loading drug dose

Clinical Safety Profile of Posterior Juxtascleral Depot Administration of Anecortave Acetate 15 mg Suspension as Primary Therapy or Adjunctive Therapy with Photodynamic Therapy for Treatment of Wet Age-Related Macular Degeneration - Regillo, C.D.; D'Amico, D.J.; Mieler, W.F.; Schneebaum, C.; Beasley, C.H.; Sullins, G.T. (Survey of Ophthalmology, 2007)
Objectives: Safety data for anecortave acetate 15 mg suspension (Retaane 15 mg, Alcon Research, Ltd., Ft. Worth, TX 76134) as primary or adjunctive therapy with photodynamic therapy are available for 358 patients with age-related macular degeneration who received this novel cortisene during clinical trials in which the drug was administered via posterior juxtascleral depot every 6 months for 2 years. Methods: Detailed ophthalmic examinations, physical examinations, and adverse event reporting were used to characterize the clinical safety of anecortave acetate 15 mg and were monitored by an Independent Safety Committee. Results: Anecortave acetate 15 mg was safe and well tolerated in the overall patient population. No serious, treatment-related deaths were reported. Ocular adverse events assessed as related to anecortave acetate 15 mg were non-serious with one exception (retinal detachment), mild to moderate in intensity with one exception, generally resolved with or without treatment, and did not interrupt patient participation in the studies with two exceptions. Conclusions: Anecortave acetate 15 mg is safe and well-tolerated when administered as a posterior juxtascleral depot at 6-month intervals for use as primary therapy or as adjunctive therapy with PDT. © 2007 Elsevier Inc. All rights reserved.
Keywords: anecortave; placebo; abnormal vision; accidental injury; adjuvant therapy; alopecia; anisocoria; arthritis; article; blurred vision; cataract; clinical trial; conjunctival hyperemia; depression; diabetes mellitus; digestive system injury; disease severity; drug delivery system; drug formulation; drug monitoring; drug safety; drug tolerability; eye discomfort; eye edema; eye examination; eye pain; eyelid edema; eyelid pruritus; gastrointestinal disease; health care organization; human; hypercholesterolemia; hyperlipidemia; hypertension; infection; intraocular foreign body; intraocular hypertension; intraocular pressure; lacrimation; lung disease; meta analysis; nausea; patient compliance; photodynamic therapy; physical examination; pigment disorder; pigmentation; population research; priority journal; ptosis (eyelid); pupil disease; retina artery occlusion; retina detachment; retina disease; age related macular degeneration; retinopathy; scar; side effect; single drug dose; suspension; systematic review; treatment indication; treatment outcome; visual acuity; vitreous body detachment; retaane

The side effects of the prostaglandin analogues - Holló, G. (Expert Opinion on Drug Safety, 2007)
In the last decade topically applied prostaglandin F2α analogues (bimatoprost, latanoprost, travoprost and unoprostone) have become widely used as a means to reduce elevated intraocular pressure in patients with glaucoma and ocular hypertension. These molecules ali have similar side-effect profiles, which include both side effects that occur frequently (e.g., conjunctiva hyperaemia, increase of iris pigmentation and eyelash changes) and rare adverse reactions (e.g., periocular pigmentation, damage to the blood-aqueous barrier and cystoid macular oedema). Conjunctiva hyperaemia, eyelash changes and cystoid macular oedema are reversible, but certain other side effects, such as increased iris pigmentation, are not. However, the systemic side-effect profile is favourable for all the prostaglandin analogues, and some of the local side effects are only of cosmetic significance. Numerous clinical studies suggest that discontinuing treatment with prostaglandin analogues on account of their side effects is rare in clinical practice. © 2007 Informa UK Ltd.
Keywords: bimatoprost; corticosteroid; eye drops; latanoprost; nonsteroid antiinflammatory agent; prostaglandin derivative; prostaglandin F2 alpha derivative; prostaglandin receptor; travoprost; unclassified drug; unoprostone; abdominal cramp; abortion; blepharitis; blood eye barrier; blurred vision; burning sensation; clinical trial; conjunctival hyperemia; cornea erosion; cornea sensibility; disease severity; drug contraindication; drug efficacy; drug half life; drug hypersensitivity; drug induced headache; drug mechanism; drug megadose; drug metabolism; drug receptor binding; drug safety; drug tissue level; drug use; drug withdrawal; dry eye; eye discharge; eye discomfort; eye inflammation; eye irritation; eye pain; eye toxicity; eyelash; eyelid disease; eyelid edema; fetotoxicity; glaucoma; herpes simplex keratitis; human; hypertrichosis; intraocular foreign body; intraocular pressure abnormality; iris disease; monotherapy; ocular pruritus; pathophysiology; patient compliance; prescription; receptor affinity; retina macula cystoid edema; review; side effect; treatment contraindication; uvea melanoma; uveitis; vasodilatation; visual disorder

Painful diabetic neuropathy: A management-centered review - Huizinga, M.M.; Peltier, A. (Clinical Diabetes, 2007)
Keywords: amitriptyline; anticonvulsive agent; antidepressant agent; capsaicin; carbamazepine; citalopram; cyanocobalamin; desipramine; doxepin; duloxetine; fluoxetine; gabapentin; glibenclamide; glitazone derivative; imipramine; insulin; lamotrigine; metformin; mexiletine; nonsteroid antiinflammatory agent; nortriptyline; paracetamol; paroxetine; pregabalin; serotonin uptake inhibitor; topiramate; tramadol; tricyclic antidepressant agent; valproic acid; venlafaxine; acute kidney failure; adult; aged; agitation; agranulocytosis; alopecia; analgesia; anorexia; aplastic anemia; application site burning; application site pruritus; application site reaction; ataxia; bicarbonate blood level; blood pressure; blurred vision; burning sensation; cardiotoxicity; case report; central nervous system disease; clinical trial; closed angle glaucoma; cognitive defect; confusion; constipation; coughing; B12 deficiency; depression; diabetes mellitus; diabetic neuropathy; diagnostic procedure; diarrhea; diplopia; disease classification; dizziness; drug contraindication; drug dose increase; drug dose titration; drug efficacy; drug substitution; lack of drug effect; drug withdrawal; dyspepsia; epidemiological data; falling; fatigue; female; glycemic control; headache; heart arrhythmia; heart proarrhythmia; heart rate; human; hyperchloremic acidosis; hyperesthesia; hypertension; hyperthermia; hyponatremia; inappropriate vasopressin secretion; insomnia; insulin treatment; kidney dysfunction; leg pain; leukopenia; liver toxicity; low drug dose; male; memory disorder; metabolic acidosis; migraine

Midterm response with latanoprost therapy in german ocular hypertension patients - Thelen, U.; Christ, T.; Schnober, D.; Hofstetter, H.-J.; Stewart, W.C. (Current Eye Research, 2007)
Purpose: The purpose of this prospective observational trial was to report the analysis of the midterm efficacy, safety, and discontinuation rates of a cohort of ocular hypertensive patients treated with latanoprost in Germany. Methods: A subanalysis of patients with ocular hypertension who were previously treated on latanoprost monotherapy and continued within the study on this same medication for at least 6 months. Results: 353 patients with ocular hypertension were included and treated with latanoprost monotherapy historically (1.4 ± 1.3 years) and within the observational period of the study for a mean of 2.2 ± 1.1 years. On latanoprost only, the average intraocular pressure at study entry was 18.4 ± 2.7 mm Hg, and at 6 months the intraocular pressure was 18.3 ± 2.3 mmHg (p = 0.54). During the observational period, the most common ocular side effect was conjunctival hyperemia (20.7%), and the most common systemic side effect was fatigue (3.1%). Nineteen patients (5.4%) discontinued latanoprost with the most common reason being insufficient efficacy (3.1%). Physician assessments of latanoprost monotherapy were "very good" to "excellent" for patient efficacy (75.2%), tolerability (83.8%), and patient satisfaction (82.1%). Conclusions: The study suggests that patients with ocular hypertension already treated with latanoprost monotherapy will continue to have, on average, at least midterm stable pressures, low incidence of side effects and discontinuations, as well as "very good" to "excellent" physician ratings of efficacy, tolerability, and patient satisfaction. Copyright © Informa Healthcare.
Keywords: latanoprost; adult; aged; article; burning sensation; clinical trial; conjunctival hyperemia; controlled clinical trial; drug efficacy; drug hypersensitivity; drug induced headache; drug response; drug safety; drug tolerability; drug withdrawal; fatigue; female; Germany; human; intraocular hypertension; intraocular pressure; major clinical study; male; monotherapy; multicenter study; nausea; observational study; patient compliance; patient satisfaction; priority journal; prospective study; sensory dysfunction; xalatan

Minimising blinding complications of cyclodiode laser in high risk and only eyes [15] - Sii, F.; Shah, P.; Lee, G.A. (Eye, 2007)
Keywords: blindness; choroid hemorrhage; diode laser; echography; glaucoma; health care utilization; high risk population; human; intraocular hypotension; intraocular pressure; laser coagulation; letter; panophthalmitis; safety; scleritis

Utilization of an ophthalmic casualty - A critical review [16] - Kadyan, A.; Sandramouli, S.; Caruana, P. (Eye, 2007)
Keywords: cataract; controlled study; demography; disease duration; emergency care; eye infection; eye inflammation; eye injury; glaucoma; health care access; health care utilization; health service; human; laser surgery; letter; major clinical study; nurse practitioner; ophthalmology; outpatient care; patient referral; vitreoretinopathy; working time

Ophthalmology workforce: Crisis? What crisis? - Persaud, D.D. (Canadian Journal of Ophthalmology, 2007)
Keywords: aging; amblyopia; cataract extraction; clinical practice; diabetic retinopathy; editorial; eye care; eye disease; general practitioner; glaucoma; health care access; health care delivery; health care personnel; health care quality; hospital admission; human; patient care; physician; residency education; strabismus

Latanoprost versus timolol gel-forming solution once daily in primary open-angle glaucoma or ocular hypertension - Harasymowycz, P.; Hutnik, C.M.L.; Nicolela, M.; Stewart, W.C. (Canadian Journal of Ophthalmology, 2007)
Background: To compare the efficacy and safety of latanoprost and timolol gel-forming solution (GFS). Methods: This was a randomized, crossover, investigator-masked, active-control study of patients with primary open-angle glaucoma and ocular hypertension. Patients received either once-daily 0.5% timolol GFS (n = 40) or once-daily 0.005% latanoprost (n = 35) for 8 weeks (period I ). Patients were then crossed over to the other medication and treated for another 8 weeks (period 2). Intraocular pressure (IOP) was determined every 2 hours from 8:00 to 20:00 at baseline and weeks 8 and 16. Safety was assessed by visual acuity, slit-lamp biomicroscopy, and adverse event reports. Results: During period I, reduction in mean (SD) diurnal IOP was significantly greater in latanoprost-treated patients (-6.9 [3.0] mm Hg) than in timolol GFS-treated patients (-5.5 [2.4] mm Hg), p = 0.034. There was also a significant reduction in IOP from baseline after switching from timolol GFS to latanoprost (p < 0.001), not observed when patients were switched from latanoprost to timolol GFS. After results from each drug's treatment periods were combined between treatment arms, latanoprost reduced IOP more (-6.9 [2.9] mm Hg) than did timolol GFS (-6.2 [2.7] mm Hg), p = 0.018. Hyperemia was the most common adverse event in both treatment groups, with 5 incidences in timolol GFS-treated patients, and IO in latanoprost. Interpretation: Latanoprost is more effective than timolol GFS in reducing IOP, and patients switched from timolol GFS to latanoprost have a further significant reduction in IOP.
Keywords: latanoprost; timolol maleate; abnormal sensation; adult; anxiety disorder; article; blepharitis; bradycardia; cardiogenic shock; clinical trial; confusion; conjunctivitis; controlled clinical trial; controlled study; crossover procedure; depression; dizziness; drug efficacy; drug fatality; drug safety; dry eye; erythema; eye discharge; eyelid edema; female; foreign body sensation; foreign body sensation; gastrointestinal symptom; headache; hearing disorder; heart disease; heart infarction; human; hyperemia; infection; intraocular hypertension; intraocular pressure; kidney disease; major clinical study; male; memory disorder; multiple cycle treatment; musculoskeletal disease; nightmare; open angle glaucoma; patient compliance; punctate keratitis; randomized controlled trial; respiratory tract disease; single blind procedure; skin discoloration; skin disease; slit lamp; superficial punctate keratitis; superficial punctate keratitis; tibia fracture; tremor; ureter obstruction; vascular disease; visual acuity; timoptic; xalatan

Optimizing the psychopharmacotherapy of depression and medication adherence in primary care - Lam, E.W.W. (Hong Kong Practitioner, 2007)
Evidence has shown that psychopharmacotherapy for patients with depression in primary care is effective. Inappropriate choice of medications and medication non-adherence are common in everyday practice. Nowadays, remission is considered as the treatment goal for depression and accurate diagnostic formulation, involving patient in management planning and rational choice of medications at different phases of treatment are pertinent. Medication adherence can be optimized through measures at drug, patient, doctor, family and community levels. Difficult cases should warrant referral and a collaborative care approach should be implemented into our primary care system.
Keywords: amfebutamone; amitriptyline; antidepressant agent; benzodiazepine; beta adrenergic receptor blocking agent; buspirone; citalopram; dosulepin; duloxetine; escitalopram; fluoxetine; generic drug; mirtazapine; paroxetine; serotonin uptake inhibitor; sertraline; tricyclic antidepressant agent; venlafaxine; zolpidem; zopiclone; agitation; anorgasmia; anticholinergic effect; article; behavior therapy; blurred vision; clinical effectiveness; clinical practice; clinical trial; constipation; controlled release formulation; cost effectiveness analysis; depression; diagnostic accuracy; drug choice; drug cost; drug efficacy; drug induced headache; drug response; drug safety; drug substitution; drug withdrawal; ejaculation disorder; erectile dysfunction; evidence based medicine; follow up; glaucoma; Hamilton Depression Rating Scale; health care cost; human; hypertension; impotence; insomnia; libido disorder; medical decision making; meta analysis; motivation; nausea; patient care; patient compliance; patient referral; practice guideline; primary medical care; psychoeducation; psychopharmacotherapy; psychotherapy; remission; risk reduction; sexual dysfunction; side effect; social support; somnolence; sustained release formulation; sweating; systematic review; tablet formulation; tachycardia; treatment duration; treatment failure; treatment planning; tremor; unspecified side effect; urine retention; body weight gain; body weight loss; xerostomia

Postkeratoplasty emergency visits - A review of 100 consecutive visits - Gnanaraj, L.; Sandhu, S.; Hildreth, A.J.; Figueiredo, F.C. (Eye, 2007)
Purpose: Preoperative counselling for penetrating keratoplasty should include awareness of symptoms and signs of possible complications as early presentation can enhance long-term success. In our corneal transplantation service, all patients are routinely instructed to arrange a same day emergency visit through a dedicated telephone line if they experience any symptoms in eyes that have undergone keratoplasty. This study was designed to evaluate the reason for presentation, management outcome of each visit and the efficiency of the system in management of postkeratoplasty complications. Methods: A review of 100 consecutive emergency visits by postpenetrating keratoplasty (PKP) patients in a tertiary eye care centre was included. Results: Sixty-two patients with varied preoperative diagnoses presented during the review period. Sixteen visits were within the first month after surgery and 40 visits within the first year. Ten patients (16%) sought consultation more than twice during the study period with one patient presenting five times. Pain and grittiness were the main presenting symptoms (68%). Loose corneal suture (25%) necessitating removal was the most common diagnosis. Sixteen visits resulted in hospital admission for treatment. The graft survived in all patients and the visual acuity was preserved in 95% of our patients. Conclusion: Most corneal surgeons educate their patients to seek prompt treatment for symptoms such as redness, sensitivity to light, loss of vision, pain, or any other symptoms in eyes that have undergone keratoplasty. Early intervention of sight threatening complications increases the chance of graft survival and best-obtained vision. This review shows a simple open access system facilitates early presentation and successful management of postgraft complications.
Keywords: antibiotic agent; steroid; adult; aged; clinical evaluation; conjunctival hemorrhage; conjunctivitis; consultation; early intervention; emergency care; emergency health service; facial nerve paralysis; female; follow up; frequency analysis; graft infection; graft rejection; graft survival; health care access; hospital admission; human; intraocular hypertension; keratitis; major clinical study; male; patient education; penetrating keratoplasty; photosensitivity; postoperative complication; postoperative pain; retina detachment; review; suture removal; treatment outcome; visual acuity; visual disorder; visual impairment

A step toward integration of an ambulatory pharmacist in a multidisciplinary diabetes team caring for the elderly - Morais, J.A.; Mallet, L. (Canadian Journal of Diabetes, 2007)
Keywords: acetylsalicylic acid; antilipemic agent; dipeptidyl carboxypeptidase inhibitor; oral antidiabetic agent; aged; ambulatory care; comorbidity; constipation; drug use; elderly care; glaucoma; human; hypertension; non insulin dependent diabetes mellitus; osteoporosis; pharmacist attitude; polypharmacy; prophylaxis; quality of life; short survey; treatment outcome; aspirin

A 9-year-old girl with bilateral superficial punctate keratitis - Schwartz, R.L.; Choy, A.E. (Journal of Pediatric Ophthalmology and Strabismus, 2007)
Keywords: antihistaminic agent; article; case report; conjunctivitis; cornea; drug withdrawal; eyelid edema; eyelid erythema; female; human; patient compliance; punctate keratitis; school child; tear flow; visual acuity

Drooling - Lal, D.; Hotaling, A.J. (Current Opinion in Otolaryngology and Head and Neck Surgery, 2006)
PURPOSE OF REVIEW: Drooling is the involuntary spillage of saliva from the mouth. It is a major morbidity associated with cerebral palsy and other neurodegenerative disorders. The consequences of drooling are not restricted to medical issues but can cause major social handicaps. Severe psycho-social consequences, such as social stigmatization and emotional devastation for the patients and their families, may result. This paper reviews recent developments in the management of drooling. RECENT FINDINGS: Recent publications report encouraging results with botulinum toxin A. Several surgeons report on their long-term results. Reviews analyze anticholinergic drugs, surgical options, biofeedback, behavioral and speech therapy, and a multidisciplinary team approach. SUMMARY: A team approach is the key to successful rehabilitation. Oromotor therapy is the most useful nonsurgical option. Drugs are unsuitable for long-term use due to adverse effects causing serious medical complications or noncompliance. Botulinum toxin A injection is promising, but no data exists on optimal dosage, duration of action and frequency of repeat injections. Bilateral submandibular duct relocation with bilateral sublingual gland excision has been shown to be effective and safe in long-term follow-up of the largest series of patients. At present, it is the best available surgical option. © 2006 Lippincott Williams & Wilkins, Inc.
Keywords: botulinum toxin A; cholinergic receptor blocking agent; scopolamine; behavior modification; behavior therapy; blurred vision; clinical trial; confusion; constipation; dysphagia; feedback system; flu like syndrome; glaucoma; human; hypersalivation; long term care; nerve excitability; oral motor therapy; patient compliance; priority journal; psychosis; review; speech therapy; surgical technique; therapy; urine retention; xerostomia

Living with the wolf - Lau, A.; Feng, P.H. (APLAR Journal of Rheumatology, 2006)
Keywords: steroid; acquired immune deficiency syndrome; adult; article; case report; clinical feature; coronary artery aneurysm; cost of illness; differential diagnosis; disease severity; doctor patient relationship; female; glaucoma; hip prosthesis; human; immune system; kidney failure; lifespan; long term care; medical specialist; mental stress; patient attitude; patient compliance; priority journal; quality of life; relapse; remission; salmonellosis; skin manifestation; staging; systemic lupus erythematosus; unspecified side effect

Considerations in developing model-based economic evaluations of glaucoma treatment - Althin, R.; Grima, D.T.; Dhawan, R.; Bernard, L.M. (Journal of Glaucoma, 2006)
PURPOSE: To facilitate future glaucoma model development and to provide guidance for decision-makers evaluating them, we provide an overview of an innovative glaucoma model and highlight important modeling considerations. CONSIDERATIONS: The considerations that were addressed include: disease outcome that is both relevant and meaningful to current clinical practice; diversity in treatment options and practices; incorporation of therapy discontinuation; and consideration of the variability in patient response to treatment. MODEL SCOPE: A state-transition, Monte Carlo simulation model was developed to simulate the management and treatment of patients with glaucoma and/or ocular hypertension. The model examines strategies involving sequential use of up to 6 pharmacologic interventions. Transitions are based on the monthly probability that a patient is no longer "successfully maintained" on therapy, which can be a consequence of lack of intraocular pressure control, adverse events, lack of compliance, or lack of persistence. Outputs of the model include months on each treatment, frequency of therapy switches, days of intraocular pressure control, frequency of ophthalmologist visits, frequency of surgery, and glaucoma-related costs. The model allows the user to specify country-specific treatment strategies, survival on therapy, surgical rates, practice patterns, and costs. CONCEPT APPLICATION: The model presented offers insights into accommodating patient and clinician variability through the use of persistence distributions. It will facilitate future glaucoma model development and provide insight for decision-makers who must evaluate model-based analyses of the economic value of glaucoma interventions. © 2006 Lippincott Williams & Wilkins, Inc.
Keywords: beta adrenergic receptor blocking agent; brimonidine; carbonate dehydratase inhibitor; latanoprost; biodiversity; clinical practice; cost effectiveness analysis; disease course; drug cost; lack of drug effect; economic evaluation; eye surgery; glaucoma; health care cost; human; intraocular hypertension; intraocular pressure; medical decision making; medical specialist; Monte Carlo method; open angle glaucoma; ophthalmology; outcome assessment; patient compliance; priority journal; probability; review; simulation; survival; treatment failure; treatment outcome; treatment planning; treatment response; treatment withdrawal

Migration of glaucoma drainage device extender into anterior chamber after trauma - Sheets, C.W.; Ramjattan, T.K.; Smith, M.F.; Doyle, J.W. (Journal of Glaucoma, 2006)
PURPOSE: Glaucoma drainage devices, on rare occasions, need repositioned and the intraocular portion of the implant tube is found to be "too short" to do so. Previously, a technique was described for "extending" the tube with angiocatheter material (rather than replacing the entire apparatus), and had been performed successfully without complication for 7 years. This case describes the first known complication: trauma causing anterior chamber migration of the tube extension requiring retrieval and reconstruction of the tube extension apparatus. PATIENT AND METHODS: One eye of 1 patient (age 8) with a prior glaucoma drainage device and tube extension with angiocatheter material with elevated intraocular pressure after direct trauma to the eye from a pencil. Office examination revealed inferior corneal edema and no tube segment visible in the anterior chamber on limited examination due to age-related compliance. Gonioscopy under anesthesia revealed the tube extender in the inferior anterior chamber. The tube extender was retrieved from the anterior chamber. The glaucoma drainage device was surgically exposed and the tube extension was reconstructed, including securing the tube extension with a suture placed through the lumens of both the angiocatheter extender and the tube extension. RESULTS: The reconstructed tube extension maintained good draining function with the secured extension and no further migration of the tube extension into the anterior chamber was seen. CONCLUSIONS: Tube extension using angiocatheter material continues to be a viable, cost-effective option in difficult cases. Placing a securing suture in patients prone to eye trauma can be considered. © 2006 Lippincott Williams & Wilkins, Inc.
Keywords: anesthesia; anterior eye chamber; article; case report; clinical examination; cornea edema; drain; eye injury; glaucoma; glaucoma drainage implant; gonioscopy; human; intraocular pressure abnormality; intravenous catheter; male; migration; patient compliance; priority journal; school child; Baerveldt

Intravitreal Bevacizumab (Avastin®) in the Treatment of Neovascular Glaucoma - Iliev, M.E.; Domig, D.; Wolf-Schnurrbursch, U.; Wolf, S.; Sarra, G.-M. (American Journal of Ophthalmology, 2006)
Purpose: To describe a case series of neovascular glaucoma (NVG) caused by central retinal vein occlusion (CRVO) that was treated with intravitreal bevacizumab (IVB; Avastin®). Design: Retrospective interventional case series. Methods: Six consecutive patients with NVG and a refractory, symptomatic elevation of intraocular pressure (IOP) and pronounced anterior segment congestion received IVB (1.25 mg/0.05 ml). Diode laser cyclophotocoagulation was carried out only if pressure was controlled insufficiently by topical medication. Follow-up examinations occurred at four to 16 weeks. Results: IVB resulted in a marked regression of anterior segment neovascularization and relief of symptoms within 48 hours. IOP decreased substantially in three eyes; in the other three eyes, adjuvant cyclophotocoagulation was necessary. No side effects were observed. Panretinal photocoagulation (PRP) was performed as soon as feasible, five to 12 weeks after IVB treatment. Conclusion: IVB leads to a rapid regression of iris and angle neovascularization and should be investigated more thoroughly as an adjunct in the management of NVG. © 2006 Elsevier Inc. All rights reserved.
Keywords: bevacizumab; carbonate dehydratase inhibitor; absence of side effects; adjuvant therapy; adult; aged; anterior eye chamber angle; anterior eye segment; article; central retina vein occlusion; clinical article; controlled study; diode laser; feasibility study; female; follow up; human; intraocular hypertension; intraocular pressure; iris disease; laser coagulation; male; neovascular glaucoma; neovascularization (pathology); patient compliance; priority journal; remission; retrospective study; symptom; topical treatment; treatment outcome; avastin

Failure of medical therapy despite normal intraocular pressure - Walland, M.J.; Carassa, R.G.; Goldberg, I.; Grehn, F.; Heuer, D.K.; Khaw, P.T.; Thomas, R.; Parikh, R. (Clinical and Experimental Ophthalmology, 2006)
The disease glaucoma is now defined by characteristic optic disc and visual field change, without specific reference to the intraocular pressure (IOP). Success of treatment is no longer judged by the mere attainment of IOP less than 21mmHg. Controversy remains, however, in deciding appropriate management where optic disc and/or visual field damage continues to progress despite a 'normal' IOP having been achieved with medical treatment. A panel of international glaucoma experts has provided management recommendations in four clinical scenarios - open-angle glaucoma, open-angle glaucoma in a myopic contact lens wearer, uveitic glaucoma and open-angle glaucoma in combination with visually significant cataract - where optic nerve and visual field progression has continued despite an IOP less than 21mmHg on full medical treatment. Surgical intervention with mitomycin trabeculectomy is the most favoured further therapy. © 2006 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: antiglaucoma agent; apraclonidine; brimonidine; carbachol; carbonate dehydratase inhibitor; dexamethasone; dorzolamide plus timolol; fluorometholone; fluorouracil; latanoprost; mitomycin; pilocarpine plus timolol; prednisolone; prostaglandin; add on therapy; adult; age distribution; anamnesis; article; case report; cataract; cataract extraction; clinical feature; contact lens; dose time effect relation; drug hypersensitivity; drug substitution; eye surgery; family history; female; glaucoma; human; hyperemia; intraocular pressure; intraoperative period; iridocyclitis; laser coagulation; life expectancy; male; myopia; optic disk; patient compliance; postoperative complication; preoperative care; risk assessment; risk factor; trabeculectomy; treatment failure; visual acuity; visual system examination

Brimonidine in the treatment of glaucoma and ocular hypertension - Cantor, L.B. (Therapeutics and Clinical Risk Management, 2006)
Treatment in glaucoma aims to lower intraocular pressure (IOP) to reduce the risk of progression and vision loss. The alpha2-adrenergic receptor agonist brimonidine effectively lowers IOP and is useful as monotherapy, adjunctive therapy, and replacement therapy in open-angle glaucoma and ocular hypertension. A fixed combination of brimonidine and timolol, available in some countries, reduces IOP as effectively as concomitant therapy with brimonidine and timolol and offers the convenience of 2 drugs in a single eyedrop. Brimonidine is safe and well tolerated. Its most common side-effects are conjunctival hyperemia, allergic conjunctivitis, and ocular pruritus. The newest formulation of brimonidine, brimonidine-Purite 0.1%, has a higher pH to improve the ocular bioavailability of brimonidine. This formulation contains the lowest effective concentration of brimonidine and is preserved with Purite® to enhance ocular tolerability. Brimonidine-Purite 0.1% is as effective in reducing IOP as the original brimonidine 0.2% solution preserved with benzalkonium chloride. Recent results from preclinical and clinical studies suggest that brimonidine may protect retinal ganglion cells and their projections from damage and death independently of its effects on IOP. The potential for neuroprotection with brimonidine is an added benefit of its use in glaucoma and ocular hypertension. © 2006 Dove Medical Press Limited. All rights reserved.
Keywords: antiglaucoma agent; benzalkonium chloride; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; brimonidine plus timolol; brimonidine purite; carbonate dehydratase inhibitor; brimonidine plus timolol; dorzolamide; eye drops; latanoprost; placebo; prostaglandin derivative; timolol; travoprost; add on therapy; allergic conjunctivitis; apnea; asthenia; bradycardia; clinical trial; conjunctival hyperemia; depression; disease course; dosage schedule comparison; drowsiness; drug bioavailability; drug blood level; drug dosage form comparison; drug formulation; drug hypersensitivity; drug withdrawal; eye burning; eye discharge; eyelid erythema; fatigue; human; hyperemia; hypotension; hypothermia; insomnia; intraocular hypertension; lethargy; monotherapy; muscle hypotonia; neuroprotection; nonhuman; ocular pruritus; open angle glaucoma; patient compliance; pH; retina ganglion cell; review; risk reduction; somnolence; visual impairment; xerostomia; alphagan; combigan

Increasing uptake of eye services by women - Lewallen, S.; Courtright, P. (Community Eye Health Journal, 2006)
Keywords: blindness; cataract; cataract extraction; decision making; eye care; glaucoma; health care access; health care personnel; health service; hospital care; human; medical literature; patient counseling; quality of life; short survey; traffic and transport

Prevalence and description of treatment with intraocular pressure-lowering topical medications in continental France - Delcourt, C.; Bron, A.; Baudouin, C.; Denis, P.; Nordmann, J.-P.; Renard, J.-P.; Rouland, J.-F.; Sellem, E.; Stephan, M.; Levrat, F.; Solesse, A. (Journal Francais d'Ophtalmologie, 2006)
Purpose: The first objective of the present study was to estimate the prevalence of patients treated for glaucoma or ocular hypertension (OHT) with an IOP (intraocular pressure) -lowering topical medication. Subjects were 40 years old and living in continental France. The second objective was to describe the type of therapy, compliance, and the quality of life of the subjects treated.Methods: This study was a telephone survey conducted in a general population on a representative sample of 5726 subjects in 2004. Subjects treated for glaucoma or OHT were defined as those declaring use of eye drops for more than 1 month and mentioning one of the 52 registered IOP-lowering topical medications and/or stating that they were taking eye drops for glaucoma or OHT. Quality of life was measured using the GlauQOL-17 questionnaire.Results: 237 subjects (4.1%) corresponded to this definition. The prevalence increased with age, from 0.7% in subjects aged 40-44 years to 10.6% in those aged 80 years or more. The age-standardized prevalence was higher in the Paris area (5.3%), the Mediterranean (4.5%), and the Southwest (4.7%), and lower in rural areas (3.2%), and in subjects with less than high school education (2.9%). Beta-blockers (49.5%) and prostaglandins (37.4%) were the most frequent treatments, followed by carbonic anhydrase inhibitors (15.3%), sympathomimetics (5.7%), and myotics (1.3%). Compliance was not total in 39% of the patients (22% of those treated with once-a-day dosage).Discussion: The results of the present study are in line with French health authority data and with the results of the French "Glaucoma and intraocular high pressure, one day" study results. Moreover, the lower prevalence in regions with low medical density, low socioeconomic level, and rural areas, suggest that glaucoma or OHT might be underdiagnosed.Conclusion: On the basis of this first nationwide study, it can be estimated that the prevalence of subjects treated with IOP-lowering topical medications is about 1.2 million in France. The number of daily doses appears to influence compliance. © 2006. Elsevier Masson SAS. Tous droits réservés.
Keywords: adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; eye drops; miotic agent; prostaglandin; academic achievement; adult; age distribution; aged; article; controlled study; France; glaucoma; health survey; human; intraocular hypertension; intraocular pressure; major clinical study; patient compliance; quality of life; questionnaire; rural area; telemedicine; topical treatment; treatment outcome

Glaucoma in the developing world - Ramchandani, M. (British Medical Journal, 2006)
Keywords: antimetabolite; fluorouracil; mitomycin; beta radiation; cataract; cataract extraction; clinical trial; cost effectiveness analysis; disease course; editorial; eye care; follow up; funding; glaucoma; health service; human; incidence; infection; intraocular pressure; medical staff; patient compliance; postoperative period; priority journal; race difference; risk factor; suture removal; trabeculectomy; trachoma; treatment outcome; urban area

The State of Being Noninferior - Diestelhorst, M. (Ophthalmology, 2006)
Keywords: latanoprost; timolol; chronotherapy; clinical observation; clinical protocol; clinical trial; drug effect; drug efficacy; glaucoma; human; intraocular hypotension; intraocular pressure; letter; patient compliance; priority journal

Psychiatric manifestations and personality traits associated with compliance with glaucoma treatment - Pappa, C.; Hyphantis, T.; Pappa, S.; Aspiotis, M.; Stefaniotou, M.; Kitsos, G.; Psilas, K.; Mavreas, V. (Journal of Psychosomatic Research, 2006)
Objective: The aim of this study was to assess the impact of psychological distress and personality traits on self-rated compliance with glaucoma treatment. Methods: One hundred patients with primary open-angle glaucoma participated in the study. General Health Questionnaire, Symptom Distress Checklist, Center for Epidemiological Studies Depression Scale, Defense Style Questionnaire, and Hostility and Direction of Hostility Questionnaire were used. Results: Forty-two percent of patients with glaucoma classified as "noncompliers," those who omitted more than two doses per week. Noncompliers presented more severe symptoms of glaucoma. Depression was found to be associated with poor compliance, whereas adoption of immature defensive style further increased the risk for noncompliance with glaucoma treatment. Conclusions: Depression is associated with self-reported noncompliance with glaucoma treatment, whereas certain personality traits are involved in the increased risk for noncompliance. Further assessment of the depressive feelings by an ophthalmologist and treatment of depression as well as proper psychotherapeutic approaches for maladaptive personality features could be an essential strategy to diminish compliance problems. © 2006 Elsevier Inc. All rights reserved.
Keywords: adult; aged; article; Center for Epidemiological Studies Depression Scale; controlled study; defense mechanism; depression; disease severity; female; General Health Questionnaire; glaucoma; high risk patient; hostility; human; major clinical study; male; mental stress; patient compliance; personality; questionnaire; risk factor; self concept; Symptom Distress Scale; treatment outcome

Effect of Proview self-tonometry on pharmaceutical compliance. - Lievens, C.W.; Gunvant, P.; Newman, J.; Gerstner, M.; Simpson, C. (Clinical & experimental optometry : journal of the Australian Optometrical Association, 2006)
AIM: To evaluate changes in patient compliance with medical treatment while using the Proview Eye Pressure Monitor. METHODS: A crossover study design was used to compare the compliance of patients with established use of topical medication to lower intraocular pressure in the treatment of primary open-angle glaucoma. Thirty-two patients currently managed with latanoprost 0.005%, brimonidine 0.15%, travoprost 0.004% or bimatoprost 0.03% as monotherapy or in combination were randomly assigned to two study groups. Group 1 was instructed in the use of Proview Eye Pressure Monitor three times daily for 30 days as an adjunct to the glaucoma regimen. Group 2 was observed with no change in the patients' treatment regimen during this phase of study. A crossover occurred at 30 days. Compliance was monitored by assigning new bottles of topical medication during each phase of study. Bottles were weighed with a Mettler balance (Mettler Toledo Co.) at the initiation and completion of each phase. The changes in bottle-weight determined the amount of medication consumed by each patient for each phase of the study. The weights were analysed to estimate changes in compliance. RESULTS: A paired samples Student t-test compared the consumed bottle weights with and without Proview Eye Pressure Monitor usage. No statistical significance or trend was identifiable (p = 0.98). Use of the Proview Eye Pressure Monitor did not significantly change compliance with adjunct eye drop medication. CONCLUSION: The use of the Proview Eye Pressure Monitor use did not improve but appeared to hinder compliance with glaucoma treatment in this study.
Keywords: antihypertensive agent; eye drops; adult; aged; article; clinical trial; controlled clinical trial; controlled study; crossover procedure; follow up; human; intraocular pressure; methodology; middle aged; oculoplethysmography; open angle glaucoma; pathophysiology; patient compliance; physiology; prognosis; prospective study; randomized controlled trial

Patients' and physicians' perceptions of the travoprost dosing aid: An open-label, multicenter study of adherence with prostaglandin analogue therapy for open-angle glaucoma or ocular hypertension - Flowers, B.; Wand, M.; Piltz-Seymour, J.; Berke, S.J.; Day, D.; Teague, J.; Smoot, T.M.; Landry, T.A.; Bergamini, M.V.W.; Mallick, S. (Clinical Therapeutics, 2006)
Objective: This study describes patients' and physicians' perceptions of issues related to dosing adherence with topical therapies for lowering intraocular pressure before and after use of the travoprost dosing aid (Travatan™ Dosing Aid, Alcon Research Ltd., Fort Worth, Texas). Methods: The study had an open-label, multicenter, single-treatment-arm design that included sequential patients with open-angle glaucoma (with or without pigment dispersion or pseudoexfoliation component) or ocular hypertension who were taking any prostaglandin analogue monotherapy. Ten participating physicians were chosen on the basis of factors such as their experience, qualifications, and previous clinical study participation. The study consisted of 2 visits: screening and week 4. Patients were asked to complete a survey about their medication adherence before study entry at the screening visit and at study exit during the week-4 visit. In addition, each physician was asked to complete an entry and exit survey on each patient as well as a survey to provide feedback on the travoprost dosing aid. Results: Of the 87 enrolled patients, 6 did not complete the exit survey; therefore, 81 patients were included in the intent-to-treat analysis. Mean (SD) age at enrollment was 65.4 (11.6) years; 61.7% (50/81) of the patients were women and 60.5% (49/81) were white. Most patients (96.3% [78/81]) had open-angle glaucoma. Participating physicians perceived that problems involving dosing and adherence were reduced after patients used the dosing aid. Physicians indicated that they would recommend continued use of the travoprost dosing aid for 91.3% (73/80) of patients. All 10 participating physicians said that they would recommend the dosing aid to patients in the future. Of the 81 patients, the majority (68.8% [55/80]) indicated that they would like to continue using the travoprost dosing aid. For 67.5% (54/80) of patients, dosing adherence as recorded by the travoprost dosing aid was >70%. The dosing lever (39.7% [31/78]) and the visual alarm (29.5% [23/78]) were the 2 most favored features of the dosing aid reported by all evaluable patients. The majority of patients (58.8% [47/80]) indicated that they were "relieved" or "very relieved" that the doctor was able to monitor when they dosed their medication; few (7.5% [6/80]) were "concerned" or "very concerned" that the doctor was able to monitor their dosing. Conclusions: The travoprost dosing aid was perceived to be effective in reminding this group of patients to take their medication as prescribed. In this study, the device was well accepted by both patients and physicians. © 2006 Excerpta Medica, Inc.
Keywords: prostaglandin derivative; travoprost; adult; aged; article; attitude to health; clinical trial; consumer attitude; controlled clinical trial; controlled study; double blind procedure; drug dose regimen; drug withdrawal; eye pain; female; health survey; human; intraocular hypertension; major clinical study; male; monotherapy; multicenter study; open angle glaucoma; patient attitude; patient compliance; physician; rectum hemorrhage; throat irritation; travatan

Brimonidine/timolol: A viewpoint by Richard Fiscella - Fiscella, R. (Drugs and Aging, 2006)
Keywords: brimonidine; dorzolamide; timolol; allergic conjunctivitis; clinical trial; drug efficacy; drug exposure; drug tolerability; glaucoma; human; hyperemia; intraocular hypertension; note; ocular pruritus; patient compliance; priority journal

Costs and utilization of end-stage glaucoma patients receiving visual rehabilitation care: A US multisite retrospective study - Gieser, D.K.; Tracy Williams, R.; O'Connell, W.; Pasquale, L.R.; Rosenthal, B.P.; Walt, J.G.; Katz, L.M.; Siegartel, L.R.; Wang, L.; Rosenblatt, L.C.; Stern, L.S.; Doyle, J.J. (Journal of Glaucoma, 2006)
PURPOSE: Glaucoma is a prevalent ophthalmologic disease and leading cause of blindness. A retrospective analysis was conducted to evaluate resources and costs for end-stage glaucoma patients receiving visual rehabilitation care (VRC). MATERIALS AND METHODS: A chart review was conducted in 3 United States VRC centers. Charts of patients with primary open-angle glaucoma as the primary cause of vision loss (1998 to 2003) were selected, yielding 81 records. Data were collected from patient-level billing and reimbursement records (ophthalmologist/optometrist visits, glaucoma medications, procedures, and specialized low-vision and glaucoma-related services). Visual rehabilitation services included utilization of low-vision devices, assessment of daily functioning, orientation and mobility training, and patient counseling. RESULTS: Mean age at baseline was 72.7 years [standard deviation (SD)=17.2, range: 29 to 95]. Of those with known sex (n=77), 55.8% were women. Medicare was the payer type for most patients (59.3%), whereas 20% had Medicaid. Mean number of visits was 7.1 (SD=6.1) in year 1 and 3.7 (SD=4.2) in year 2, for an annual mean of 5.4 (SD=5.0) visits overall. Total mean cost per patient in year 1 was greater than year 2 [$2170 (SD=$2252) vs. $1202 (SD=$1080), respectively]; of the total 2-year costs, 15% were VRC, 37% ophthalmology care, and 48% pharmacy. Analysis of nonpharmacy costs revealed that VRC accounted for 28% and ophthalmology for 72%. CONCLUSIONS: End-stage glaucoma is associated with appreciable resource utilization and costs, because of both vision rehabilitation and ophthalmology care. Advanced primary open-angle glaucoma has a substantial cost-of-illness, warranting improved management in early stages of disease. Copyright © 2006 by Lippincott Williams & Wilkins.
Keywords: adult; aged; blindness; cataract extraction; consultation; daily life activity; demography; disease duration; family history; female; glaucoma; health care cost; health care utilization; human; major clinical study; male; medicaid; medicare; multicenter study; occupational therapy; open angle glaucoma; patient counseling; patient mobility; patient selection; pharmacy (shop); prevalence; priority journal; race; rehabilitation care; reimbursement; retrospective study; review; statistical analysis; trabeculectomy; trabeculoplasty; United States; visual acuity; visual field; visual impairment; visual rehabilitation

Treating chronic noninfectious posterior segment uveitis: The impact of cumulative damage: Proceedings of an expert panel roundtable discussion - Nguyen, Q.D.; Callanan, D.; Dugel, P.; Godfrey, D.G.; Goldstein, D.A.; Wilensky, J.T. (Retina, 2006)
Chronic noninfectious posterior segment uveitis refers to inflammation of the retina, choroid, vitreous, or optic nerve, and may result in permanent vision loss. The inflammation can be constant, or characterized by periodic exacerbations on an underlying baseline of inflammation. Recent studies indicate that this vision loss often results from cumulative damage over multiple recurrences of inflammation, rather than from a single initiating event. Most forms of local therapy provide only transient suppression of inflammation, and the use of systemic agents may be limited by serious side effects. The course of uveitis may, therefore, be marked by recurrent episodes of inflammation, each contributing to progressive and permanent loss of visual acuity. The goal of uveitis treatment should not only be to suppress inflammation when it recurs but also to attain complete remission of inflammation, and thus prevent complications such as cystoid macular edema (CME) and permanent cumulative damage. The RETISERT intravitreal implant offers sustained local control of inflammation without the systemic side effects that limit standard immunosuppressive and oral corticosteroid therapies. The recommendation of the expert panel was that RETISERT is a useful addition to the armamentarium for the treatment of chronic noninfectious posterior segment uveitis and may help to prevent cumulative damage from repeated occurrences of inflammation, especially when vision can be improved rather than only stabilized.
Keywords: adalimumab; azathioprine; chlorambucil; cholesterol; corticosteroid; cyclophosphamide; cyclosporine; cytokine receptor antagonist; daclizumab; etanercept; fluocinolone acetonide; glucose; immunosuppressive agent; infliximab; methotrexate; mycophenolate mofetil; prednisone; triamcinolone acetonide; acne; adrenal suppression; aplastic anemia; avascular necrosis; blood toxicity; bone marrow suppression; cancer risk; cardiovascular disease; cataract; cataractogenesis; clinical trial; conference paper; Cushingoid syndrome; demyelinating disease; drug contraindication; drug efficacy; drug induced headache; drug safety; endophthalmitis; gastrointestinal symptom; gingiva hyperplasia; glaucoma; growth retardation; human; hypercholesterolemia; hyperglycemia; hypertension; hypertrichosis; hypotony maculopathy; immunosuppressive treatment; infection complication; infection risk; infertility; intraocular pressure abnormality; kidney failure; liver toxicity; malaise; mental instability; myalgia; myopathy; nephrotoxicity; optic nerve lesion; orbit disease; orbit fat prolapse; osteoporosis; patient compliance; practice guideline; ptosis (eyelid); recurrent disease; retina detachment; retina macula cystoid edema; side effect; skin toxicity; stomatitis; stria; teratogenicity; treatment outcome; treatment response; uveitis; visual field defect; visual impairment; cellcept; imuran; kenalog; leukeran; neoral; retisert

Clinical and Surgical Ophthalmology: Guest editorial - Kirk, A. (Clinical and Surgical Ophthalmology, 2006)
Keywords: eye drops; Ginkgo biloba extract; hydroxymethylglutaryl coenzyme A reductase inhibitor; magnesium; memantine; anxiety; blindness; editorial; glaucoma; human; patient attitude; patient care; patient compliance; visual impairment

Travoprost/timolol: A viewpoint by Anastasios G.P. Konstas - Konstas, A.G.P. (Drugs and Aging, 2006)
Keywords: timolol; travoprost; timolol plus travoprost; unclassified drug; glaucoma; human; intraocular pressure; monotherapy; note; patient compliance; priority journal; prognosis

Travoprost/timolol: A viewpoint by Robert J. Noecker - Noecker, R.J. (Drugs and Aging, 2006)
Keywords: eye drops; prostaglandin derivative; timolol; travoprost; timolol plus travoprost; unclassified drug; glaucoma; human; note; patient compliance; priority journal

Treatment of glaucoma: A new fixed combination lowers the intraocular pressure (Deutsche Apotheker Zeitung, 2006)
Keywords: beta 1 adrenergic receptor blocking agent; beta 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; cyclic AMP; prostaglandin derivative; prostaglandin F2; timolol; water; glaucoma; human; intraocular hypertension; intraocular pressure; note; patient compliance; protein synthesis; treatment indication

Glaucoma in the aged - Barriers to understanding and compliance - Dietlein, T.S. (Ophthalmologe, 2006)
Glaucoma is a relatively common ocular disease among adults aged >65 years. However, knowledge about glaucoma, the physical capacity to perform self-application of antiglaucomatous drops, and general compliance may be massively restricted in the older population owing to significantly increasing comorbidity and other factors (e.g. their social and financial situation). Additional efforts by ophthalmologists, the pharmaceutical industry and health politics are required to improve knowledge and compliance among elderly glaucoma patients. © 2006 Springer Medizin Verlag.
Keywords: article; comorbidity; eye disease; geriatric care; glaucoma; health education; health program; human; patient compliance; patient education; pharmacy (shop); quality of life; self medication

Trends in on and off-label calcipotriene use - Pearce, D.J.; Camacho, F.; Balkrishnan, R.; Fleischer Jr., A.B.; Feldman, S.R. (Journal of Dermatological Treatment, 2006)
Following its introduction in 1994, calcipotriene quickly became the single most prescribed medication for psoriasis according to National Ambulatory Medical Care Survey (NAMCS) data. Primarily through regulation of cellular differentiation, calcipotriene may be effective in dermatoses other than psoriasis. We characterize the clinical trends in the utilization of calcipotriene by analyzing a representative sample of visits to US physicians. Demographic characteristics, specialty of the provider, and off-label uses are reported. Calcipotriene was mentioned at 5.8 million of all NAMCS visits during the study period. Nearly 57% of mentions of calcipotriene were not linked to a diagnosis of psoriasis. Adjusted use for gender and race were relatively stable; there was a rise in non-psoriasis uses and use among non-dermatologists in 1997. Our findings support previous reports of the utility of calcipotriene in treating other dermatoses as witnessed by the numerous conditions for which its use was observed. Physicians and policy-makers should be aware of the role that this medication plays in the delivery of dermatologic care. © 2006 Taylor & Francis.
Keywords: calcipotriol; acne; adult; age distribution; aged; alopecia; ambulatory care; article; atopic dermatitis; bacterial infection; candidiasis; cataract; contusion; demography; dermatitis; drug utilization; female; glaucoma; human; ischemic heart disease; keratoderma; major clinical study; male; melanoma; myopia; off label drug use; priority journal; psoriasis; psoriatic arthritis; race; sex ratio; skin atrophy; skin hypertrophy; United States; vaginitis; varicosis; vulvovaginitis; dovonex

Setting the pace for VISION 2020 in Ghana: The case of Bawku Eye Care programme - Gyasi, M.E. (Community Eye Health Journal, 2006)
Keywords: antimetabolite; retinol; blindness; cataract; community based rehabilitation; extracapsular cataract extraction; eye care; Ghana; glaucoma; health care delivery; health care quality; health care utilization; health education; health insurance; health program; human; medical education; onchocerciasis; open angle glaucoma; refraction error; short survey; trachoma; visual impairment; vitamin supplementation

Improvement in open-angle glaucoma by nocturnal home haemodialysis - Kocak, H.; Ly, J.; Chan, C.T. (Nephrology Dialysis Transplantation, 2006)
Keywords: calcium carbonate; insulin; lisinopril; metoprolol; timolol; adult; article; blood pressure regulation; case report; dialysate level; drug withdrawal; female; home dialysis; human; hypertension; intraocular pressure; kidney failure; non insulin dependent diabetes mellitus; open angle glaucoma; patient compliance; priority journal; visual acuity

Prostaglandin analogues for the treatment of glaucoma and ocular hypertension: A systematic review of economic evidence - Orme, M.; Boler, A. (PharmacoEconomics, 2006)
We conducted a systematic review of economic studies of prostaglandin analogues for the treatment of glaucoma to assess the scope of current cost-effectiveness evidence and its relevance to decision-makers. The literature search retrieved 102 studies published before July 2005; after additional hand searching of conference proceedings, 13 full-text articles and 13 abstracts met the inclusion criteria. The reviewers extracted the key characteristics of each of the economic evaluations, and all studies received a grade in five categories to summarise the quality of the study: methodology, transparency, sensitivity, relevance and overall score. The current economic literature is predominantly focused on identifying the short-term direct cost of glaucoma treatment, particularly the precise quantification of glaucoma drug costs. Using the European and US treatment guidelines as a benchmark, it is evident that the current body of literature does not satisfy the needs of decision-makers, although certain studies provide some valuable information, which is a step towards reaching this goal. The main methodological issue in the economic models is an absence of a clinically relevant long-term effectiveness measure, or where this measure is produced, there is a lack of transparency and validation of the methods used. More attention needs to be given to modelling the consequences of treatment, and those consequences should include patient compliance, control of intraocular pressure and progression of visual field deficit, since these drive both the costs and the overall outcomes. We recognise that constructing the 'ideal' clinical outcome measure represents a major challenge to researchers. As such, we have outlined a modelling framework that could be used to produce the required level of economic evidence, and ongoing clinical research (such as the Early Manifest Glaucoma Trial) could provide the validated link between intraocular pressure and disease progression, which forms an essential part of such models. © 2006 Adis Data Information BV. All rights reserved.
Keywords: bimatoprost; latanoprost; latanoprost plus timolol; prostaglandin derivative; timolol; travoprost; unoprostone isopropyl ester; clinical research; cost effectiveness analysis; disease course; economic aspect; human; intraocular hypertension; intraocular pressure; long term care; medical assessment; medical decision making; medical information; medical literature; methodology; open angle glaucoma; patient compliance; practice guideline; priority journal; quality control; review; systematic review; treatment outcome; visual field defect; lumigan; rescula; travatan; xalacom; xalatan

Antiglaucomatic drugs - Content of preservatives and the patient's compliance - Výborný, P.; Sejčková, L. (Ceska a Slovenska Oftalmologie, 2006)
The presence of preservatives in eye drops, may have, depending on the concentration, cytotoxic influence on the corneal and conjunctival cells, and may cause the patients' subjective inconveniences. The authors compare the benzalconium chloride (BAC) concentrations in individual drug used for glaucoma treating. The daily dose of BAC was calculated according to the drop's size and BAC concentration. The daily dose of BAC differs depending on the selected therapy markedly - doses in the range from 0 to 10 micrograms were found. The BAC concentration is one of important factors affecting the patient's compliance in the treatment of the primary open angle glaucoma.
Keywords: antiglaucoma agent; benzalkonium chloride; eye drops; preservative; article; concentration response; drug dose regimen; human; open angle glaucoma; patient compliance; prescription

Systemic side effects of inhaled corticosteroids in patients with asthma - Dahl, R. (Respiratory Medicine, 2006)
Asthma is a complex disease of the respiratory tract associated with chronic inflammation in which an intricate network of cells and cellular factors plays a major role. Asthma is one of the most common chronic diseases, with an estimated 300 million cases worldwide, imposing a considerable burden on society in morbidity, quality of life, and healthcare costs. Inhaled corticosteroids (ICSs) form the gold standard, first-line therapy in the effective management of persistent asthma and reduce morbidity and mortality from asthma. However, long-term use of high-dose ICS therapy has potential to cause systemic side effects-impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts. Hypothalamic-pituitary-adrenal-axis suppression, measured by serum or urine cortisol decrease, correlates with the occurrence of systemic side effects of high-dose ICSs. Therefore, cortisol may be a relevant surrogate marker to identify the potential for adverse effects from ICS therapy. Ciclesonide is a new generation ICS with demonstrable safety and efficacy in the treatment of asthma. The unique pharmacologic characteristics of ciclesonide, such as reduced local adverse effects, lack of cortisol suppression, and the option for once-daily dosing, may improve compliance with therapy and allow long-term use of ICSs without fear of systemic adverse effects. © 2005 Elsevier Ltd. All rights reserved.
Keywords: beclometasone; beclomethasone dipropionate; budesonide; ciclesonide; corticosteroid; flunisolide; fluticasone propionate; hydrocortisone; mometasone furoate; nedocromil; placebo; prednisolone; triamcinolone; adrenal cortex insufficiency; asthma; bone disease; bronchospasm; cataract; clinical trial; correlation function; coughing; dose response; drug absorption; drug bioavailability; drug efficacy; drug exposure; drug megadose; drug metabolism; drug safety; dysphonia; fracture; glaucoma; growth disorder; human; hydrocortisone blood level; hydrocortisone urine level; hypothalamus hypophysis adrenal system; intraocular hypertension; long term care; morbidity; mortality; oropharynx candidiasis; osteoporosis; patient compliance; pharyngitis; priority journal; review; risk benefit analysis; single drug dose; skin contusion; systemic disease

Health Literacy and Adherence to Glaucoma Therapy - Muir, K.W.; Santiago-Turla, C.; Stinnett, S.S.; Herndon, L.W.; Allingham, R.R.; Challa, P.; Lee, P.P. (American Journal of Ophthalmology, 2006)
Purpose: To describe the health literacy of subjects with open angle glaucoma and to investigate the hypothesis that low health literacy is associated with poor glaucoma medication adherence. Design: Cross-sectional patient survey and concomitant chart review. Methods: One hundred and ninety-seven subjects with open angle glaucoma participated in a survey which included basic demographic information such as age, gender, ethnicity, and level of education completed, and a test of heath literacy, the Rapid Assessment of Adult Literacy in Medicine. Information was collected regarding visual field tests and prescribed medication. The subjects' pharmacies were contacted to ascertain the number of refills requested over the previous six months. Results: Although 146 subjects (74%) reported completing high school, only 94 subjects (48.0%) read at or above a ninth grade level; 23 (11.7%) read at a level of third grade or below. The mean number of refills requested by a subject in the preceding six months was not predicted by race (P = .27,) gender (P = .31), age (P = .92), mean deviation of the visual field (P = .36), or level of education (P = .58). There was a positive relationship between health literacy and the number of refills obtained (P = .003). Conclusions: Many patients with open angle glaucoma may have poor health literacy. The subjects in our study with low literacy were less adherent with their glaucoma medications than those with a higher level of literacy. Interventions specifically targeting patients with low literacy may improve medication adherence. © 2006 Elsevier Inc. All rights reserved.
Keywords: antiglaucoma agent; academic achievement; age distribution; aged; article; controlled study; demography; ethnology; female; health education; human; male; medical record review; open angle glaucoma; patient compliance; prescription; priority journal; sex ratio; vision test; visual field

Factors Associated with Failure to Follow Up after Glaucoma Screening. A Study in an African American Population - Gwira, J.A.; Vistamehr, S.; Shelsta, H.; Bashford, K.; Forster, S.; Palmisano, P.; Shafranov, G.; Shields, M.B. (Ophthalmology, 2006)
Purpose: To evaluate variables associated with failure to access free eye care after participating in glaucoma screening. Design: Review of responses to a survey completed by participants during glaucoma screening. Participants: Two hundred seventy-three surveys completed by participants of African descent during screening. Methods: African Americans 40 years or older participated in community glaucoma screening clinics, which included a survey with demographic and social variables. Each participant was given a preliminary diagnosis and encouraged to attend a free eye clinic for a complete examination. Survey results were correlated with attendance at the follow-up examination, using Student's t test, chi-square test, and logistic regression analysis. Main Outcome Measure: Noncompliance with follow-up after glaucoma screening. Results: When adjusting for risk factors in logistic regression analysis, noncompliance was associated with living alone (P = 0.008), smoking (P = 0.0005), and lacking a car (P<0.01). Odds of noncompliance for participants living alone were 2.2 times higher than those for participants not living alone. Odds of noncompliance for participants who smoked were 3.0 times greater than those for participants who did not smoke. Odds of noncompliance for participants who did not have access to a car for their last eye examination were 2.1 times greater than those for participants who did. Conclusion: Socioeconomic factors such as smoking, lack of access to a car for eye examinations, and living alone are associated with noncompliance to follow-up after glaucoma screening clinics. Identifying persons with these variables may facilitate improved compliance. © 2006 American Academy of Ophthalmology.
Keywords: African American; article; chi square test; comparative study; demography; evaluation study; eye care; glaucoma; health survey; human; logistic regression analysis; medical examination; patient attitude; priority journal; risk assessment; risk factor; sample size; screening test; smoking; social aspect; socioeconomics; Student t test

Uveitis: Advances in understanding of pathogenesis and treatment - Read, R.W. (Current Rheumatology Reports, 2006)
Uveitis is a leading cause of blindness affecting individuals of all ages, genders, and races. Uveitis may be due to autoimmune, infectious, toxic, malignant, or traumatic processes. Some evidence supports an association between conditions previously presumed to be autoimmune and viral infectious agents. For autoimmune uveitis, therapy is nonspecific, typically beginning with corticosteroids. For nonresponsive disease or for corticosteroid sparing, recent reports on mycophenolate mofetil, infliximab, and interferon therapy show success for various forms of uveitis. Treatment of the complications of uveitis, especially cystoid macular edema, is difficult. Vitamin E appears to offer little benefit, whereas octreotide may be effective. Recent collaborative efforts at standardization in the field should enhance studies on these conditions. Copyright © 2006 by Current Science Inc.
Keywords: acetazolamide; alkylating agent; alpha interferon; alpha tocopherol; antiinfective agent; antiinflammatory agent; azathioprine; beta interferon; bevacizumab; chlorambucil; colchicine; corticosteroid derivative; cotrimoxazole; cyclophosphamide; cyclosporine; etanercept; fluocinolone acetonide; infliximab; interferon; lipopolysaccharide; methotrexate; mycophenolate mofetil; naproxen; octreotide; prednisone; pyrimethamine sulfadiazine; tacrolimus; toll like receptor 4; triamcinolone acetonide; tumor necrosis factor inhibitor; absence of side effects; ankylosing spondylitis; antibody production; autoimmune disease; Behcet disease; cataract; childhood disease; clinical trial; congestive heart failure; disease association; dose response; drug delivery system; drug efficacy; drug implant; drug implantation; drug megadose; drug release; drug tolerability; gastrointestinal symptom; HLA system; human; innate immunity; intraocular hypertension; intraocular pressure; lung embolism; lupus like syndrome; morbidity; multiple sclerosis; nonhuman; optic neuritis; pathogenesis; patient compliance; retina macula cystoid edema; review; risk reduction; sustained release formulation; toxoplasmosis; treatment response; uveitis; virus infection; visual impairment; vitreous hemorrhage; Vogt Koyanagi syndrome; retisert

Microprocessor controlled compliance monitor for eye drop medication - Hermann, M.M.; Diestelhorst, M. (British Journal of Ophthalmology, 2006)
Background/aims: The effectiveness of a self administered eye drop medication can only be assessed if the compliance is known. The authors studied the specificity and sensitivity of a new microprocessor controlled monitoring device. Methods: The monitoring system was conducted by an 8 bit microcontroller for data acquisition and storage with sensors measuring applied pressure to the bottle, temperature, and vertical position. 10 devices were mounted under commercial 10 ml eye drops. Test subjects had to note down each application manually. A total of 15 applications each within 3 days was intended. Results: Manual reports confirmed 15 applications for each of the 10 bottles. The monitoring devices detected a total of 149 events; one was missed; comprising a sensitivity of 99%. Two devices registered three applications, which did not appear in the manual protocols, indicating a specificity of about 98%. Refrigerated bottles were correctly identified. The battery lifetime exceeded 60 days. Conclusion: The new monitoring device demonstrated a high reliability of the collected compliance data. The important, yet often unknown, influence of compliance in patient care and clinical trials shall be illuminated by the new device. This may lead to a better adapted patient care. Studies will profit from a higher credibility and results will be less influenced by non-compliance.
Keywords: eye drops; article; container; drug monitoring; glaucoma; human; information processing; intraocular pressure; microprocessor; monitor; monitoring; ophthalmology; patient care; patient compliance; priority journal; questionnaire; reliability; sensitivity and specificity; sensor; temperature

Utilization of eye care services in Victoria - Müller, A.; Vu, H.T.; Ferraro, J.G.; Keeffe, J.E.; Taylor, H.R. (Clinical and Experimental Ophthalmology, 2006)
Purpose: To determine baseline eye care utilization by older Victorians in order to assess change in 2 years after an eye health promotion campaign. Methods: A letter of invitation to participate was sent to all people aged 70-79 years in randomly selected Melbourne postcode areas. A questionnaire was designed to allow gathering of eye health-related information. Eye exams included autorefraction, frequency doubling technology and non-mydriatic fundus photography. Results were compared with the Melbourne Vision Impairment Project. Results: A total of 1695 people with a mean age of 74 years were recruited. The overall proportion with visual impairment was 8% (134/ 1695), of which 27% (36/134) was due to non-refractive causes. Only 31% (11/36) of visually impaired people knew about low-vision services, of whom 20% (7/36) had used them. Of all people with diabetes, only 52% (96/ 184) had a dilated eye exam within the recommended 2 years (Melbourne Vision Impairment Project 44%). Conclusions: Compliance rates with recommendations for 2-yearly eye exams for people with diabetes have not improved since the last major eye health study in Victoria 10 years ago. The same is true for the rate of undiagnosed glaucoma, suggesting that messages about eye examinations need to be promoted for older people at high risk of vision loss, for example, those with diabetes and at risk of vision loss from glaucoma. © 2006 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: aged; article; Australia; cataract; clinical feature; controlled study; diabetes mellitus; diabetic retinopathy; eye care; eye photography; female; follow up; geriatric care; glaucoma; health care utilization; health promotion; health service; human; information processing; major clinical study; male; patient compliance; quality of life; questionnaire; randomization; refraction error; risk assessment; visual impairment; visual system examination

What do glaucoma specialists know about their patients? - Dietlein, T.S.; Jordan, J.; Dinslage, S.; Krieglstein, G.K. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2006)
Background: Although interaction between doctor and patient is undoubtedly influenced by their mutual expectations, little information is available about the knowledge and expectations of glaucoma doctors concerning their patients' attitudes and treatment patterns. The aim of our prospective study was to compare the actual responses of glaucoma patients concerning various issues related to their disease and the responses the glaucoma doctors expected their patients to give. Methods: Glaucoma patients consecutively sent to our glaucoma centre were asked to complete a standardised questionnaire about their glaucoma history, treatment routines and opinions on issues related to glaucoma. Ophthalmologists at the glaucoma centre were asked to predict patients' answers. Results: One hundred and twenty-eight consecutive glaucoma patients completed the patients' questionnaire and 12 glaucoma specialists completed the corresponding questionnaire for doctors. Frequency of intraocular pressure (IOP) measurements and visual field testing, as well as the number of topical medications, were relatively accurately predicted by the glaucoma doctors. Differences between the doctors' predictions and patients' responses were found concerning discomfort after surgery and the influence of stress or environmental factors on IOP. The largest range of doctors' predictions (0-100%) was observed concerning the portion of patients claiming a 100% adherence to glaucoma medication. Conclusion: Glaucoma specialists are familiar with the treatment patterns of their patients. The knowledge of glaucoma specialists of their patients' subjective attitudes to glaucoma-related issues deserves further investigation, as discrepancies between doctors' and patients' responses were observed in this area. © Springer-Verlag 2005.
Keywords: topical agent; accuracy; adult; aged; article; attitude to illness; doctor patient relationship; environmental factor; glaucoma; glaucoma surgery; human; intraocular pressure; major clinical study; medical specialist; ophthalmology; patient care; patient compliance; physician attitude; postoperative complication; prediction; priority journal; questionnaire; physiological stress; vision test; visual field

Baseline behavioral assessment for the New Jersey Health Wellness Promotion Act - Sheffet, A.M.; Ridlen, S.; Louria, D.B. (American Journal of Health Promotion, 2006)
Purpose. To determine baseline use rates for health-promoting behaviors of the recently adopted New Jersey Health Wellness Promotion Act and to examine the effects of demographic and socioeconomic factors on the use of preventive services included in the Act. Design. A random telephone survey of 3094 households was conducted using questions from the Behavioral Risk Factor Surveillance System supplemented by questions related to provisions of the Act. Setting. All New Jersey households. Subjects. State representative adult sample of 1246 subjects. Measures. Rates for getting timely screening tests, for obtaining influenza immunizations, and engaging in selected health-promoting behaviors. Results. Rates for receiving recommended screening tests ranged from 0.88 for blood pressure testing to 0.29 for osteoporosis screening. According to bivariate analysis, having insurance was the most consistent determinant associated with receiving preventive services but was associated only with sigmoidoscopy, mammography, and Pap smear testing in the multivariate modeling. Reminders were significantly associated with respective screening tests. Age was positively associated with receiving the majority of tests. Gender, ethnicity, education, and income affected receipt sporadically. Half the respondents were overweight and a quarter were current smokers. Conclusions. Receipt of appropriate screening tests and adoption of health-promoting behaviors fell short of desired goals. Having health insurance increased receipt rates, but was not enough to achieve usage goals. Procedure-specific reminders may improve usage rates. Copyright © 2006 by American Journal of Health Promotion, Inc.
Keywords: cholesterol; glucose; hemoglobin; adult; bone density; breast cancer; breast self examination; cancer screening; cardiovascular disease; cholesterol blood level; cigarette smoking; colon cancer; diabetes mellitus; early diagnosis; exercise; female; glaucoma; glucose blood level; health care policy; health care utilization; health promotion; health survey; hemoglobin blood level; human; hypercholesterolemia; hypertension; influenza; influenza vaccination; low back pain; major clinical study; male; mammography; occult blood test; osteoporosis; Papanicolaou test; prostate cancer; review; screening test; seatbelt; sigmoidoscopy; smoking cessation; traffic accident; United States; uterine cervix cancer; body weight loss; wellbeing

Relationship between compliance and background factors of glaucoma patients - Ikushima, T.; Mori, K.; Ishibashi, T.; Ikeda, Y.; Naruse, S.; Hozono, Y.; Kinoshita, S. (Nippon Ganka Gakkai zasshi, 2006)
PURPOSE: To obtain useful information for the improvement of patient compliance in the medical treatment of glaucoma. SUBJECTS AND METHODS: An unsigned attitude survey on glaucoma and eye drops was conducted with 431 glaucoma patients. Correlation between compliance and individual(objective and subjective) factors was investigated. Objective factors were age, sex, number of eye drop products, duration of disease, and degree of visual field defects. Subjective factors were "stinging sensation with application of eye drops" and "worry about blindness". RESULTS: Thirty-eight percent of the glaucoma patients were compliant, instilling eye drops at the right time and with good technique. For the factor "duration of disease", patients who had glaucoma for 6-10 years had the best compliance. Compliance became poorer with an increasing number of eye drop products. In the subjective factors, less pain and worry led patients to better compliance. CONCLUSION: To improve compliance with medical treatment, we should categorize patients based on objective factors, eliminating their pain and worry, and instructing them not only in the frequency of instillation but also in the technique of administration.
Keywords: article; attitude; female; glaucoma; human; male; middle aged; patient; patient compliance; psychological aspect

Antiglaucoma drugs--content of preservatives and the patient's compliance - Výborný, P.; Sejcková, L. (Ceská a slovenská oftalmologie : casopis Ceské oftalmologické spolecnosti a Slovenské oftalmologické spolecnosti, 2006)
The presence of preservatives in eye drops, may have, depending on the concentration, cytotoxic influence on the corneal and conjunctival cells, and may cause the patients' subjective inconveniences. The authors compare the benzalconium chloride (BAC) concentrations in individual drug used for glaucoma treating. The daily dose of BAC was calculated according to the drop's size and BAC concentration. The daily dose of BAC differs depending on the selected therapy markedly--doses in the range from 0 to 10 micrograms were found. The BAC concentration is one of important factors affecting the patient's compliance in the treatment of the primary open angle glaucoma.
Keywords: benzalkonium; eye drops; preservative; article; chemistry; human; open angle glaucoma; patient compliance

Cost-effectiveness analysis in glaucoma: What drives utility? Results from a pilot study in Sweden - Kobelt, G.; Jonsson, B.; Bergström, A.; Chen, E.; Lindén, C.; Alm, A. (Acta Ophthalmologica Scandinavica, 2006)
Purpose: To investigate the effect of different levels of visual field defect in glaucoma on utilities and to test if utilities could be assessed using a general questionnaire such as the EQ-5D. Methods: cross-sectional study in 199 patients with ocular hypertension or open-angle glaucoma grouped into 5 severity stages according to visual field defects was performed in 4 specialized ophthalmic centres. Descriptive analysis was performed for the sample and by stage, and the effect of vision loss on utility was investigated with multiple step-wise regression analysis. Results: The mean age of the sample was 70 and the mean MD in the worse eye was-13.1 dB (SD 10.2). Visual acuity (VA) was 0.63 and 0.87 in the worse and better eye, respectively, and the mean utility was 0.80 (SD 0.23). Utility decreased with increasing glaucomatous damage, ranging from 0.84 for mild disease to 0.72 for severe damage (MD-2.5 to -28.1), but the difference between the groups was not statistically significant when controlling for co-morbidity, except for the most severe stage (p < 0.01). In multiple regression analysis, visual field in the better eye was significantly correlated with utility, and there was an indirect correlation between visual field in the worse eye and utility: the effect of total VA on utility was significant, and MD in the worse eye was correlated with total VA. Conclusions: Utility is strongly correlated with overall vision. Our results suggest a relationship between glaucomatous damage and utility, and patients with severe damage have a significantly lower utility. However, this should be further investigated in larger samples that include more patients with moderate-severe bilateral damage. © Acta Ophthalmol Scand, 2006.
Keywords: adrenergic receptor stimulating agent; alpha adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin derivative; adult; aged; article; cataract extraction; comorbidity; controlled study; correlation analysis; cost effectiveness analysis; disease severity; female; glaucoma; health care utilization; human; intraocular hypertension; major clinical study; male; multiple regression; open angle glaucoma; pilot study; priority journal; questionnaire; statistical significance; Sweden; trabeculectomy; utilization review; vision; visual acuity; visual field defect; visual impairment

Effect of written instructions on accuracy of self-reporting medication regimen in glaucoma patients - Kharod, B.V.; Johnson, P.B.; Nesti, H.A.; Rhee, D.J. (Journal of Glaucoma, 2006)
PURPOSE: Our purpose was to evaluate the accuracy of self-reporting of the prescribed medication regimen in a glaucoma population, identify contributing factors, and assess the effect of written instructions. METHODS AND MATERIALS: All patients at an urban resident glaucoma clinic were offered participation in this prospective, case-controlled study. Two trained interviewers administered a confidential questionnaire consisting of six questions regarding the name and dosage of ophthalmic medications, education level, ability to read, and age. A verbatim response for each question was recorded on the questionnaire. At the end of the visit, patients were given a written chart describing their ophthalmic medications, frequency, and dosage. At their next scheduled visit, the same questionnaire was repeated. The patients' responses from both visits were compared with the regimen they were prescribed and with each other. This information was used to determine the accuracy of reporting medications. RESULTS: A total of 193 patients were enrolled in the study over a 10-month period; 164 patients completed both phases (85% completion rate). The study population consisted of 85 women and 79 men with a mean age of 68.40 ± 11.6 years. Eighty-four patients had attained less than 12th grade education and 80 had completed high school. At the first visit, 66 patients (40%) showed less than 100% accuracy. Forty-nine of 84 (58%) patients who had not completed high school education showed less than 100% accuracy with a mean score of 65% (P≤0.001), whereas 17 of 80 (21%) of patients who had completed high school showed less than 100% accuracy with a mean score of 87% (P≤0.001). After written instruction, the accuracy of reporting improved by 23.36 ± 30.8 percentile points in patients without completion of high school education and improved by 8.46 ± 21.7 percentile points in patients who had completed high school (P<0.001). The mean number of ophthalmic medications prescribed was 2.10 ± 0.93 (range 1 to 4). Patients on one medication had 100% accuracy in reporting 82% of the time, whereas those with four medications had 100% accuracy 21% of the time. Gender, age, and race of the patient were not correlated with the accuracy of self-reporting (P>0.05). CONCLUSION: The education level of the patient and the number of medications showed direct correlation with patients' ability to report medications accurately. Patients showed improvement in accuracy of reporting medications when given written instructions about their regimen, regardless of their level of education or number of medications. Copyright © 2006 by Lippincott Williams & Wilkins.
Keywords: agents acting on the eye; academic achievement; accuracy; adult; aged; article; case control study; controlled study; demography; drug dose regimen; drug information; evaluation study; female; glaucoma; human; major clinical study; male; medical assessment; patient compliance; patient education; patient participation; prescription; priority journal; sample size; scoring system; self report; sex ratio; structured interview; urban population

Update on prostaglandin-related drugs in glaucoma management - Sarkisian Jr., S.R.; Netland, P.A. (Clinical and Surgical Ophthalmology, 2006)
Prostaglandin-related drugs include latanoprost, unoprostone, travoprost, and bimatoprost. In addition, a fixed combination of latanoprost and timolol has recently been introduced. This article reviews the development of prostaglandin-related drugs and presents an evidence-based discussion of each drug in this class, and the clinical use of these drugs including side effects, additivity, and patient compliance issues.
Keywords: acetazolamide; epinephrine; adrenergic receptor stimulating agent; alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; bimatoprost; bimatoprost plus timolol; brimonidine; carbonate dehydratase inhibitor; dipivefrine; dorzolamide; dorzolamide plus timolol; timolol plus travoprost; bimatoprost plus timolol; latanoprost; latanoprost plus timolol; latanoprost plus timolol; pilocarpine; prostaglandin derivative; prostaglandin F2 alpha; timolol; timolol plus travoprost; travoprost; unclassified drug; unoprostone isopropyl ester; blurred vision; burning sensation; clinical trial; conjunctival hyperemia; dose response; drug contraindication; drug effect; drug efficacy; drug potentiation; drug receptor binding; drug safety; drug substitution; drug tolerability; evidence based medicine; eye pain; glaucoma; human; hyperpigmentation; hypertrichosis; intraocular hypertension; lacrimation; multicenter study; nonhuman; ocular pruritus; patient compliance; retina macula cystoid edema; review; side effect; uveitis; extravan; ganfort; lumigan; rescula; travatan; xalacom; xalatan

Efficacy of first- or second-line latanoprost on intraocular pressure and ocular symptoms in patients with open-angle glaucoma or ocular hypertension - Baudouin, C.; Rouland, J.-F.; Nordmann, J.-P.; Bron, A.; Pelen, F. (Journal Francais d'Ophtalmologie, 2006)
Objectives: The aim of this study was to assess the changes in intraocular pressure (IOP) and ophthalmic symptoms with the Glaucoma Symptom Scale in patients suffering from open-angle glaucoma (OAG) or ocular hypertension (OHT) after 3 months of treatment with latanoprost. Materials and methods: This multicentric open study was carried out in adult patients suffering from OAG or simple OHT (naive or previously treated with monotherapy) and needing a change or initiation of anti-glaucomatous treatment. One drop of latanoprost 0.005% was instilled every evening for 12 weeks in each affected eye. Efficacy was assessed by the variation in IOP and ophthalmic symptomatology at the end of treatment. Prognosis factors associated with a relative IOP reduction of at least 30% were sought (using a logistic regression model). Results: A total of 920 patients suffering from OAG (54%) or OHT (44%), either previously treated (69%) or naive (31%), were included. The male:female ratio was 0.78 and the mean age was 63±13 years. At inclusion, the mean IOP was 22.1 ±3.8 mmHg. After treatment, IOP was significantly decreased by 5.1±4 mmHg, corresponding to a 22% reduction. IOP reduction was 7.1±4 mmHg, corresponding to 29% in naive patients and 4.2±4 mmHg, corresponding to 19% in previously treated patients. A relative IOP reduction of at least 30% was reached by 47% of naive patients and 21% of previously treated patients. In previously treated patients, a relative IOP reduction of at least 30% had a greater chance of being reached in men with previous ophthalmic history and high IOP at inclusion (above 21 mmHg). IOP reduction was similar in patients with OAG and OHT. A significant improvement in ophthalmic symptoms was observed after treatment in previously treated patients. A total of 7% of the patients presented an adverse event affecting the visual system: eye irritation (2%), eye pain (2%), or eye hyperemia (1%). Compliance was good for 94% of the patients. Conclusion: Latanoprost given as first or second-line treatment at the recommended dose effectively decreases IOP in patients with OAG or OHT. This treatment also improves visual and nonvisual symptoms in previously treated patients and presents a good safety profile. © Masson, 2006.
Keywords: antiglaucoma agent; eye drops; latanoprost; adult; age distribution; aged; article; clinical trial; controlled clinical trial; controlled study; drug efficacy; eye irritation; eye pain; female; glaucoma symptom scale; human; hyperemia; intraocular hypertension; intraocular pressure; logistic regression analysis; major clinical study; male; monotherapy; multicenter study; open angle glaucoma; open study; patient compliance; phase 4 clinical trial; prognosis; rating scale; sex ratio; statistical significance; symptomatology; treatment duration; treatment outcome; visual system; xalatan

56 000 ways? No way! - Brown, G.C. (Current Opinion in Ophthalmology, 2006)
Keywords: antiglaucoma agent; benzoporphyrin derivative; bevacizumab; hydroxymethylglutaryl coenzyme A reductase inhibitor; pegaptanib; ranibizumab; triamcinolone; clinical practice; comparative study; cost benefit analysis; cost effectiveness analysis; digestive system perforation; economic aspect; editorial; endophthalmitis; eye color; glaucoma; headache; health care; health care utilization; human; hyperemia; hyperlipidemia; hypertension; thermotherapy; laser coagulation; neovascularization (pathology); ophthalmology; photodynamic therapy; phototoxicity; priority journal; quality of life; respiratory distress; macular degeneration; side effect; skin discoloration; subretinal neovascularization; wound dehiscence; avastin; lucentis; macugen

A Comparison of Mepivacaine Versus Lidocaine for Episcleral (Sub-Tenon's) Block for Cataract Surgery in an Ambulatory Setting - Ripart, J.; Nouvellon, E.; Chaumeron, A.; Chanial-Bourgaux, C.; Mahamat, A. (Regional Anesthesia and Pain Medicine, 2006)
Background and Objectives: For eye surgery, motor block is still often requested by the surgeon. For cataract surgery, rapid block resolution allows eyelids to move and allows eye-patch removal. Therefore, short-duration block is useful in early rehabilitation for ambulatory surgery. Lidocaine is classically assumed to have shorter duration than mepivacaine. Therefore, lidocaine alone might be considered as an alternative to mepivacaine. Methods: In this randomized, double-blind study, we compared mepivacaine 2% (n = 22) and lidocaine 2% (n = 25) in 47 patients who received episcleral (sub-Tenon's) block for cataract surgery. Akinesia score was measured 1, 5, 10, and 15 minutes and 1, 2, 4, and 6 hours after the end of injection. Primary outcome was block duration (time from injection to full recovery). Secondary outcomes were time to block onset and best akinesia score for each patient. Complications were recorded. Results: The 2 groups were similar for demographic and anesthetic features. We observed no significant difference between mepivacaine and lidocaine in terms of onset, quality of akinesia, and block duration. One case of ocular hypertonia and 1 case of strabismus were observed in the lidocaine group, which could be imputed to hyaluronidase unavailability during the study period or to increased lidocaine myotoxicity. Conclusions: We found no argument to favor lidocaine over mepivacaine in episcleral (sub-Tenon's) eye block, especially in terms of motor-block duration. © 2006 American Society of Regional Anesthesia and Pain Medicine.
Keywords: hyaluronidase; lidocaine; local anesthetic agent; mepivacaine; adult; aged; akinesia; ambulatory care; article; bioavailability; cataract extraction; chemosis; clinical observation; clinical trial; conjunctival hemorrhage; controlled clinical trial; controlled study; demography; double blind procedure; drug safety; female; human; injection; intraocular hypertension; male; nerve block; outcomes research; postoperative complication; priority journal; qualitative analysis; randomized controlled trial; recording; sclera; scoring system; strabismus; sub tenon nerve block; time

Adjunctive glaucoma therapy use associated with travoprost, bimatoprost, and latanoprost - Covert, D.; Robin, A.L. (Current Medical Research and Opinion, 2006)
Purpose: This study contrasts the utilization of adjunctive medication associated with travoprost, bimatoprost, or latanoprost, as primary glaucoma therapies. Methods: Patients in the Medco Health database who initiated prostaglandin analog therapy on travoprost, bimatoprost or latanoprost between January 1, 2002 and July 31, 2002 were selected if they had no prostaglandin analog use in the prior 6 months. Patients were also required to have 12 months of prostaglandin therapy subsequent to the initial prescription. Data were available through July 31, 2003. The t-test and chi-square were used where appropriate to calculate p-values and assess significant differences. Results: A total of 13 171 benefit-eligible subjects were identified of which 8381 (64%), 2637 (20%), and 2153 (16%) patients were treated with latanoprost, bimatoprost, and travoprost, respectively. There were no significant differences in mean age or gender between the three study groups with the exception that latanoprost patients were statistically older than travoprost patients (69.0 vs. 68.0). This was not considered a clinically meaningful difference. Overall, patients using travoprost or bimatoprost had a significantly lower rate of adjunctive medication use compared to patients starting on latanoprast monotherapy (22.5%, 23.2%, and 30.2%, respectively). Therefore, for every 14 patients treated with latanoprost instead of travoprost or bimatoprost, one additional patient would be expected to need adjunctive therapy with another agent. The difference between travoprost and bimatoprost patients was not significant. Conclusions: The use of adjunctive medications to control intraocular pressure was significantly higher for latanoprost patients compared to travoprost and bimatoprost patients. This finding should be interpreted in the context that this study was based only on prescription claims data. It is important to simplify ophthalmic medical regimen as it is more cost effective, better for the patient, and minimizes the washout effect from administering two eye medications within 5 min. Decreasing the complexity of the patients' drug regimen may lead to increased adherence to prescribed therapy and a decreased risk of the incidence of blindness. © 2006 Librapharm Limited.
Keywords: bimatoprost; latanoprost; prostaglandin; travoprost; adult; aged; article; blindness; controlled study; cost effectiveness analysis; female; glaucoma; human; intraocular pressure; major clinical study; male; monotherapy; patient compliance; population research; prescription; risk assessment; risk factor; Student t test

Nebulizer therapy in pulmonology: Review of the literature - Melani, A.S.; Bracci, L.S. (Current Respiratory Medicine Reviews, 2006)
The lung is a very attractive target for drug delivery. Currently, as direct access for the treatment of lower respiratory diseases. Possibly, in the future, as the route of administration for systemic therapies. Nebulizers are widely used throughout the world in adult and padiatric medical practice. They are used for the management of acute bronchoconstriction both at home and in hospital,but also for long-term home treatment of various lower respiratory diseases, mainly in elderly and in infants. Overall, bronchodilators are the first class of drugs used by nebulization. The efficiency of the nebulizer has to be assured mainly for suspension, such as corticosteroids, and hyperviscous solution, such as antimicrobials, which aerolize with more difficulties with respect to bronchodilators. Unfortunately, knowledge on the optimal use of nebulizers is limited. Guidelines on best nebulizer practice are often lacking. There is a need to establish some guidance for both the drug and nebulizer manufacturers and prescribing physicians for optimization of nebulizer therapy, individuating not only drugs, dosing and administration schedule, but also the effective nebulizer system and the method for its optimal use and maintenance. © 2006 Bentham Science Publishers Ltd.
Keywords: amphotericin B; antibiotic agent; antiinfective agent; antiinflammatory agent; beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; beta lactam; bronchodilating agent; budesonide; cholinergic receptor blocking agent; colistin; corticosteroid; cromoglycate disodium; fluticasone; furosemide; glucosamine derivative; heparin; ipratropium bromide; magnesium sulfate; morphine; mucolytic agent; pentamidine; polymyxin; prostacyclin; ribavirin; salbutamol; surfactant; taurolidine; tobramycin; aerosol; airway obstruction; bronchospasm; bronchus hyperreactivity; chest tightness; clinical trial; coughing; drug bioavailability; drug blood level; drug delivery system; drug dose regimen; drug fatality; drug potentiation; glaucoma; heart arrhythmia; heart disease; home care; human; hypokalemia; hypoxemia; inhaler; long term care; lung aspergillosis; medical practice; metered dose inhaler; nebulizer; patient compliance; pharmacodynamics; physician; Pneumocystis pneumonia; practice guideline; prescription; priority journal; pulmonary hypertension; respiratory tract disease; respiratory tract infection; review; skin atrophy; tachycardia; tremor; Aerotech II; AERx; Aiolos; EcoNeb; Master; Multisonic Compact; Pari InhalierBoy; Pari LC Plus; Pari LC Star; PulmoAide; Respimat; Respirgaard II; TurboBoy; Turbohaler; Updraft II

Keeping an eye on glaucoma treatment. (The Johns Hopkins medical letter health after 50, 2006)
Keywords: eye drops; article; glaucoma; human; patient compliance; polypharmacy; statistics

Dirty little secrets - Quigley, H.A. (Clinical and Experimental Ophthalmology, 2006)
Keywords: eye drops; prostaglandin; developing country; doctor patient relationship; editorial; electronics; eye care; family history; gender bias; gonioscopy; government; health care cost; health care management; health insurance; health program; human; medical specialist; open angle glaucoma; optic disk; patient attitude; patient compliance; practice guideline; prescription; reimbursement; risk factor; visual impairment

Tandem Scanning Confocal Corneal Microscopy in the Diagnosis of Suspected Acanthamoeba Keratitis - Parmar, D.N.; Awwad, S.T.; Petroll, W.M.; Bowman, R.W.; McCulley, J.P.; Cavanagh, H.D. (Ophthalmology, 2006)
Objective: To evaluate the role of in vivo corneal tandem scanning confocal microscopy (TSCM) in the definitive diagnosis of suspected Acanthamoeba keratitis (AK). Design: Noncomparative interventional single-institution case series. Method: A retrospective case review of patients consecutively referred with suspected AK and undergoing corneal TSCM was performed. Results: A total of 63 cases that met the inclusion criteria for the study were referred for diagnostic evaluation. Tandem scanning confocal microscopy demonstrated Acanthamoeba cysts/trophozoites in 54 cases and fungal hyphae in 2, whereas 1 case was positive for both Acanthamoeba and fungus. Culture of the cornea or contact lenses was carried out in 35 cases, 9 of which were positive for Acanthamoeba. Six of the TSCM-positive cases also underwent corneal biopsy, being positive for Acanthamoeba in only 2. Six patients were negative for Acanthamoeba on TSCM, the etiology being fungal in 1 case, as shown by subsequent culture. One patient was positive on culture for Acanthamoeba but falsely negative by TSCM, which was limited by poor cooperation during the examination. Two cases initially masqueraded as Acanthamoeba keratitis but showed fungus on TSCM. Mean follow-up was 14 months. Conclusion: In vivo corneal TSCM can establish the diagnosis of Acanthamoeba keratitis rapidly and noninvasively, particularly when conventional microbiology is inconclusive. © 2006 American Academy of Ophthalmology.
Keywords: Acanthamoeba; adolescent; adult; aged; article; confocal laser scanning microscopy; controlled study; corneal biopsy; diagnostic accuracy; diagnostic test; diagnostic value; evaluation study; female; follow up; fungal detection; fungus culture; fungus hyphae; human; keratitis; major clinical study; male; medical record; patient compliance; patient referral; patient selection; priority journal; tandem mass spectrometry; trophozoite

Side effects of antidepressants: An overview - Khawam, E.A.; Laurencic, G.; Malone Jr., D.A. (Cleveland Clinic Journal of Medicine, 2006)
Adverse effects of antidepressant drugs can decrease compliance and delay recovery. It is therefore crucial to consider potential side effects when choosing an antidepressant. Although there is no perfect antidepressant that works quickly and is completely free of adverse reactions, newer antidepressants are safer, better tolerated, and associated with a lower rate of noncompliance.
Keywords: amfebutamone; amitriptyline; antidepressant agent; benzodiazepine derivative; buspirone; citalopram; cyproheptadine; desipramine; doxepin; duloxetine; escitalopram; fluoxetine; fluvoxamine maleate; imipramine; mirtazapine; monoamine oxidase inhibitor; nefazodone; nortriptyline; paroxetine; pentazocine; serotonin uptake inhibitor; sertraline; sildenafil; tetracyclic antidepressant agent; trazodone; tricyclic antidepressant agent; tryptophan; unindexed drug; venlafaxine; warfarin; agitation; akathisia; anorexia; anticholinergic effect; anticholinergic syndrome; anxiety disorder; atrioventricular block; bleeding; blurred vision; cardiotoxicity; central nervous system disease; closed angle glaucoma; coma; confusion; constipation; decreased appetite; delirium; depression; diarrhea; dizziness; drug approval; drug blood level; drug classification; drug half life; drug mechanism; drug metabolism; drug safety; drug substitution; drug tolerability; ECG abnormality; epileptic state; epistaxis; extrapyramidal symptom; fatigue; gastrointestinal hemorrhage; gastrointestinal symptom; headache; heart muscle conduction disturbance; human; hyperreflexia; hypertension; hyperthermia; hyponatremia; increased appetite; insomnia; liver dysfunction; liver toxicity; mydriasis; myoclonus; nausea; nervousness; neutropenia; nightmare; orthostatic hypotension; patient compliance; priapism; psychotherapy; pyridoxine deficiency; QT prolongation; restlessness; review; rigidity; sedation; seizure; serotonin syndrome; sexual dysfunction; shock; side effect; sleep disorder; somnolence

Effect of Vasoactive Therapy on Cerebral Circulation - Rhoney, D.H.; Liu-DeRyke, X. (Critical Care Clinics, 2006)
Many questions regarding blood pressure management after acute stroke remain unanswered, resulting in an ongoing debate about whether to treat hypertension acutely and how aggressively blood pressure should be lowered. This review discusses normal and altered cerebrophysiology and provides evidence supporting and opposing the active management of blood pressure within the first 24 hours after stroke. Commonly used intravenous antihypertensive agents and their cerebrovascular effects are reviewed, and therapeutic recommendations are given based on the available evidence. © 2006 Elsevier Inc. All rights reserved.
Keywords: angiotensin receptor antagonist; antihypertensive agent; atenolol; beta adrenergic receptor blocking agent; calcium channel blocking agent; candesartan hexetil; captopril; diltiazem; dipeptidyl carboxypeptidase inhibitor; dopamine 1 receptor stimulating agent; enalaprilat; esmolol; fenoldopam; glyceryl trinitrate; hydralazine; labetalol; losartan; metoprolol; nicardipine; nifedipine; nitroprusside sodium; oxprenolol; sotalol; trimetaphan; vasoactive agent; antihypertensive activity; blood pressure monitoring; bradycardia; brain blood flow; brain hemorrhage; cardiovascular autoregulation; cerebrovascular accident; clinical trial; congestive heart failure; cyanide poisoning; dizziness; dose response; drug contraindication; drug effect; drug efficacy; drug half life; drug indication; drug mechanism; drug metabolism; drug tolerance; flushing; headache; hemodynamics; human; hypertension; hypertensive crisis; hypotension; intracranial hypertension; intracranial pressure; intraocular hypertension; mean arterial pressure; neuroprotection; neurotoxicity; nonhuman; pathophysiology; patient compliance; priority journal; review; risk benefit analysis; cerebrovascular accident; tachycardia; tachyphylaxis; treatment planning

Prophylactic pharmacotherapy for migraine headaches - Buchanan, T.M.; Ramadan, N.M. (Seminars in Neurology, 2006)
Migraine therapeutics are pharmacological, including acute and preventive, nonpharmacological and/or both. Preventive pharmacological strategies serendipitously were discovered to be effective and include drugs from various pharmacological classes (e.g., β-adrenergic blocker, anticonvulsant, tricyclic antidepressants, serotonin receptor antagonist). Converging level I evidence and clinical experience support the use of the antidepressant amitriptyline, the anticonvulsants divalproex and topiramate, and the β-adrenergic blockers propranolol, timolol, and metoprolol in migraine prevention. Other options for migraine prophylaxis exist, but the level of evidence in support of their use is not as robust. All of these drugs have varying degrees of adverse effects, some of which can limit their use. Balancing potential efficacy with risk of adverse effects, addressing patients' expectations and desires, complying with management recommendations, adequate follow up, and accurate assessment of treatment goals are key to migraine prevention. Finally, future migraine-preventive drugs likely will target migraine mechanisms more specifically, which undoubtedly will enhance the therapeutic index. Copyright © 2006 by Thieme Medical Publishers, Inc.
Keywords: alpha 2 adrenergic receptor stimulating agent; amitriptyline; angiotensin; angiotensin 2 receptor antagonist; anticonvulsive agent; beta adrenergic receptor blocking agent; calcium channel blocking agent; candesartan; clonidine; dipeptidyl carboxypeptidase inhibitor; flunarizine; gabapentin; guanfacine; imipramine; lisinopril; metoprolol; nortriptyline; oxcarbazepine; pregabalin; propranolol; serotonin antagonist; serotonin uptake inhibitor; timolol; tizanidine; topiramate; tricyclic antidepressant agent; unindexed drug; valproate semisodium; venlafaxine; verapamil; abdominal pain; attention disturbance; cardiotoxicity; clinical trial; closed angle glaucoma; comorbidity; concentration loss; constipation; coughing; depression; dizziness; drowsiness; drug classification; drug efficacy; drug mechanism; evidence based medicine; extrapyramidal symptom; fatigue; follow up; hair loss; headache; heart muscle conduction disturbance; heart muscle fibrosis; human; hyperchloremic acidosis; hypotension; increased appetite; language disability; lung fibrosis; memory disorder; migraine; nausea; nephrolithiasis; nerve cell excitability; orthostatic hypertension; orthostatic hypotension; outcome assessment; paresthesia; patient compliance; patient satisfaction; polypharmacy; priority journal; prophylaxis; psychomotor disorder; retroperitoneal fibrosis; review; risk benefit analysis; sedation; sexual dysfunction; side effect; somnolence; speech disorder; spreading cortical depression; body weight gain; xerostomia

Glaucoma screening: Current trends, economic issues, technology, and challenges - Nduaguba, C.; Lee, R.K. (Current Opinion in Ophthalmology, 2006)
Purpose of review: Glaucoma is one of the leading causes of irreversible blindness worldwide. Early glaucoma detection and treatment are currently the only known methods for preventing blindness and low vision resulting from this frequently asymptomatic disease. Recent findings: New technologies for detecting early glaucomatous damage are important in diagnosing optic nerve disease, not only in community screening settings but also in clinics. Imaging of the optic nerve head and macula and retinal nerve fiber layer analysis can provide quick, automated, and quantitative measurements in agreement with clinical estimates of optic disc structure and visual function. In the area of perimetry, frequency-doubling technology is a promising and feasible mass-screening method with reasonable sensitivity for detecting visual field loss. Central corneal thickness has emerged as a new risk factor for the development and progression of glaucoma, thereby complicating the role of tonometry and measurement of intraocular pressure as screening parameters for glaucoma. Along with technological advances, strides are also being made with public policy and legislative efforts to bring glaucoma onto the national and global health care agenda. These initiatives incorporate vision-screening goals into national disease prevention programs emphasizing the need for early glaucoma detection and treatment. Summary: Glaucoma awareness needs to be increased through better education, and compliance with follow-up care needs to be improved to decrease the economic and social costs from glaucoma. In addition, screening models need to be developed that will be effective in developing countries where the risk of blindness from glaucoma is highest. © 2006 Lippincott Williams & Wilkins.
Keywords: automation; awareness; clinical assessment; closed angle glaucoma; cornea; cornea thickness; disease course; disease model; early diagnosis; early intervention; economic aspect; feasibility study; follow up; frequency analysis; functional assessment; genetic screening; glaucoma; health care; health care cost; health care policy; health center; health education; human; imaging; intraocular pressure; law; mass screening; measurement; nerve fiber; optic disk; optic nerve disease; parameters; pathogenesis; patient compliance; perimetry; practice guideline; prevalence; priority journal; prophylaxis; public health; quantitative analysis; retina macula lutea; retina nerve cell; review; risk assessment; risk factor; sensitivity analysis; social aspect; technology; tonometry; vision; visual field; visual impairment

Medication adherence in glaucoma: Approaches for optimizing patient compliance - Tsai, J.C. (Current Opinion in Ophthalmology, 2006)
Purpose of review: To summarize recent literature regarding medication adherence with a focus on the complexities inherent in glaucoma management. Recent findings: Adherence to medications can be enhanced by undertaking the following strategies: enhanced patient education; improved dosing schedules; increased accessibility to healthcare (including longer hours, evening hours, and shorter wait times), and improved provider-patient relationships (e.g. increased trust). Patients may be less likely to forgo medication use due to cost pressures if the physician trust level is high. Recent studies suggest a role for baseline screening for adherence predictors and focused interventions in addressing modifiable risk factors for poor adherence (such as depression, stress, and lower education). Summary: Many factors are associated with the lack of medication adherence in patients. The solution is likely to be multidimensional and employ combination strategy (must be individualized for the patient). Educational interventions involving patients, family members, or both can be effective in improving adherence. © 2006 Lippincott Williams & Wilkins.
Keywords: eye drops; depression; doctor patient relationship; drug cost; drug dose regimen; ethnic or racial aspects; glaucoma; health care; human; patient compliance; patient education; prescription; priority journal; review; risk factor; screening; social aspect; social environment; socioeconomics; physiological stress

Prevalence of glaucomas in a Black Cameroonian population - Ellong, A.; Mvogo, C.E.; Bella-Hiag, A.L.; Mouney, E.N.; Ngosso, A.; Litumbe, C.N. (Cahiers Sante, 2006)
Objectives: To determine the prevalence and the various types of glaucoma in a Black urban Cameroonian population. Material and method: A retrospective analysis of 1,343 glaucomatous patients' files (757 men and 586 women) from a total of 24,462 Cameroonian patients of all ages was carried out from January 1991 to December 2001 in the Douala General Hospital in Cameroon in Central Africa. Results: The prevalence of glaucoma of all types is 5.5%. It increases with age. Of subjects with glaucoma, 79.6% had not been previously diagnosed. The mean patient's age is 533 (+/-17.1) years. The mean intraocular pressure is 29.6 (+/-12.6) mmHg. The mean vertical cup-disc ratio is 0.7 (+/-0.2). The prevalence of primary glaucoma of any type is 4.5%. The overall prevalence of primary open-angle glaucoma, primary angle-closure glaucoma and congenital glaucoma was 4.3%, 0.03% and 0.07%, respectively. The normal-tension glaucoma is rare in this study (6.3% of primary open-angle glaucoma).The most common form of primary angle closure glaucoma is chronic angle closure glaucoma (61,1%) and is usually undiagnosed due to a lack of gonioscopic evaluation. The prevalence of secondary glaucoma of any type is 1%. The most common forms of secondary angle closure glaucoma were neovascular glaucoma (47.4% of cases with the prevalence of 0.5%) and post-traumatic glaucoma (23.1% of cases with the prevalence of 0.2%). Prevalence of bilateral and monocular blindness due to glaucoma is 8% (108/1,343) and 32.9% (441/1,343) respectively of glaucoma patients. Conclusion: This study confirms the high prevalence of glaucoma in a black African population. Gonioscopy is an important diagnostic tool that should be promoted to guide more effective glaucoma treatment in our region. The very high rate of blindness among the glaucoma patients in Cameroon is due to a lack of care. The patients are young, the disease is advanced, and compliance and follow-up are poor. Glaucoma surgery therefore offers a favourable option from an economical standpoint. Glaucoma is a devastating disease and constitutes a significant public health problem.
Keywords: adult; article; Cameroon; closed angle glaucoma; controlled study; female; glaucoma; gonioscopy; hospital; human; intraocular pressure; major clinical study; male; Black person; open angle glaucoma; prevalence

Misunderstandings of some problems in glaucoma medications - Wang, N.-L.; Li, S.-N. (Ophthalmology in China, 2006)
Medication is one of the important methods in treatment of glaucoma, but misunderstandings of some problems during glaucoma medication still exist, such as how to use and evaluate the drugs and when to use the drugs etc. These are reviewed and discussed in this paper.
Keywords: antiglaucoma agent; drug indication; drug monitoring; drug response; editorial; follow up; glaucoma; human; outcomes research; patient compliance; systematic review

Compare of daily cost of ophthalmic solutions for glaucoma - Gao, Y.; Wu, L.-L.; Li, A.-J. (Ophthalmology in China, 2006)
Objective: To determine and compare the daily cost of various ophthalmic solutions for glaucoma in China. Design: Investigative study. Participants: The majority ophthalmic solutions for glaucoma available in our country were included in the research. Methods: Five bottles of each solution were tested separately by five researchers. After the number of drops and the actual volume for each bottle were calculated, the mean number of drops per bottle and the mean volume per bottle were determined. The volume per drop was calculated by dividing the mean volume per bottle by the mean number of drops per bottle, and the cost per drop was calculated by dividing the market price by the mean number of drops in a bottle. The number of days for both eyes usage per bottle was calculated by dividing the mean number of drops in a bottle by the number of drops required daily for both eyes. The cost per day was calculated by multiplying the cost per drop by the number of drops required daily for both eyes. Main outcome measures: The number of days for both eyes usage per bottle and the daily cost for both eyes usage per bottle. Results: 1. The volume per drop ranged from 0.027 ml(Lumigan) to.0.053 ml(Chengrui and 0.5%Zhenrui). 2. The cost per bottle ranged from 5.7Yuan(Malaisuan Saimaluo'er) to 338Yuan (Xalatan). 3. The number of days for both eyes usage per bottle ranged from 52d (Lumigan) to 12d (Zhenrui). 4. The daily cost for both eyes usage from expensive to cheap were Xalatan 7.51 Yuan, Travatan 6.30 Yuan, Lumigan 3.84 Yuan, Alphagan 3.36 Yuan, Dilijian 2.97 Yuan, Pailiming 2.83 Yuan, 2%Zhenrui 2.34 Yuan, Betagan 2.11 Yuan, Beiteshu 2.0 Yuan, 0.5% Zhenrui 1.49 Yuan, 2%Huming 1.29 Yuan, Mikelan1.21 Yuan, 1%Huming 0.85 Yuan, Chengrai 0.63 Yuan, Malaisuan Saimaluo'er 0.23 Yuan. Conclusions: The daily cost of ophthalmic solution for glaucoma ranged wildly. These data may be useful in selecting ophthalmic solution for glaucoma therapy.
Keywords: antiglaucoma agent; bimatoprost; brimonidine; carteolol; dilijian; eye drops; huming; latanoprost; levobunolol; timolol maleate; travoprost; unclassified drug; article; China; commercial phenomena; drug cost; economic aspect; glaucoma; health care cost; human; outcomes research; patient compliance; alphagan; betagan; chengrui; dilijian; huming; lumigan; malaisuan saimaluoer; travatan; xalatan

Current status of topical medication by glaucoma patients - Kobayashi, H.; Iwakiri, R.; Kobayashi, K.; Okinami, S. (Japanese Journal of Clinical Ophthalmology, 2006)
Purpose: To evaluate the state of use of eyedrops by patients of open-angle glaucoma, and to assess related factors. Method: A total of 168 glaucoma patients were interviewed who were randomly chosen out of those attending Saga University Hospital. The series comprised 74 males (42%) and 94 females (58%). Their ages ranged from 21 to 84 years, average 61 years. Results: Eyedrops were being instilled in full accordance to prescriptions by 84% of patients. Instillation of eyedrops was missed one to three times a month by 8% of patients. Eyedrops were more correctly used by patients with more advanced visual field defect. A significant correlation was present between complicance and mean deviation (MD) by program 302 of Humphrey visual field analysis. Compliance was worse in instillation in daytime than that in the morning or evening (p<0.05). Conclusion: Eyedrops are more correctly used by glaucoma patients with more advanced visual field defect. Improved awareness of glaucoma may result in better complicance.
Keywords: antiglaucoma agent; eye drops; adult; aged; article; awareness; drug instillation; female; human; major clinical study; male; open angle glaucoma; patient compliance; prescription; visual field; visual field defect

Patient-reported behavior and problems in using glaucoma medications - Sleath, B.; Robin, A.L.; Covert, D.; Byrd, J.E.; Tudor, G.; Svarstad, B. (Ophthalmology, 2006)
Objective: The objectives of the current study were to describe the different types of problems patients receiving adjunctive therapy reported having when taking their glaucoma medications and to examine the relationship between patient-reported problems in taking their glaucoma medications and patient adherence. Design: Cross-sectional survey. Participants: A survey was distributed to glaucoma patients in 4 geographically distinct ophthalmology practices. We excluded patients using only 1 glaucoma medication. The survey was completed by 324 patients. Methods: For each patient, average percent adherence to his or her glaucoma medication regimen was calculated. Logistic regression was used to examine how patient characteristics and problems in using glaucoma medications were related to reported adherence. Main Outcome Measure: Whether patients were less than 100% adherent in the previous week. Results: We found that 60% of patients reported 1 or more problems with taking their glaucoma medications. Fourteen percent of patients reported being less than 100% adherent to their glaucoma regimen medications during the previous week. Patients who had difficulty remembering to take their glaucoma medications and those who reported that they had other problems or concerns with their glaucoma medications were significantly less likely to be 100% adherent. Conclusions: Patient adherence to a glaucoma medication regimen could be improved among patients receiving adjunctive therapy. Ophthalmologists and their clinical colleagues should make sure to discuss the problems and concerns that patients may have in taking their glaucoma medications in an effort to improve adherence. © 2006 by the American Academy of Ophthalmology.
Keywords: antiglaucoma agent; adult; aged; article; behavior; controlled study; female; glaucoma; human; major clinical study; male; patient compliance; priority journal; self report

Ocular drug delivery - Ghate, D.; Edelhauser, H.F. (Expert Opinion on Drug Delivery, 2006)
Drug delivery to the eye is hampered by anatomical factors, including the corneal epithelium, the blood-aqueous barrier and the blood-retinal barrier. This review aims to outline the major routes of ocular drug delivery, including systemic, topical, periocular and intravitreal. The pharmacokinetics, the disadvantages and the clinical relevance of these drug delivery routes have been emphasised. Recent advances in surgical techniques, therapeutic approaches and material sciences have produced exciting new therapies for ocular diseases. The role of ophthalmic drug formulation in targeting the desired ocular tissue and enhancing drug delivery by the chosen route whilst minimising side effects is also discussed. © 2006 Ashley Publications.
Keywords: amikacin; antiinflammatory agent; benzalkonium chloride; bile acid; bile salt; carbonate dehydratase inhibitor; carboplatin; cefazolin; chloramphenicol; ciprofloxacin; cisplatin; cyclodextrin; cyclosporine; dexamethasone; digitonin; eye drops; eye ointment; gatifloxacin; indometacin; inulin; minocycline; nonionic surfactant; ofloxacin; pilocarpine; prednisolone sodium phosphate; prednisolone acetate; saponin; steroid; timolol maleate; unindexed drug; blood eye barrier; blood retina barrier; cornea epithelium; drug administration route; drug delivery system; drug dose regimen; drug formulation; drug penetration; drug targeting; drug tissue level; endophthalmitis; eye disease; glaucoma; human; hydrocolloid; iontophoresis; nonhuman; patient compliance; retina tumor; review; surgical technique; unspecified side effect; viscosity; ocusert; restasis

Opaque contact lens treatment for older children with amblyopia - Anderson, J.E.; Brown, S.M.; Mathews, T.A.; Mathews, S.M. (Eye and Contact Lens, 2006)
PURPOSE. To investigate the usefulness of daily-wear opaque contact lens treatment for older children with amblyopia. METHODS. A retrospective chart review of all children undergoing opaque contact lens therapy for amblyopia between 2000 and 2003 was performed. All patients were included except for those younger than 5 years of age, those undergoing maintenance treatment only, those lost to follow-up, or those unable to cooperate with Snellen visual acuity testing. RESULTS. Thirteen children were identified, and seven met the inclusion criteria. The seven patients had a mean age of 7.5 years (range, 5.7-8.7 years). The causes of amblyopia were anisometropia (five patients), cataract (one patient), and strabismus (one patient). For all seven patients, the mean logMAR improvement in visual acuity was 0.52 (range, 0.26-1.22). The average duration of opaque contact lens use was 9.3 months (range, 2-21 months). Compliance problems were encountered in three patients. No major complications occurred, but one patient had an episode of mild superficial punctate keratitis. CONCLUSIONS. Daily-wear opaque contact lens treatment is a useful occlusion method for amblyopia treatment in older children with various practical and social impediments to skin patching. Meaningful improvement in visual acuity can be obtained, even in children older than 8 years of age. © 2006 Lippincott Williams & Wilkins, Inc.
Keywords: amblyopia; analytic method; anisometropia; cataract; child; clinical article; contact lens; controlled study; follow up; groups by age; human; maintenance therapy; medical record review; patient compliance; pediatrics; priority journal; punctate keratitis; retrospective study; review; skin; statistical analysis; strabismus; treatment duration; treatment outcome; visual acuity; Kontur

Prostanoids in the therapy of glaucoma - Ishida, N.; Odani-Kawabata, N.; Shimazaki, A.; Hara, H. (Cardiovascular Drug Reviews, 2006)
Elevated intraocular pressure (IOP) is one of the most important risk factors for the development of glaucoma, which is a progressive optic neuropathy. Lowering IOP is currently the only therapeutic approach to the therapy of glaucoma. Since the use of pilocarpine eye drops for glaucoma treatment was reported in the late 1870s, academic researchers and pharmaceutical companies attempted to discover new drugs with more potent, prolonged, and safer IOP-reducing effects. These persistent efforts finally paid off, and prostanoids with FP-receptor agonist activity were found to be very potent IOP-lowering agents. To date, three prostanoids (latanoprost, travoprost and bimatoprost) have been launched in many countries, and now a new FP-receptor agonist, tafluprost, is entering clinical development. All of these prostanoids are superior to the β-adrenoceptor antagonists in their IOP-lowering efficacy, and no severe side effects have been reported in their long-term clinical use. In addition, tafluprost may be expected to improve ocular blood flow. Hence, prostanoids currently occupy center stage among glaucoma medications. It cannot be denied that in terms of efficacy, safety, patient compliance, and medical economy prostanoids are currently the first-line medicines among ocular antihypertensive drugs. © 2006 Blackwell Publishing, Inc.
Keywords: alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; dorzolamide; latanoprost; muscarinic agent; prostanoid; tafluprost; timolol; travoprost; unclassified drug; antihypertensive activity; blood flow; clinical trial; conjunctival hyperemia; drug efficacy; drug mechanism; drug potency; drug safety; drug selectivity; drug structure; drug synthesis; glaucoma; human; in vitro study; intraocular hypertension; intraocular pressure; long term care; monotherapy; nonhuman; ocular blood vessel; open angle glaucoma; pathogenesis; patient compliance; priority journal; recommended drug dose; review; socioeconomics; treatment duration; lumigan; travatan; xalatan

Accuracy of an electronic monitoring and reminder device for use with travoprost eye drops - Boden, C.; Sit, A.; Weinreb, R.N. (Journal of Glaucoma, 2006)
Purpose: To evaluate the accuracy of a prototype electronic device for recording eye drop usage. Participants and Methods: Ten volunteers were randomly assigned to one of five usage patterns designed to mimic common patterns of use in glaucoma patients from 100% compliant to 50% compliant. All participants agreed to adhere to a pre-determined "dosing" schedule for 15 days using the monitoring/reminder device to instill artificial tears. Participants also recorded drop usage in a diary. The main outcome measures were device accuracy and reproducibility. Device accuracy was defined as the magnitude of the difference between the diary and device output for three variables: date, number of drops, and instillation time. Results: Date stamping by the device was 100% accurate. The mean ± SD time difference between the device and the diary was -2.0 ± 19.7 minutes when data from all participants was pooled. In seven of the ten participants, the device did not record at least one drop. The mean ± SD difference in the number of drops recorded by the device minus the diary was 0.16 ± 0.97 when data from all participants was pooled. Conclusions: The prototype compliance reminder/monitoring device may underestimate compliance in some patients. The date and time stamping mechanisms were generally accurate and reproducible. Copyright © 2006 by Lippincott Williams & Wilkins.
Keywords: travoprost; accuracy; article; clinical article; devices; electronics; glaucoma; human; monitoring; outcome assessment; patient compliance; priority journal; reproducibility

The rising cost of glaucoma drugs - Azuara-Blanco, A.; Burr, J. (British Journal of Ophthalmology, 2006)
Keywords: alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin derivative; cost benefit analysis; drug cost; drug efficacy; drug indication; drug safety; drug tolerability; editorial; glaucoma; glaucoma surgery; health care utilization; human; prescription; prevalence; priority journal; trabeculoplasty; treatment indication; visual field

Complications of ophthalmic regional blocks: Their treatment and prevention - Kumar, C.M.; Dowd, T.C. (Ophthalmologica, 2006)
Complications following ophthalmic regional anaesthesia are rare but are reported during both needle (intraconal and extraconal blocks) and blunt cannula (sub-Tenon's block) techniques. At present there is no perfect technique of ophthalmic regional anaesthesia. This article reports on the complications, treatment and prevention of commonly used ophthalmic regional blocks. Thorough knowledge of the measures required to deal with complications when they occur are of paramount importance for safe clinical practice. Copyright © 2006 S. Karger AG.
Keywords: acetazolamide; adjuvant; epinephrine; benzodiazepine derivative; bupivacaine; etidocaine; hyaluronidase; intravenous anesthetic agent; lidocaine; local anesthetic agent; mepivacaine; opiate; tetracaine; akinesia; anesthesia complication; article; brain stem; chemosis; clinical feature; clinical practice; conjunctival hemorrhage; consciousness disorder; conservative treatment; cornea opacity; cornea thickness; decompression surgery; drug hypersensitivity; drug safety; excitement; facial nerve paralysis; human; incidence; injection site pain; intraocular hypertension; intraocular pressure; local anesthesia; neurologic disease; oculocardiac reflex; ophthalmoplegia; optic nerve atrophy; optic nerve lesion; orbit pseudotumor; orbit tumor; paresis; patient compliance; patient satisfaction; perforating eye injury; practice guideline; regional anesthesia; retina detachment; retina ischemia; retrobulbar anesthesia; retrobulbar hemorrhage; risk assessment; risk factor; shock; side effect; skin contusion; spinal anesthesia; taste disorder; topical anesthesia; vision

To adhere or not to adhere: An important decision - Gorman, J.M. (CNS Spectrums, 2006)
Keywords: acetylsalicylic acid; antihypertensive agent; eye drops; isoniazid; proteinase inhibitor; anxiety; comorbidity; depression; editorial; glaucoma; heart infarction; human; Human immunodeficiency virus infection; hypertension; mental disease; patient compliance; priority journal; tuberculosis

A multicentre, retrospective study of resource utilization and costs associated with glaucoma management in France and Sweden - Lindblom, B.; Nordmann, J.-P.; Sellem, E.; Chen, E.; Gold, R.; Polland, W.; Williamson, W.; Buchholz, P.; Walt, J.G.; Groleau, D.; Curry, A.; Evans, S.J. (Acta Ophthalmologica Scandinavica, 2006)
Purpose: To assess resource utilization and costs associated with glaucoma management in France and Sweden. Methods: A total of 267 patient records (121 in France, 146 in Sweden) with diagnoses of primary open-angle glaucoma (POAG) and ocular hypertension (OH), treated medically, were reviewed for a 2-year period (beginning during 1997-99) for relevant clinical and resource utilization data. Economic data were applied to estimate treatment costs. Results: The annual cost of treating glaucoma was estimated at SEK5305 (€531)/patient in Sweden and €390/patient in France. In both countries, medication costs comprised about half of the total costs. Surgical procedures and hospitalizations represented greater proportions of total cost in France (7.0% and 9.6%, respectively) than in Sweden (3.7% and 0.6%, respectively). Conclusion: Medication costs represent a high proportion of total treatment costs. These findings highlight the relative importance of medical therapy and of assessing the cost-effectiveness of medications in glaucoma. Copyright © Acta Ophthalmol Scand 2005.
Keywords: alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin derivative; adult; aged; article; consultation; controlled study; cost effectiveness analysis; diagnostic test; drug cost; economic evaluation; female; France; glaucoma surgery; health care cost; health care utilization; hospitalization; human; intraocular hypertension; major clinical study; male; medical record; open angle glaucoma; priority journal; resource management; retrospective study; Sweden

Should patients choose their own eyedrops? [3] - Buller, A.; Hercules, B.L. (Acta Ophthalmologica Scandinavica, 2006)
Keywords: antiglaucoma agent; eye drops; circadian rhythm; clinical article; controlled study; drug bioavailability; drug dose regimen; drug indication; drug preference; glaucoma; human; intraocular pressure; letter; outpatient department; patient attitude; patient care; patient compliance; priority journal; questionnaire; visual analog scale

Compliance and persistance - Detry-Morel, M. (Journal Francais d'Ophtalmologie, 2006)
Purpose: 1) To summarize the literature on compliance (the extent to which the patient's behaviors correspond with the provider's recommendations) and persistence (total time on therapy) in patients with open-angle glaucoma or ocular hypertension. 2) To suggest guidelines to improve these two parameters, which are both essential and integral elements of optimizing patient care. Methods: Compliance-related research published between 1980 and March 2005. Results: Medication compliance has mostly been investigated and measured using patient self-reports, electronic monitoring, and medication possession ratio. Noncompliance-related problems are underestimated, complex, unpredictable and frequent. Noncompliance rates of at least 25% have been reported. The main obstacles to medication compliance are situational/ environmental or related to the side effects or complexity of the medication regimen. Persistence with glaucoma medications has also been proven to be poor. Based on retrospective studies using survival analyses, fewer than 25% of patients may be persistent over 12 months. Persistence rates differ from one treatment to another and may fluctuate with time in the same patient. Conclusions: Improving the quality of information, the patient-physician relationship, and educating patients are all crucial. Simplification of the treatment regimen and selection of medications with the fewest systemic and ocular side effects must be a priority. Accurately assessing patient compliance and persistence are indispensable to reducing mistakes from either medication noncompliance or lack of persistence with poor efficacy and to avoid unnecessary changes in a patient's therapeutic regimen or surgery. © Masson, 2006.
Keywords: environmental factor; human; intraocular hypertension; monitoring; open angle glaucoma; patient compliance; review; self report; survival

Patient perspectives in glaucoma care: Introduction to the American Journal of Ophthalmology supplement - Lee, P.P. (American Journal of Ophthalmology, 2006)
Keywords: antiglaucoma agent; prostaglandin; chronic disease; doctor patient relationship; drug cost; editorial; expectation; glaucoma; human; interpersonal communication; intraocular pressure; long term care; open angle glaucoma; patient care; patient compliance; patient education; patient satisfaction; prescription; priority journal; quality of life; role playing; vision; visual impairment

Evaluation of quality of life for patients with glaucoma - Spaeth, G.; Walt, J.; Keener, J. (American Journal of Ophthalmology, 2006)
• PURPOSE: To understand the impact of glaucoma on ability to function and on quality of life to guide therapeutic choices and strategies for improved adherence to therapeutic regimens and to suggest alterations to environments to help the patient to cope better with the effects of the disease. • DESIGN: Review of the published literature on quality-of-life assessments of patients with glaucoma. • METHODS: The published literature on quality-of-life impacts of glaucoma was reviewed with a focus on the design and evolution of quality-of-life instruments, correlations of responses with objective measures of disease progression, and insights that were gained from the analyses of results. • RESULTS: Information about the impact of glaucoma has been derived from responses to general health-related questionnaires, vision-specific questionnaires, and questionnaires that were designed to be glaucoma specific. Responses to glaucoma-specific instruments tend to correlate best with visual field measurements and other objective measures of disease progression, which suggests that such responses reflect the effects of glaucoma rather than the effects of other health-related issues in this patient population. Recent advances in the design of glaucoma-specific instruments and in analysis of the responses to them have provided some interesting insights. For example, patients who have experienced significant (peripheral) visual field loss attach greater importance to their central vision than do patients with less-advanced disease, but these patients seem to have accepted or adapted to their difficulties with outdoor mobility. • CONCLUSION: Continued improvements in the collection and analysis of quality-of-life data should assist health care providers with the effective delivery of therapies to patients with glaucoma. © 2006 by Elsevier Inc. All rights reserved.
Keywords: coping behavior; correlation analysis; data analysis; disease course; evaluation study; functional assessment; glaucoma; human; devices; measurement; methodology; patient compliance; priority journal; quality of life; questionnaire; rating scale; review; Short Form 36; Sickness Impact Profile; validation study; vision; visual field; visual field defect; visual impairment

Measurement of persistence and adherence to regimens of IOP-lowering glaucoma medications using pharmacy claims data - Wilensky, J.; Fiscella, R.G.; Carlson, A.M.; Morris, L.S.; Walt, J. (American Journal of Ophthalmology, 2006)
• PURPOSE: Determine persistence and adherence of glaucoma patients to therapeutic regimens of prostaglandin/prostamide-class IOP-lowering medications. • DESIGN: Retrospective, population-based study. • METHODS: Glaucoma patients in the IMS Health LifeLink database with a pharmacy claim for latanoprost (n = 1567), travoprost (n = 381), or bimatoprost (n = 476) between September, 2001 and March, 2002 who had no claims for IOP-lowering medication in the previous 180 days, and who were persistent during the first 90 days of therapy. Values reported in the quantity dispensed and days supply fields of the database were used in an algorithm that corrected anomalous data and adjusted days supply to calculate the main outcome measures, persistence, and adherence to therapy. • RESULTS: The percentage of patients persistent for the 12-month observation period was 69.4% (1087/1567) for those prescribed latanoprost, 70.6% (269/381) for those prescribed travoprost, and 68.1% (324/467) for those prescribed bimatoprost. Mean adherence for patients prescribed latanoprost was 75.4% of the year, for those prescribed travoprost, 77.1% of the year, and for those prescribed bimatoprost, 78.2% of the year. The mean number of days adherent for bimatoprost-treated patients (291.2 days) was significantly greater than for latanoprost-treated patients (281.0 days), and not remarkably different from travoprost-treated patients (287.0 days). • CONCLUSIONS: Overall, patients in this study who were taking IOP-lowering prostaglandin/prostamide medications had a mean adherence rate of 76% on average, suggesting that opportunities remain for improvement of adherence to therapeutic regimens for glaucoma treatment with prostamides and prostaglandins. © 2006 by Elsevier Inc. All rights reserved.
Keywords: antiglaucoma agent; bimatoprost; latanoprost; travoprost; algorithm; article; controlled study; data base; glaucoma; human; major clinical study; outcomes research; patient compliance; pharmacy (shop); population research; priority journal; quantitative study; retrospective study

Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease - Mills, R.P.; Budenz, D.L.; Lee, P.P.; Noecker, R.J.; Walt, J.G.; Siegartel, L.R.; Evans, S.J.; Doyle, J.J. (American Journal of Ophthalmology, 2006)
PURPOSE: To provide a reliable, comprehensive staging system to assess glaucoma stage in the absence of an universally accepted glaucoma staging system (GSS) on the basis of visual field results. DESIGN: Literature review and GSS adaptation. METHODS: After a review of published GSSs was conducted, the Bascom Palmer (Hodapp-Anderson-Parrish) GSS was selected as an appropriate platform for a retrospective GSS on the basis of visual fields. The system was modified by a panel of glaucoma specialists, and additional modifications were made after pilot testing to cover the full range of disease progression, from preglaucoma diagnosis to complete blindness; the ordered stages reflect the typical progression of glaucoma. RESULTS: The GSS is comprised of six ordered stages and is on the basis of the Humphrey visual field. The completed GSS was validated by reviewing patient charts from 12 US glaucoma centers. CONCLUSIONS: The GSS allows accurate staging of 100% of glaucoma on the basis of visual fields and other data, enabling evaluation of disease progression and resource utilization at various glaucoma stages. Additionally, treatment costs may be assigned to determine cost-effectiveness of treatment. Research utilizing the GSS has found that cost of care increases with increasing disease severity. The GSS may be used as the basis for creating treatment guidelines, which have the potential to delay glaucoma progression and lower treatment costs. © 2006 by Elsevier Inc. All rights reserved.
Keywords: article; blindness; disease course; disease severity; glaucoma; health care cost; health care utilization; human; medical research; medical specialist; practice guideline; priority journal; visual field

Protein therapeutics - Lessons learned and a view of the future - Johnson-Léger, C.; Power, C.A.; Shomade, G.; Shaw, J.P.; Proudfoot, A.E.I. (Expert Opinion on Biological Therapy, 2006)
Protein therapeutics represent a rapidly growing proportion of marketed drugs and have an undisputed place alongside chemistry-based oral therapies; indeed, for certain indications they are the only effective therapy. Therapeutic proteins can be mined from diverse sources to target interactions that are not accessible to small molecules, and can be engineered to have optimal pharmacological properties. Nevertheless, the development of such therapeutics is hampered by several issues, such as cost of production, patient compliance, immunogenicity and reticence of reimbursement agencies to pay for their use in chronic treatment. Herein we review some of these issues in detail. The application of technological advancements will address some of these issues and enable the development of a growing number of biological therapies that will continue to improve patient quality of life for decades to come. © 2006 Ashley Publications.
Keywords: agalsidase beta; autoantibody; beta interferon; binding protein; cell surface receptor; corticosteroid; cytokine; cytokine receptor; death receptor; eptifibatide; etanercept; Fc receptor; follitropin; hirudin; immunoglobulin heavy chain; interleukin 1 receptor; interleukin 1alpha; interleukin 1beta; ion channel; nonsteroid antiinflammatory agent; OKT 3; pig insulin; protein; recombinant erythropoietin; anakinra; recombinant protein; serine proteinase inhibitor; thrombin; tumor necrosis factor; unindexed drug; asthma; atherosclerotic plaque; chronic kidney failure; clinical trial; corticosteroid induced osteoporosis; cost; diabetes mellitus; drug efficacy; drug formulation; Fabry disease; fluid retention; glaucoma; hepatitis C; human; human genome; hypertension; immunogenicity; immunotherapy; infertility; inflammation; multiple sclerosis; nephrotoxicity; nonhuman; patient compliance; pure red cell anemia; reimbursement; review; skin atrophy; thrombosis; ulcer; enbrel; fabrazyme; integrelin

Refractive laser surgery in children with coexisting medical and ocular pathology - Astle, W.F.; Papp, A.; Huang, P.T.; Ingram, A. (Journal of Cataract and Refractive Surgery, 2006)
PURPOSE: To report the visual, refractive, and functional outcomes of photorefractive keratectomy (PRK) and of laser-assisted subepithelial keratectomy in a group of children with significant refractive error and underlying medical conditions or ocular pathology who were noncompliant with traditional management. SETTING: Nonhospital surgical facility and a hospital clinic. METHODS: This case series comprised 5 individual cases of anisometropic amblyopia and/or high myopia. Underlying medical and ocular conditions were as follows: upper eyelid hemangioma with oblique myopic astigmatism, Pelizaeus-Merzbacher leukodystrophy with nystagmus, Klippel-Trenaunay-Weber syndrome with glaucoma, incontinentia pigmenti with unilateral optic nerve atrophy, and Goldenhar syndrome with unilateral optic nerve hypoplasia. Photorefractive keratectomy or LASEK was performed in 6 eyes of 5 patients. Age range at the time of surgery was 1.0 to 7.0 years. All procedures were performed under general anesthesia. RESULTS: Best corrected visual acuity improved by 2 lines in 2 patients and 1 line in 2 patients by 6 months after surgery. Stereopsis and/or fusional status improved in 3 patients. Amblyopia treatment compliance improved in 1 patient. Alignment improved without strabismus surgery in 2 cases. A functional vision survey demonstrated a positive effect on the ability of all 5 children to function in their environment. CONCLUSION: During the period of visual cortical plasticity, refractive surgery, by eliminating the refractive component of amblyopia and by promoting fusional ability, provides considerable improvement in children, even those with underlying medical conditions associated with ocular pathology. © 2006 ASCRS and ESCRS.
Keywords: amblyopia; anisometropia; article; astigmatism; child; clinical article; controlled study; female; glaucoma; health survey; human; laser epithelial keratomileusis; laser surgery; male; myopia; operation duration; optic nerve atrophy; optic nerve hypoplasia; patient compliance; photorefractive keratectomy; priority journal; refraction error; refractive surgery; spectacles; treatment outcome; vision test; visual acuity

Observational survey on the use of dual therapy in ocular hypertension or glaucoma treatment - Bron, A.; Nordmann, J.-P.; Rouland, J.-F.; Baudouin, C.; Sartral, M. (Journal Francais d'Ophtalmologie, 2006)
Aim: To ascertain why ophthalmologists shift therapy to a fixed-combination or non-fixed-combination drug therapy. Patients and methods: A prospective multicenter observational study was conducted among French ophthalmologists working in private or mixed practice. The study included adult patients with open-angle glaucoma or ocular hypertension, treated with monotherapy or dual therapy and needing to modify their initial treatment. The patients had to fill out a self-questionnaire 15 days after the change in therapy, evaluating the compliance and assessment of the new treatment. Results: The analysis was made on 775 questionnaires filled out by ophthalmologists between March 1 st and July 31st 2003 on 5734 patients. The mean age was 66.4±12.4 years and women represented 53.6% of the patients. The diagnosis had been made, on average, 7.5±7.3 years before. The mean initial intraocular pressure under treatment was 19.8±4.1 mmHg in both eyes. Initially, 58.2% of the patients had monotherapy, 40.4% dual therapy and 1.4% triple therapy. The main reasons for shifting therapy were "high intraocular pressure under treatment" for 63.5% of the patients and "simplification of the treatment" for 39.1% of the patients (several reasons per patient were accepted). Most of the patients were satisfied with their new therapy (71%), which in most cases was a fixed-combination therapy (95.2%). Discussion: This study has shown that the use of at least two active principles is a common practice in the treatment of glaucoma and ocular hypertension. An additive therapy is given in order to better control the intraocular pressure, mainly with a fixed combination. © Masson, 2006.
Keywords: adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; cholinergic receptor stimulating agent; prostaglandin derivative; adult; aged; article; clinical trial; controlled clinical trial; controlled study; female; health survey; human; intraocular hypertension; intraocular pressure; major clinical study; male; monotherapy; multicenter study; observation; open angle glaucoma; ophthalmology; patient compliance; patient satisfaction; questionnaire; sclerotomy; trabeculoplasty; trabeculotomy

The clinical validity of the treatment satisfaction survey for intraocular pressure in ocular hypertensive and glaucoma patients - Day, D.G.; Sharpe, E.D.; Atkinson, M.J.; Stewart, J.A.; Stewart, W.C. (Eye, 2006)
Purpose: To provide initial validation of the Treatment Satisfaction Survey-Intraocular Pressure (TSS-IOP) quality-of-life survey that analyses specific issues related to side effects, patient satisfaction, and compliance. Methods: A prospective, observational cohort of 250 consecutive patients with primary open-angle glaucoma or ocular hypertension was administered the TSS-IOP survey. Results: Factors that correlated with patient satisfaction included perceived effectiveness of the medicine (F=7.47, P<0.001), ocular irritation (F=6.06, P<0.001), conjunctival hyperaemia (F=4.40, P<0.001), ease of use (F=8.52, P<0.001), and convenience of use (F=6.90, P<0.001). Patient compliance, acceptance of their illness, and knowledge of glaucoma were also related to perceived effectiveness of the medicine (P<0.001), ease of use (P<0.05) and convenience (P<0.001). Physician ratings of patient pressure control, side effects, and instillation problems also were significantly correlated to patient satisfaction (R=0.13=0.26, P=0.05-0.001). The physician ratings of patient compliance, however, were not significantly related to any dimension of patient satisfaction (P>0.05). Among monotherapy prostaglandin treatments, latanoprost demonstrated statistically greater satisfaction than bimatoprost or travoprost regarding conjunctival hyperaemia (P<0.05) and eye irritation (P<0.01). Conclusions: This study provides initial evidence that patient satisfaction may be related to compliance, perceived effectiveness of treatment, adverse side effects, ease and convenience of use, acceptance of illness, and knowledge of glaucoma. © 2006 Nature Publishing Group. All rights reserved.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; carbonate dehydratase inhibitor; latanoprost; prostaglandin; travoprost; adult; article; attitude to illness; clinical trial; cohort analysis; conjunctival hyperemia; controlled clinical trial; controlled study; correlation analysis; drug efficacy; drug utilization; eye irritation; female; human; intraocular hypertension; intraocular pressure; knowledge; major clinical study; male; monotherapy; observational study; open angle glaucoma; patient compliance; patient satisfaction; physician attitude; quality of life; questionnaire; rating scale; treatment satisfaction survey intraocular pressure; validity

Brimonidine/timolol: A viewpoint by Francisco J. Goñi - Goñi, F.J. (Drugs and Aging, 2006)
Keywords: apraclonidine; brimonidine; carbonate dehydratase inhibitor; clonidine; prostaglandin derivative; timolol; adjuvant therapy; clinical trial; drug efficacy; drug safety; glaucoma; human; intraocular pressure; note; patient compliance; prescription; priority journal

Ocular trauma in the Solomon Islands [6] - Baker, M.; Le Mesurier, R.; Szetu, J.; Painter, G.; Hue, J.; Mclellan, S.; Aluta, W. (Clinical and Experimental Ophthalmology, 2006)
Keywords: antibiotic agent; chloramphenicol; antibiotic therapy; blindness; cornea injury; cornea opacity; cornea ulcer; eye burn; eye care; eye injury; eye surgery; health belief; health care access; health care delivery; health care financing; health care personnel; health promotion; human; keratitis; letter; medical education; monocular vision; penetrating trauma; preventive medicine; public health service; resource allocation; resource management; scar formation; self medication; Solomon Islands; traditional medicine; visual acuity

Practical measures: Advantages of fixed combination treatments - Denis, P. (Journal Francais d'Ophtalmologie, 2006)
Even if glaucoma treatment often begins with monotherapy, combined treatments are in fact frequent. However, they are associated with poorer compliance, which may lead to lower efficacy, notably if the delay between two eyedrops is too short. The main advantages of fixed combinations are better therapeutic compliance and a lesser effect of dilution of the first eyedrops by the second. Nevertheless, it is impossible to change the dosing interval of one or the other of the components and adverse side effects cannot be controlled. The fixed combinations available today or in the near future are based for the most part on the combination of timolol and a prostaglandin. Their efficacy is comparable to the efficacy of each of the components or of nonfixed combinations, but it is not strictly equivalent. This difference (on the order of 1 mmHg) could be explained by unsuitable frequency or poor timing of the instillation. © Masson, 2006.
Keywords: brimonidine; carpilo; carteolol; brimonidine plus timolol; dorzolamide; dorzolamide plus timolol; timolol plus travoprost; latanoprost; latanoprost plus timolol; pilobloq; pilocarpine; prostaglandin; timolol; article; clinical trial; dilution; disease association; drug efficacy; glaucoma; human; intraocular pressure; patient compliance; unspecified side effect; carpilo; combigan; cosopt; duotrav; pilobloq; xalacom; xalatan

Compliance with medicine - Shaya, F.T. (Ophthalmology Clinics of North America, 2005)
Compliance with medication regimens is critical in assessing the effectiveness of treatments. As new drugs are approved for marketing and prescribed to diverse patient populations, the FDA now recommends further observational studies to continuously monitor unforeseen side effects or efficacy. More research is needed to develop valid and reliable tools to assess adherence of patients to treatment recommendations and adherence of physicians to treatment guidelines, when applicable. Information on adherence is as relevant to physicians and their patients as it is to insurers and payers, who need to implement cost-effective disease management programs. This review also has highlighted examples in the adherence literature specific to glaucoma medications and based on longitudinal survival analyses of claims data. Such results may be best complemented by primary, survey-based data collected from patients in observational studies. © 2005 Elsevier Inc. All rights reserved.
Keywords: beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; dorzolamide; latanoprost; timolol; travoprost; clinical practice; doctor patient relationship; drug cost; drug efficacy; drug safety; drug screening; drug withdrawal; glaucoma; human; hyperemia; information; intraocular pressure; ophthalmology; patient attitude; patient compliance; patient monitoring; priority journal; review; side effect

Racial differences in glaucoma care: The longitudinal pattern of care - Ostermann, J.; Sloan, F.A.; Herndon, L.; Lee, P.P. (Archives of Ophthalmology, 2005)
Objective: To examine if racial differences exist in longitudinal care patterns for Medicare beneficiaries with glaucoma. Methods: We analyzed national longitudinal Medicare claims data from January 1, 1991, through December 31, 1999 in 21 644 Medicare beneficiaries linked to the National Long-Term Care Survey. Logistic regression was used to predict whether a person underwent an eye examination or eye surgery during the year, and negative binomial regression was used to predict the number of eye examinations and surgical procedures for glaucoma per year. Annual use of eye examinations was nearly identical for black persons (1.85 per year) and white persons (1.89 per year), whereas surgery rates were higher among blacks (0.15) than whites (0.08, P<.001). Results: Blacks were more likely than whites to have glaucoma diagnosed, but rates among whites were higher than in prior population-based studies. When we controlled for other factors, blacks were not significantly less likely to undergo eye examination during the year; however, blacks were 78% more likely to undergo surgery (P < .001) and had 76% higher rates of surgical procedures (P < .001). Conclusions: No systematic pattern was found of underuse among blacks relative to whites after glaucoma diagnosis. Higher rates of surgery among blacks may indicate delayed onset of care and/or greater disease severity. ©2005 American Medical Association. All rights reserved.
Keywords: aged; article; binomial distribution; comparative study; controlled study; glaucoma; health care access; health survey; human; logistic regression analysis; major clinical study; medical examination; medicare; patient care; prediction; priority journal; race difference; surgical approach

Influence of switching to travoprost on intraocular pressure of uncontrolled chronic open-angle glaucoma patients compliant to previously-used topical medication - Holló, G.; Vargha, P.; Kóthy, P. (Current Medical Research and Opinion, 2005)
Objective: To investigate the influence of switching to travoprost on intraocular pressure (IOP) of chronic open-angle glaucoma (COAG) patients. Research design and methods: Multicentre, open-label, non-comparative, 12-week, phase IV study conducted at 10 academic and hospital centres in Hungary. Patients' compliance to use of the pre-study medication was confirmed at a visit 10 days before the baseline measurements, and compliance was monitored throughout the study period. Results: Of the 203 COAG patients three (1.48%) ceased travoprost medication due to ocular hyperaemia, and one subject was lost from follow-up. Self-reported compliance was optimal except for two patients. For the per-protocol analysis 197 patients were evaluable. IOP of the 37 per-protocol patients receiving additional travoprost medication decreased from 23.1 ± 3.2 mmHg (mean ± SD) to 17.3 ± 2.6 mmHg at week 12 (p < 0.001). Switching the 121 per-protocol patients from latanoprost to travoprost IOP decrease from 20.8 ± 3.5 mmHg to 17.7 ± 2.4 mmHg (p < 0.001). IOP of the 11 patients switched from topical nonselective beta-blockers to travoprost decreased from 20.1 ± 2.1 mmHg to 15.7 ± 1.5 mmHg (p < 0.001). For the whole per-protocol population (n = 197) IOP decreased from 21.0 ± 3.4 mmHg to 17.4 ± 2.4 mmHg (p < 0.001 ). Defining responders as having an IOP decrease > 2.0 mmHg or ≥ 5 mmHg at week 12, the responder rate was respectively 62.9% or 31% for the total study population; 86.5% or 54.1% when travoprost was added to the established therapy; 54.5% or 24.0% if latanoprost was switched to travoprost; and 90.9% or 36.4% for those who switched from beta-blockers. Conclusion: Travoprost provided a clinically and statistically significant IOP decrease in uncontrolled COAG patients whose self-reported compliance to their previous topical medication was optimal. Our results suggest that the IOP reduction found after switching to travoprost is not explainable by improved compliance due to the clinical study situation. © 2005 Librapharm Limited.
Keywords: beta adrenergic receptor blocking agent; latanoprost; travoprost; adult; aged; article; clinical protocol; clinical trial; conjunctival hyperemia; controlled clinical trial; controlled study; drug response; drug substitution; dry eye; dyspnea; eye color; eye disease; eye inflammation; eyelash; female; headache; heart palpitation; human; intraocular foreign body; intraocular hypotension; intraocular pressure; iris disease; major clinical study; male; multicenter study; non insulin dependent diabetes mellitus; ocular pruritus; open angle glaucoma; patient compliance; patient monitoring; patient participation; phase 4 clinical trial; sample size; skin allergy; university hospital; visual impairment

Ocular hypotensive effect of additional 1% dorzolamide in mixed glaucoma eyes - Shibata, M.; Yukawa, E.; Nitta, N.; Morishita, K.; Ishibashi, H.; Hara, Y. (Japanese Journal of Clinical Ophthalmology, 2005)
We evaluated the effect of additional instillation of 1% dorzolamide for mixed glaucoma in 20 eyes of 20 patients. All the eyes had received laser iridotomy. All the eyes showed poor control of intraocular pressure (IOP) by topical latanoprost and beta-blockers. The IOP averaged 21.0±2.0 mmHg. IOP decreased significantly from the baseline value when measured 1, 3 and 6 months after addition of dorzolamide (p< 0.05). The findings show that additional dorzolamide may induce further IOP decrease if patients show good compliance to treatment.
Keywords: beta adrenergic receptor blocking agent; dorzolamide; latanoprost; article; clinical article; controlled study; drug effect; drug instillation; glaucoma; human; intraocular hypotension; intraocular pressure; iridotomy; laser surgery; mixed glaucoma; patient compliance; treatment outcome

Comparison of latanoprost monotherapy and combined therapy of 0.5% timolol and 1% dorzolamide in chronic primary angle-closure glaucoma (CACG) in Japanese patients - Sakai, H.; Shinjyo, S.; Nakamura, Y.; Nakamura, Y.; Ishikawa, S.; Sawaguchi, S. (Journal of Ocular Pharmacology and Therapeutics, 2005)
To compare the efficacy, adverse effects, and patient compliance of latanoprost monotherapy with unfixed combination therapy with 0.5% timolol maleate and 1% dorzolamide in the treatment of chronic primary angle-closure glaucoma (CACG), 36 Japanese patients with CACG following laser iridotomy (LPI) were treated for 12 weeks with instillation of latanoprost alone or with unfixed combination therapy of 0.5% timolol maleate and 1% dorzolamide hydrochloride. After 12 weeks of treatment, latanoprost reduced intraocular pressure (IOP) from 22.2 ± 2.0 mmHg to 14.8 ± 1.9 mmHg (33% reduction); timolol maleate and dorzolamide hydrochloride also reduced IOP from 22.5 ± 2.2 mmHg to 17.1 ± 2.7 mmHg (24% reduction). Latanoprost monotherapy significantly lowered IOP compared with unfixed combination therapy of 0.5% timolol maleate and 1% dorzolamide hydrochloride. Furthermore, a systemic adverse effect of bradycardia was not observed in the latanoprost monotherapy group. Concerning compliance, no significant difference was observed between the two groups. Thus, latanoprost monotherapy is more effective than unfixed combination therapy with 0.5% timolol maleate and 1% dorzolamide in the treatment of CACG following relief of pupillary block in Japanese patients. © Mary Ann Liebert, Inc.
Keywords: acetazolamide; betaxolol; dorzolamide plus timolol; latanoprost; pilocarpine; timolol; adult; aged; article; bradycardia; clinical article; clinical trial; closed angle glaucoma; controlled clinical trial; controlled study; drug efficacy; drug mechanism; female; human; iridotomy; Japan; male; patient compliance; randomized controlled trial

Visual acuity development after the implantation of unilateral intraocular lenses in infants and young children - Birch, E.E.; Cheng, C.; Stager Jr., D.R.; Felius, J. (Journal of AAPOS, 2005)
Purpose: Intraocular lenses (IOLs) are now being implanted in infants and children with unilateral cataracts. However, there are no prospective data on the development of visual acuity after implantation. The aim of the present study was to prospectively assess the development of acuity in infants and preschool children who received IOLs or aphakic contacts lenses (CLs) after the extraction of a unilateral cataract. Methods: Visual acuity was assessed using Teller Acuity Cards and/or crowded HOTV tests at target ages of 6 months, 1, 2, 3, and 4 years. Results: Infants who received a primary IOL after extraction of dense congenital unilateral cataract (n = 5) showed improvement from an initially low mean visual acuity of 20/170 at 6 months to 20/85 at 12 months and 20/54 at 4 years. Visual acuity in the IOL group was similar to that of children who had good-to-excellent compliance with CL wear (n = 36; 4-year visual acuity 20/50) and better than that of children who had moderate-to-poor compliance (n = 11; 4-year visual acuity 20/135). Children who received IOLs after extraction of developmental unilateral cataracts by 6 months (n = 4; 4-year visual acuity 20/55) had visual acuity development similar to those treated with CLs (n = 5; 4-year visual acuity 20/55). Children who received IOLs after extraction of developmental unilateral cataracts after 1 year of age (n = 18) had better visual acuity than children those treated with CLs (n = 4) at 4 years of age (20/40 vs. 20/135). Conclusion: IOLs and aphakic CLs support similar visual acuity development after surgery for a unilateral cataract. IOLs may support better visual acuity development when compliance with CL wear is moderate to poor or when a cataract is extracted after 1 year of age. Copyright © 2005 by the American Association for Pediatric Ophthalmology and Strabismus.
Keywords: aphakia; article; cataract; cataract extraction; clinical trial; contact lens; controlled clinical trial; controlled study; endophthalmitis; glaucoma; human; infant; lens implant; major clinical study; patient compliance; preschool child; priority journal; visual acuity

Ophthalmological side effects of antidepressant, anxiolytic and mood stabilizer agents - Fornaro, P.; Venuti, S.; Fornaro, M.; Sartore, F.; Gabrielli, F. (Minerva Psichiatrica, 2005)
Of the various undesired side effects associated with antidepressants, minor tranquilizers and mood stabilizers commonly used in psychiatry, those affecting the eye and vision are often neglected and largely ignored. This review of published data calls the clinician's attention to the need for a better understanding of such adverse affects to ensure a correct, more rational pharmacotherapy with such agents, as they are also often employed in chronic treatment. Specifically, lesser known and not infrequently rare complications are examined, including mydriasis and tricyclic-antidepressant-induced cycloplegia, which may lead to the onset of acute glaucoma and augment the risk of irreversible severe eye damage, including blindness; the undesired effects of lithium salts are frequently a sign of neurotoxicity; the effects of carbamazepine and especially those caused by topyramate, an anticonvulsant increasingly used in psychiatry because of its therapeutic efficacy in the treatment of bipolar disorders and because of its ability to induce weight loss. The ocular side effects these agents cause may sometimes be so severe that compliance is reduced and health risks are increased. Close collaboration with the oculist and accurate monitoring of the patient's ophthalmic conditions are therefore recommended.
Keywords: amitriptyline; anticonvulsive agent; antidepressant agent; anxiolytic agent; bethanechol; brofaromine; carbamazepine; citalopram; clomipramine; clorgyline; desipramine; escitalopram; fluoxetine; fluvoxamine; imipramine; isocarboxazid; lithium; moclobemide; monoamine oxidase inhibitor; mood stabilizer; oxcarbazepine; paroxetine; phenelzine; phenothiazine derivative; sertraline; topiramate; tranylcypromine; tricyclic antidepressant agent; trifluoperazine; trimipramine; accommodation paralysis; bipolar disorder; blindness; closed angle glaucoma; drug mechanism; extrapyramidal symptom; eye disease; eye injury; health hazard; human; long term care; mydriasis; neurotoxicity; patient compliance; patient monitoring; review; body weight loss

Post-traumatic glaucoma with irido-corneal angle injuries in Cameroon - Ellong, A.; Ebana Mvogo, C.; Nyouma Moune, E.; Bella-Hiag, A.; Ngosso, A.; Njoh Litumbe, C. (Bulletin de la Société belge d'ophtalmologie, 2005)
AIM: To study the particularities of late post-traumatic glaucoma with irido-corneal angle injuries in black Cameroonians. MATERIAL AND METHODS: Retrospective analysis of 1343 files of glaucomatous patients was carried out from January 1991 to December 2001 at the Douala General Hospital in Cameroon in Central Africa. Fifty seven of them had post-traumatic glaucoma. Of these 28 were secondary to irido-corneal angle injuries. RESULTS: The prevalence of post-traumatic glaucoma related to irido-corneal angle injuries in our population was 2.1%. The mean patients age was 45.9 +/- 18.3 years (range, 17 to 67 years). The time from injury to diagnosis ranged from 1 year 4 months to 7 years (median: 3.7 years). The follow-up period ranged from 3 months to 5 years 6 months, with a mean of 1.7 +/- 1.9 years. The prevalence of monocular blindness was 61.9% and 81% at the first and last examination respectively. The mean intraocular pressure was 36.9 +/- 13.8 mmHg (range: 22 and 66 mmHg) at the first examination and 24.3 +/- 13 mmHg (range: 12 and 29 mmHg) at the last examination. The mean recorded cup/disc ratio was 0.8 +/- 0.2. It was equal to 1.0 in 61.9% of cases. Irido-corneal angle recession was the most common lesion (61.9%) followed by iridodialysis (38.1%) and cyclodialysis (14.3%). Normalization of the intraocular pressure was achieved with medical treatment in 23.8% and with trabelectomy in 12.3% of the cases. Neovascular glaucoma was found in 4.8% of the cases. CONCLUSION: The treatment of secondary post-traumatic open angle glaucoma is disappointing. The patients are young, the disease is advanced, and the compliance and follow-up are poor. The prevention of post-traumatic glaucoma is based on the control of ocular trauma and the periodic follow-up of patients with and history of non perforating injury of the eye.
Keywords: adolescent; adult; aged; article; blindness; Cameroon; comorbidity; cornea; eye injury; female; follow up; human; injury; iris; male; middle aged; open angle glaucoma; prevalence; retrospective study; treatment outcome

Improving capacity building by implementing comprehensive eye care project, experiences from Kuandian County, China - Lin, Y.; Yu, Y.-J.; Zhao, Z.-Y. (Chinese Medical Journal, 2005)
Keywords: eye drops; agricultural worker; article; blindness; cataract; China; cost benefit analysis; economic aspect; geography; glaucoma; government; health care access; health care cost; health care organization; health care planning; health care system; health practitioner; health promotion; health service; health survey; human; incidence; income; ophthalmology; population size; refraction error; resource allocation; rural population; social class; sustainable development; trichiasis; visual impairment; workshop; World Health Organization

New drugs in the treatment of epilepsy in children - Donner, E.J.; Snead III, O.C. (Current Problems in Pediatric and Adolescent Health Care, 2005)
Keywords: 4 aminobutyric acid; alpha amino 3 hydroxy 5 methyl 4 isoxazolepropionic acid; anticonvulsive agent; benzodiazepine derivative; calcium ion; carbamazepine; clonazepam; contraceptive agent; cytochrome P450; cytochrome P450 3A; ethosuximide; etiracetam; felbamate; fosphenytoin sodium; gabapentin; glutamate decarboxylase; lamotrigine; n methyl dextro aspartic acid; nitrazepam; oxcarbazepine; phenobarbital; phenytoin; pregabalin; primidone; tiagabine; topiramate; unindexed drug; valproic acid; vigabatrin; zonisamide; agitation; anticonvulsant activity; anticonvulsant therapy; anxiety; aplastic anemia; asthenia; ataxia; behavior disorder; body weight disorder; cardiovascular disease; caregiver; childhood disease; chronic disease; clinical feature; clinical trial; closed angle glaucoma; cognition; differential diagnosis; diplopia; disease classification; disease control; dizziness; drug cost; drug efficacy; drug mechanism; electroencephalography; employment; epidermolysis; epilepsy; focal epilepsy; tonic clonic seizure; health care access; health care cost; health care need; human; hyperchloremia; hyperthermia; infection; injection pain; kidney dysfunction; laboratory test; learning; liver dysfunction; liver failure; metabolic acidosis; morbidity; mortality; myopia; nausea; nephrolithiasis; neurotransmission; ovary polycystic disease; pathophysiology; physical examination; quality of life; rash; retina disease; review; sedation; somnolence; Stevens Johnson syndrome; cerebyx; felbatol; gabitril; keppra; lamictal; lyrica; neurontin; sabril; topamax

Medical management of glaucoma: Clinical and research update - Kanner, E.M.; Tsai, J.C. (Geriatrics and Aging, 2005)
Glaucoma is a sight-threatening, progressive optic neuropathy whose incidence increases with age. Currently, the only proven treatment for glaucoma is the reduction of intraocular pressure (IOP). As medical treatment has become safer and diagnostic modalities have become more sensitive, it has become possible to detect and treat glaucoma earlier. This means that with more aggressive screening and treatment, a common cause of irreversible blindness can be prevented. As more patients are treated earlier, it is important not only for ophthalmologists but also for primary care physicians to be aware of the barriers to adherence and possible interactions and side effects of glaucoma medications. Parallels between glaucoma and other neurodegenerative disease are stimulating new approaches to therapy beyond IOP control, targeted directly at the prevention of axonal loss.
Keywords: epinephrine; adrenergic receptor stimulating agent; alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; beta lactam antibiotic; betaxolol; bimatoprost; brinzolamide; carbachol; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; dipivefrine; dorzolamide; dorzolamide plus timolol; glutamate receptor; glutamic acid; latanoprost; levobunolol; memantine; metipranolol; n methyl dextro aspartic acid receptor blocking agent; neuroprotective agent; pilocarpine; prostaglandin derivative; timolol; travoprost; unindexed drug; unoprostone isopropyl ester; aging; allergic reaction; article; awareness; bradycardia; bronchitis; bronchospasm; cardiogenic shock; cataract; clinical research; clinical trial; conjunctival hyperemia; conjunctivitis; degenerative disease; dermatitis; diarrhea; dizziness; drowsiness; drug mechanism; dyspnea; early diagnosis; erythema; eye burning; eye disease; falling; fatigue; gastrointestinal disease; glaucoma; headache; heart arrhythmia; heart block; heart failure; human; hypertension; hypotension; incidence; intraocular foreign body; intraocular hypertension; intraocular pressure; keratitis; medical specialist; muscle cramp; nausea; nephrolithiasis; nerve fiber; nonhuman; ocular pruritus; ophthalmology; optic nerve disease; pathophysiology; patient compliance; physician; primary medical care; retina macula cystoid edema; salivation; screening test; side effect; sweating; faintness; tachycardia; taste disorder; thorax pain; treatment planning; urticaria; vomiting; xerostomia

Drug delivery systems improve pharmaceutical profile and facilitate medication adherence - Wertheimer, A.I.; Santella, T.M.; Finestone, A.J.; Levy, R.A. (Advances in Therapy, 2005)
Innovations in dosage forms and dose delivery systems across a wide range of medications offer substantial clinical advantages, including reduced dosing frequency and improved patient adherence; minimized fluctuation of drug concentrations and maintenance of blood levels within a desired range; localized drug delivery; and the potential for reduced adverse effects and increased safety. The advent of new large-molecule drugs for previously unbeatable or only partially treatable diseases is stimulating the development of suitable delivery systems for these agents. Although advanced formulations may be more expensive than conventional dosage forms, they often have a more favorable pharmacologic profile and can be cost-effective. Inclusion of these dosage forms on drug formulary lists may help patients remain on therapy and reduce the economic and social burden of care. ©2005 Health Communications Inc.
Keywords: fluticasone propionate plus salmeterol xinafoate; alpha interferon; beta adrenergic receptor blocking agent; budesonide; calcium channel blocking agent; carmustine; cholinergic receptor blocking agent; clonidine; corticosteroid; cyclosporine; diuretic agent; dorzolamide; doxorubicin; fentanyl; fluticasone propionate plus salmeterol; glyceryl trinitrate; gonadorelin; lidocaine; liposome; macrogol; methylphenidate; nicotinic acid; nifedipine; opiate; oxybutynin; polymer; pulmicort respule; recombinant granulocyte colony stimulating factor; somatostatin derivative; testosterone; unindexed drug; verapamil; acquired immune deficiency syndrome; asthma; attention deficit disorder; blurred vision; brain tumor; cardiotoxicity; cognitive defect; confusion; constipation; cost effectiveness analysis; drowsiness; drug blood level; drug delivery system; drug dosage form; drug dose reduction; drug formulary; drug formulation; drug safety; dyslipidemia; flushing; glaucoma; hepatitis C; human; hypertension; hypophysis adenoma; Kaposi sarcoma; patient compliance; prostate cancer; psoriasis; review; side effect; urge incontinence; xerostomia; advair diskus; gliadel; pulmicort respule

Modeling and simulation of adherence: Approaches and applications in therapeutics - Kenna, L.A.; Labbé, L.; Barrett, J.S.; Pfister, M. (AAPS Journal, 2005)
Partial adherence with a prescribed or randomly assigned dose gives rise to unintended variability in actual drug exposure in clinical practice and during clinical trials. There are tremendous costs associated with incomplete and/or improper drug intake - to both individual patients and society as a whole. Methodology for quantifying the relation between adherence, exposure and drug response is an area of active research. Modeling and statistical approaches have been useful in evaluating the impact of adherence on therapeutics and in addressing the challenges of confounding and measurement error which arise in this context. This paper reviews quantitative approaches to using adherence information in improving therapeutics. It draws heavily on applications in the area of HIV pharmacology. Copyright ©2003. All Rights Reserved.
Keywords: amlodipine; beta adrenergic receptor blocking agent; calcium channel blocking agent; diltiazem; dipeptidyl carboxypeptidase inhibitor; doxazosin; efavirenz; hydroxymethylglutaryl coenzyme A reductase inhibitor; low density lipoprotein; nonsteroid antiinflammatory agent; oral contraceptive agent; pilocarpine; placebo; zidovudine; analytical error; blood pressure monitoring; cardiovascular disease; clinical practice; clinical trial; computer analysis; cost effectiveness analysis; drug bioavailability; drug clearance; drug dose regimen; drug exposure; drug mechanism; drug response; drug use; Food and Drug Administration; glaucoma; government regulation; health care cost; high risk behavior; human; Human immunodeficiency virus infection; hypertension; medical research; methodology; patient attitude; patient compliance; prescription; quality adjusted life year; quantitative analysis; review; statistical analysis

A three-month, multicenter, double-masked study of the safety and efficacy of travoprost 0.004%/timolol 0.5% ophthalmic solution compared to travoprost 0.004% ophthalmic solution and timolol 0.5% dosed concomitantly in subjects with open angle glaucoma or ocular hypertension - Hughes, B.A.; Bacharach, J.; Craven, E.R.; Kaback, M.B.; Mallick, S.; Landry, T.A.; Bergamini, M.V.W. (Journal of Glaucoma, 2005)
Purpose: The primary objective of this study was to compare the intraocular pressure (IOP)-lowering efficacy of travoprost 0.004%/timolol 0.5% fixed combination to the concomitant administration of travoprost 0.004% (TRAVATAN®) and timolol 0.5% in subjects with open angle glaucoma or ocular hypertension. Methods: This was a randomized, multicenter, double-masked, active-controlled, parallel group study. Three hundred sixteen patients with open angle glaucoma or ocular hypertension were randomly assigned to travoprost 0.004%/timolol 0.5% ophthalmic solution fixed combination once daily in the morning or concomitant administration of timolol 0.5% once daily in the morning and travoprost 0.004% ophthalmic solution once daily in the evening. The efficacy and safety of the fixed combination were compared with concomitant therapy over three months. The primary efficacy outcome measure was mean intraocular pressure. Results: Both travoprost 0.004%/timolol 0.5% fixed combination and the concomitant administration of travoprost 0.004% and timolol 0.5% produced statistically significant reductions from baseline in IOP, with mean IOP ranging from 15.2 to 16.5 mm Hg in the patients using travoprost 0.004%/timolol 0.5% fixed combination compared with 14.7 to 16.1 mm Hg in the concomitant group. The upper 95.1% confidence limit for the differences in mean IOP (fixed combination minus concomitant) was ≤ 1.5 mm Hg at 7 of 9 visits, including all three 8 AM time points, 24-hours post-dose. Mean IOP reductions from baseline ranged from 7.4 to 9.4 mm Hg in the fixed combination group compared with 8.4 to 9.4 mm Hg with concomitant therapy. Safety analysis demonstrated equivalent safety between the two treatment groups. Conclusions: A fixed combination of travoprost 0.004% and timolol 0.5% produced clinically relevant TOP reductions in patients with open angle glaucoma or ocular hypertension that were comparable to concomitant therapy with its components. Safety and tolerability of the fixed combination were also equivalent to concomitant therapy. Travoprost 0.004%/timolol 0.5% fixed combination offers IOP reduction equivalent to concomitant therapy, with potential benefits that include convenience (fewer bottles and drops per day), improved compliance, cost savings (based on fewer co-payments), and elimination of potential washout effects. Copyright © 2005 by Lippincott Williams & Wilkins.
Keywords: beta adrenergic receptor blocking agent; dorzolamide; dorzolamide plus timolol; eye drops; latanoprost; latanoprost plus timolol; timolol; timolol plus travoprost; travoprost; unclassified drug; adult; aged; article; clinical trial; controlled clinical trial; controlled study; cornea disease; double blind procedure; drug efficacy; drug mechanism; drug mixture; drug safety; drug tolerability; dry eye; female; human; hyperemia; intraocular hypertension; intraocular pressure; major clinical study; male; multicenter study; ocular pruritus; open angle glaucoma; patient compliance; priority journal; randomized controlled trial; cosopt; travatan; xalatan; xalcom

Systemic medications and glaucoma patients [6] - Covert, D.; Robin, A.L.; Novack, G.D. (Ophthalmology, 2005)
Keywords: acetylsalicylic acid; calcium; proton pump inhibitor; timolol; travoprost; vitamin; adult; age distribution; aged; comorbidity; controlled study; drug dose regimen; drug efficacy; drug safety; female; gender; glaucoma; human; intraocular hypertension; letter; major clinical study; male; patient compliance; prescription; priority journal

Persistence and adherence with topical glaucoma therapy - Nordstrom, B.L.; Friedman, D.S.; Mozaffari, E.; Quigley, H.A.; Walker, A.M. (American Journal of Ophthalmology, 2005)
• PURPOSE: The present study describes the patterns and predictors of treatment persistence and adherence among patients who are diagnosed with glaucoma or as glaucoma suspects (based on claims codes). • DESIGN: A retrospective cohort study using health insurance claims data. • METHODS: Newly treated individuals with diagnosed glaucoma (n = 3623) and suspect glaucoma (n = 1677) were obtained from healthcare claims data in the Ingenix Research Database. For each of these two diagnostic groups, we calculated the duration of continuous treatment with the initially prescribed medication (persistence) and the prevalence of use of the initial medication at various time points (adherence). Four drug classes were included: β-blockers, α-agonists, carbonic anhydrase inhibitors, and prostaglandin analogs. • RESULTS: Nearly one half of the individuals who had filled a glaucoma prescription discontinued all topical ocular hypotensive therapy within six months, and just 37% of these individuals recently had refilled their initial medication at three years after the first dispensing. Prostaglandins were associated with better persistence than any other drug class, which was indicated by hazard ratios for discontinuation of prostaglandins compared with β-blockers of 0.40 (95% confidence interval, 0.35-0.44) for diagnosed patients and 0.44 (95% confidence interval, 0.37-0.52) for patients with suspect glaucoma. Prostaglandins showed a similar advantage in adherence. Furthermore, patients with diagnosed glaucoma were more likely to adhere to therapy than patients with suspect glaucoma (relative risk = 1.11; 95% confidence interval, 1.05-1.18). • CONCLUSION: Persistence and adherence were substantially better with prostaglandins than with other drug classes, and patients with diagnosed open-angle glaucoma were more likely to adhere to treatment than suspected glaucoma. © 2005 by Elsevier Inc. All rights reserved.
Keywords: alpha adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; carteolol; dipivefrine; dorzolamide; dorzolamide plus timolol; ecothiopate; latanoprost; levobunolol; metipranolol; miotic agent; pilocarpine; prostaglandin; timolol; travoprost; unoprostone isopropyl ester; adult; aged; article; cohort analysis; comparative study; confidence interval; controlled study; female; glaucoma; health insurance; human; major clinical study; male; patient compliance; prescription; prevalence; priority journal; treatment withdrawal

Intravitreal triamcinolone acetonide as an adjuvant therapy to panretinal photocoagulation for proliferative retinopathy with high risk characteristics in type 1 diabetes: Case report with 22 weeks follow-up - Kytö, J.P.; Ångerman, S.; Lumiste, E.; Paloheimo, M.; Summanen, P.A. (Acta Ophthalmologica Scandinavica, 2005)
Purpose: To describe a new treatment protocol to deliver panretinal photocoagulation that may avoid further deterioration of vision in patients with type 1 diabetes mellitus with proliferative retinopathy with high risk characteristics for severe visual loss and cystoid macular oedema. Methods: Fundus photography, measurement of foveal thickness with optical coherence tomography and best corrected visual acuity (BCVA) determined by Snellen and ETDRS charts were measured before and after treatment in a 28-year-old man. Results: Over 9 weeks, BCVA improved from 0.05 to 0.25 and the number of letters read at 2 metres from four to 39 after panretinal photocoagulation and adjuvant intravitreal triamcinolone injection under intraconal anaesthesia. Foveal thickness decreased from 691 μm to 239 μm and cysts disappeared by 15 weeks. By 22 weeks, foveal thickness had increased to 282 μm and small cysts had reappeared, but BCVA remained at 0.2 and the number of letters read at 30. Conclusion: Proliferative retinopathy regressed, cystoid macular oedema disappeared and vision improved after panretinal photocoagulation and adjuvant intravitreal triamcinolone acetonide injection under intraconal anaesthesia. This represents a feasible option in cases where pain during laser treatment and impairment of vision afterwards due to cystoid macular oedema result in poor compliance with standard laser treatment under topical anaesthesia. Copyright © Acta Ophthalmol Scand 2005.
Keywords: brimonidine; dorzolamide; enalapril; levofloxacin; nifedipine; triamcinolone; triamcinolone acetonide; adjuvant therapy; adult; anamnesis; anesthesiological procedure; article; case report; diabetic retinopathy; disease severity; eye photography; feasibility study; follow up; human; insulin dependent diabetes mellitus; intraocular hypertension; laser coagulation; male; microalbuminuria; optical coherence tomography; patient compliance; priority journal; recurrent disease; remission; retina macula cystoid edema; risk assessment; treatment outcome; visual acuity; visual impairment; vitrectomy; kenacort

Does adjunctive glaucoma therapy affect adherence to the initial primary therapy? - Brown, M.M. (Evidence-Based Ophthalmology, 2005)
Keywords: antiglaucoma agent; eye drops; latanoprost; drug use; glaucoma; health behavior; human; illness behavior; intraocular pressure; monotherapy; note; patient care; patient compliance; patient education; prescription; priority journal; probability

Direct costs of glaucoma and severity of the disease: A multinational long term study of resource utilisation in Europe - Traverso, C.E.; Walt, J.G.; Kelly, S.P.; Hommer, A.H.; Bron, A.M.; Denis, P.; Nordmann, J.-P.; Renard, J.-P.; Bayer, A.; Grehn, F.; Pfeiffer, N.; Cedrone, C.; et al. (British Journal of Ophthalmology, 2005)
Background: Resource utilisation and direct costs associated with glaucoma progression in Europe are unknown. As population progressively ages, the economic impact of the disease will increase. Methods: From a total of 1655 consecutive cases, the records of 194 patients were selected and stratified by disease severity. Record selection was based on diagnoses of primary open angle glaucoma, glaucoma suspect, ocular hypertension, or normal tension glaucoma; 5 years minimum follow up were required. Glaucoma severity was assessed using a six stage glaucoma staging system based on static threshold visual field parameters. Resource utilisation data were abstracted from the charts and unit costs were applied to estimate direct costs to the payer. Resource utilisation and estimated direct cost of treatment, per person year, were calculated. Results: A statistically significant increasing linear trend (p = 0.018) in direct cost as disease severity worsened was demonstrated. The direct cost of treatment increased by an estimated €86 for each incremental step ranging from €455 per person year for stage 0 to €969 per person year for stage 4 disease. Medication costs ranged from 42% to 56% of total direct cost for all stages of disease. Conclusions: These results demonstrate for the first time in Europe that resource utilisation and direct medical costs of glaucoma management increase with worsening disease severity. Based on these findings, managing glaucoma and effectively delaying disease progression would be expected to significantly reduce the economic burden of this disease. These data are relevant to general practitioners and healthcare administrators who have a direct influence on the distribution of resources.
Keywords: adult; aged; article; disease course; disease severity; Europe; female; follow up; general practitioner; glaucoma; health care cost; health care utilization; human; intraocular hypertension; major clinical study; male; medical record; open angle glaucoma; priority journal; statistical significance; visual field

Noncompliance with medical treatment among glaucoma patients in Oman - A cross-sectional descriptive study - Khandekar, R.; Shama, M.E.-S.; Mohammed, A.J. (Ophthalmic Epidemiology, 2005)
Purpose: Glaucoma is a priority eye disease in Oman. In order to revise the existing policies for eye care, a study was conducted to review the noncompliance rates among glaucoma patients. Methods: Using the random method, we selected 105 glaucoma patients from among those visiting glaucoma clinics during 2003. They were interviewed by trained health professionals. A closed-ended questionnaire with 42 questions was used to note their responses. The questions dealt with their personal characteristics along with the patients' glaucoma treatment and their knowledge of and attitudes towards different components of noncompliance with medical treatment. The field staffs also observed the 'practice' of instilling placebo eyedrops. The responses were analyzed to grade the compliance, knowledge, attitude and practice of each patient. Results: Excellent compliance was found in 26 patients. Discontinuation of medication in the past was reported by 87 patients. Missing instillation of eyedrops and irregular visits to the ophthalmologist were noted in 10 and 14 patients, respectively. Adequate knowledge about glaucoma and its complications was negatively associated with noncompliance [RR 2.05 (95% CI 1.07-3.93)]. Conclusions: The high rates of noncompliance among glaucoma patients in Oman demand a systematic programmed approach. Longitudinal studies are needed to confirm the causal association between noncompliance and Knowledge, Attitude and Practice. Health education, communication while dispensing medication, reducing the frequency of medication and using devices for the easy administration of eyedrops could further improve compliance. Copyright © Taylor & Francis Inc.
Keywords: eye drops; placebo; adolescent; adult; aged; article; child; controlled study; female; glaucoma; health education; human; infant; male; Oman; patient attitude; patient compliance; patient education; priority journal; questionnaire; treatment refusal

Selective laser trabeculoplasty - Latina, M.A.; De Leon, J.M.S. (Ophthalmology Clinics of North America, 2005)
In summary, SLT has been shown to be safe, well tolerated, and effective in IOP reduction as therapy in several forms of OAG. The preservation of TM architecture and the demonstrated efficacy in lowering IOP make SLT a reasonable and safe alternative to ALT. SLT may also be effective for cases of failed ALT and is a procedure that may also be repeatable, unlike ALT. SLT is also a simple technique for an ophthalmologist to learn as the large spot size eliminates the need to locate a particular zone of treatment on the TM. SLT has been demonstrated to be effective as primary treatment for open angle glaucoma and can be an effective adjunct in the early treatment of glaucoma. Furthermore, SLT can be considered as a treatment option in patients who cannot tolerate or who are noncompliant with their glaucoma medications, without interfering with the success of future surgery. © 2005 Elsevier Inc. All rights reserved.
Keywords: antiglaucoma agent; antiinflammatory agent; apraclonidine; dexamethasone; indometacin; ketorolac trometamol; prednisolone acetate; proxymetacaine; argon laser; clinical trial; cornea thickness; dose response; drug effect; drug mechanism; drug tolerability; histopathology; human; intermethod comparison; intraocular pressure; laser surgery; medical specialist; nonhuman; open angle glaucoma; ophthalmology; patient compliance; postoperative period; priority journal; race; review; safety; selective laser trabeculoplasty; surgical technique; trabecular meshwork; trabeculectomy; trabeculoplasty; treatment indication; treatment outcome; treatment planning

Migraine prophylaxis - Graff-Radford, S.B. (Clinics in Family Practice, 2005)
Migraine prevention is an art and not a science. Careful attention to triggers, personality traits, and comorbid health issues help guide the choice of medication. Often, multiple agents providing different mechanisms of action may be needed. It is essential that patients use their acute medication even when on prophylaxis but less than two times per week on an ongoing basis. It is imperative to be patient with preventative outcome because it can take weeks to establish. Supportive care and parallel cognitive interventions helps patients not become frustrated. Migraine remains a devastating condition, with a minimal number of appropriate patients receiving preventative therapy.
Keywords: acetazolamide; anticonvulsive agent; antidepressant agent; atenolol; barbituric acid derivative; beta adrenergic receptor blocking agent; botulinum toxin; calcium channel blocking agent; candesartan; cimetidine; desogestrel; diltiazem; ergot alkaloid; gabapentin; gestagen; indometacin; methysergide; methysergide maleate; metoprolol; metoprolol tartrate; mineral; nonsteroid antiinflammatory agent; norgestimate; oral contraceptive agent; placebo; riboflavin; serotonin agonist; serotonin antagonist; topiramate; tricyclic antidepressant agent; unindexed drug; venlafaxine; abdominal pain; acupuncture; agranulocytosis; alternative medicine; altitude; aplastic anemia; arthralgia; ataxia; behavior therapy; body weight disorder; clinical trial; cognitive therapy; comorbidity; confusion; constipation; depression; diarrhea; drowsiness; drug absorption; drug contraindication; drug half life; drug mechanism; drug metabolism; drug utilization; drug withdrawal; electromyography; evidence based medicine; exercise; fatigue; food drug interaction; gastrointestinal symptom; gingiva hyperplasia; glaucoma; heart block; herbal medicine; homeopathy; human; hypnosis; hypotension; interpersonal communication; leukopenia; liver dysfunction; lung fibrosis; medical decision making; menstruation; meta analysis; migraine; nephrolithiasis; paresthesia; patient compliance; patient education; personality; practice guideline; prophylaxis; psychophysiology; QT prolongation; relaxation training; retroperitoneal fibrosis; review; sexual behavior; supraventricular tachycardia; systematic review; transcutaneous electrical nerve stimulation; treatment outcome; tremor; urine retention; body weight gain; xerostomia

Intraocular pressure after withdrawal of hypotensive medications except latanoprost - Fujikawa, A.; Tsuiki, E.; Ogawa, T.; Kitaoka, T. (Japanese Journal of Clinical Ophthalmology, 2005)
Purpose: To evaluate changes in intraocular pressure before and after withdrawal of topical medications except latanoprost. Cases and Method: This study involved 7 eyes of 5 patients who had been treated by multiple topical medications including latanoprost. The series comprised primary open-angle glaucoma 4 eyes, secondary glaucoma 2 eyes and capsular glaucoma 1 eye. Tonometry was performed before withdrawal of medications except latanoprost and after 8 weeks following withdrawal. They were followed up for 61.7±6.5 weeks. Results: The intraocular pressure (OP) averaged 16.2 mmHg before withdrawal and 15.4 mmHg after withdrawal. The difference was not significant (p=0.21). Conclusion: Treatment with latanoprost alone was equally effective as multiple medications. Latanoprost monotherapy may lead to improved complicance and less damage to the cornea.
Keywords: antihypertensive agent; latanoprost; adult; aged; capsular glaucoma; clinical article; conference paper; cornea injury; drug withdrawal; female; follow up; glaucoma; human; intraocular pressure; male; monotherapy; open angle glaucoma; patient compliance; secondary glaucoma; tonometry

The role of venlafaxine and duloxetine in the treatment of depression with decremental changes in somatic symptoms of pain, chronic pain, and the pharmacokinetics and clinical considerations of duloxetine pharmacotherapy - Barkin, R.L.; Barkin, S. (American Journal of Therapeutics, 2005)
Chronic pain is among the most common conditions to initiate medical care; 40% of patients victimized by chronic pain are not under the supervision of a physician, and about 70% of patients with severe pain are receiving pain medical care. About $100 billion is an annual estimated cost representing loss of productivity, increased medical costs, and income loss. Major depressive disorder is not infrequently encountered in daily clinical practice often presenting with somatic complaints that include varieties of pain, and these may be so prominent as to direct the treatment to the somatic complaint evaluation to the exclusion of underlying psychopathology. Anxiety disorders and other psychiatric disorders may also present with such a somatization evaluation focus. Serotonin noradrenergic reuptake inhibitors (SNRIs), ie, venlafaxine and duloxetine, offer benefits over tricyclic antidepressants and serotonin reuptake inhibitors. Years of experience with venlafaxine representing a first-line pharmacotherapy for depression and anxiety have benefited patients presenting with somatic symptoms with a robust onset. A more rapid achievement by venlafaxine of remission and a high-quality pharmacokinetic and pharmacodynamic profile lead to patient compliance and facilitate both fewer relapses and recurrences. Duloxetine is broadly discussed, revealing pharmacokinetic, pharmacodynamic, adverse/side effects, cautions with requisite patient-specific selection, and laboratory monitoring. The management of somatic pain complaints of physical and psychiatric origin is discussed. © 2005 Lippincott Williams & Wilkins.
Keywords: anticonvulsive agent; antidepressant agent; anxiolytic agent; carbamazepine; celecoxib; duloxetine; fluoxetine; fluvoxamine; methadone; muscle relaxant agent; nonsteroid antiinflammatory agent; paroxetine; pethidine; serotonin; serotonin noradrenergic reuptake inhibitors; serotonin uptake inhibitor; tramadol; tricyclic antidepressant agent; unclassified drug; valdecoxib; venlafaxine; anxiety disorder; appetite disorder; area under the curve; asthenia; behavior therapy; chronic pain; clinical practice; clinical trial; closed angle glaucoma; constipation; diaphoresis; diarrhea; dizziness; dose response; drug binding; drug half life; ejaculation disorder; erectile dysfunction; fatigue; health care cost; human; hypertension; income; insomnia; liver toxicity; major depression; medical care; mental disease; mydriasis; nausea; neuropathic pain; pain assessment; patient compliance; patient selection; physician; pollakisuria; priority journal; productivity; quality of life; recurrent disease; relapse; review; side effect; somatization; somnolence; symptomatology; urinary dysfunction; vomiting; withdrawal syndrome; xerostomia

Microbial keratitis in overnight orthokeratology: Review of the first 50 cases - Watt, K.; Swarbrick, H.A. (Eye and Contact Lens, 2005)
Purpose. Despite growing evidence for clinical efficacy of orthokeratology (OK) for the temporary reduction of myopic refractive error, there has been an increasing number of reports of microbial keratitis (MK) in association with overnight wear of OK lenses. This article analyzes the first 50 cases of MK reported in overnight OK, in order to define the spectrum of the disease and to identify possible risk factors. Methods. All reported cases of presumed MK in overnight OK from 2001 onwards were included in the analysis. Demographic data of patients affected and lenses worn, and details of the disease process and possible risk factors were extracted from these reports. Results. Most cases of MK in OK were reported from East Asia (80%) and most affected patients were Asian (88%). The peak age range was from 9 to 15 years (61%). Although Pseudomonas aeruginosa was the predominant organism implicated in this series of cases (52%), an alarmingly high frequency of Acanthamoeba infection (30%) was found. Inappropriate lens care procedures, patient noncompliance with practitioner instructions, and persisting in lens wear despite discomfort emerged as potential risk factors. Conclusions. The high frequency of MK in overnight OK in young Asian patients is likely to reflect the demographics of the OK lens-wearing population. The high frequency of Acanthamoeba infection strongly suggests that tap water rinsing should be eliminated from the lens care regimen for overnight OK. This study does not reveal the absolute incidence or relative risk of MK in overnight OK, and it is therefore premature to ascribe increased risk to this lens-wearing modality compared with other contact lens modalities. © 2005 Contact Lens Association of Ophthalmologists, Inc.
Keywords: aminoglycoside antibiotic agent; antibiotic agent; antifungal agent; antiprotozoal agent; cephalosporin; quinoline derived antiinfective agent; steroid; tap water; Acanthamoeba keratitis; adolescent; adult; article; Asia; clinical article; conservative treatment; contact lens; demography; device infection; disease association; disease classification; doctor patient relationship; female; human; keratitis; male; monotherapy; morbidity; myopia; orthokeratology lens; patient compliance; priority journal; Pseudomonas aeruginosa; refraction error; risk factor; school child

The current state of corneal reshaping - Walline, J.J.; Holden, B.A.; Bullimore, M.A.; Rah, M.J.; Asbell, P.A.; Barr, J.T.; Caroline, P.J.; Cavanagh, H.D.; Despotidis, N.; Desmond, F.; Koffler, B.H.; Reeder, K.; et al. (Eye and Contact Lens, 2005)
Purpose. The application of contact lenses to alter the shape of the cornea and temporarily reduce or eliminate myopia is known as orthokeratology, corneal refractive therapy, or corneal reshaping. It was first introduced in the 1960s, but high oxygen permeable materials and more sophisticated designs allow patients to wear contact lenses only during sleep, while dramatically improving the predictability and rate of myopia reduction. Many studies have shown that most corneal reshaping patients achieve uncorrected visual acuity of 20/25 or better that lasts all day long in one to two weeks of nighttime wear. 1-3 Treatment is primarily effective through central epithelial thinning and midperipheral epithelial and stromal thickening. Much remains to be learned about corneal reshaping contact lenses and their effects on the cornea. Methods. The authors reviewed existing knowledge and determined what needs to be learned in order to provide patients with appropriate informed consent prior to corneal reshaping contact lens wear. Results. While corneal reshaping contact lenses are effective at temporarily reducing or eliminating myopia, claims about the progress of myopia being controlled with corneal reshaping contact lenses should not be made until further studies are published in peer-reviewed literature. The incidence and prevalence of microbial keratitis related to corneal reshaping contact lens wear is not known. Any overnight wear of contact lenses increases the risk of infection, but it is not known whether the risks of microbial keratitis are greater for corneal reshaping overnight contact lens wearers than other form of overnight contact lens wear. It is also not known whether the risk of microbial keratitis is greater for children than adults, but we must determine if children are at greater risk than adults because many children are wearing corneal reshaping contact lenses. Conclusions. Finally, it is recommended that ongoing education be provided to practitioners and staff regarding safety, informed consent, and prevention of potential problems, with special emphasis on the critical need to properly and thoroughly disinfect lenses that will be worn overnight. © 2005 Contact Lens Association of Ophthalmologists, Inc.
Keywords: conservative treatment; contact lens; cornea curvature; cornea epithelium; cornea reshaping; cornea thickness; disinfection; eye refraction; human; infection complication; infection control; infection risk; informed consent; keratitis; myopia; patient compliance; patient education; priority journal; refraction error; review; risk assessment; risk reduction; visual acuity

The economics of topical immunomodulators for the treatment of atopic dermatitis - Abramovits, W.; Boguniewicz, M.; Paller, A.S.; Whitaker-Worth, D.L.; Prendergast, M.M.; Tokar, M.; Tong, K.B. (PharmacoEconomics, 2005)
Atopic dermatitis is a common, chronic, relapsing inflammatory skin disease frequently affecting infants and children. The worldwide prevalence of atopic dermatitis is estimated to be 5-20% of the paediatric population. First-line therapy has generally consisted of dry skin care, avoidance of triggers, application of topical corticosteroids, and administration of antihistamines and oral antibacterials. Topical corticosteroids improve the lesions of atopic dermatitis; however, concern on the part of physicians and patients regarding adverse effects has led to reluctance to utilise topical corticosteroids early and especially for prolonged periods. Topical immunomodulators (TIMs), including tacrolimus ointment and pimecrolimus cream, were recently introduced for the treatment of atopic dermatitis. Clinical data show that TIMs are effective in atopic dermatitis, yet do not cause the significant adverse effects associated with topical corticosteroids. Questions remain regarding the place of TIMs as a treatment for atopic dermatitis and how to use them most effectively, from both therapeutic and pharmacoeconomic standpoints. Specifically, two major issues remain unresolved: (i) how TIMs measure up to other therapies, especially topical corticosteroids; and (ii) how members of the TIM drug class compare against each other. Previous research has established that atopic dermatitis has a significant impact on quality of life (QOL) and carries a substantial economic burden. Some studies have also measured the utility of various atopic dermatitis disease states. While there is a need for further research, early economic studies provide evidence that TIMs positively affect the QOL of patients and families. In certain patients, TIMs may be cost effective and have an acceptable incremental cost utility compared with topical corticosteroids. Making cost-effectiveness comparisons between tacrolimus and pimecrolimus is challenging because there are limited head-to-head comparative data. Given currently available efficacy data, the results of one study suggest that tacrolimus may be more cost effective than pimecrolimus in paediatric patients with moderate atopic dermatitis. The full economic and QOL benefits of both agents are yet to be completely understood. The studies reviewed herein are the first to delineate the pharmacoeconomic benefits of TIMs in atopic dermatitis, and lay the foundation for future analyses. TIMs represent an exciting advance in the treatment of atopic dermatitis. Additional research will help determine the proper place of TIMs among the current array of therapeutic options for atopic dermatitis. © 2005 Adis Data Information BV. All rights reserved.
Keywords: antibiotic agent; antihistaminic agent; corticosteroid; cyclosporine; cytokine; hydrocortisone acetate; hydrocortisone butyrate; immunomodulating agent; immunosuppressive agent; pimecrolimus; tacrolimus; acne; adolescence; adrenal suppression; antibiotic therapy; atopic dermatitis; Australia; bacterial infection; body surface; carcinogenicity; cataract; clinical feature; clinical practice; clinical trial; comorbidity; comparative study; corticosteroid therapy; cost benefit analysis; cost effectiveness analysis; cost utility analysis; cream; Denmark; disease severity; drug absorption; drug blood level; drug cost; drug dose regimen; drug effect; drug efficacy; drug mechanism; drug potency; drug safety; drug tolerability; epidemiological data; face; folliculitis; Germany; gingiva hyperplasia; glaucoma; growth retardation; health care cost; health care utilization; human; hypertension; hypopigmentation; Italy; long term care; meta analysis; monotherapy; mycosis; nephrotoxicity; Netherlands; New Zealand; nonhuman; ointment; perioral dermatitis; prevalence; priority journal; pruritus; quality of life; rating scale; review; rosacea; scoring system; side effect; skin atrophy; skin burning sensation; skin infection; skin manifestation; stria; Sweden; systemic disease; telangiectasia; topical treatment; treatment indication; treatment outcome; tremor; United Kingdom; United States; virus infection

Review following peripheral iridotomy - Yatco, M. (Asian Journal of Ophthalmology, 2005)
Keywords: antiglaucoma agent; closed angle glaucoma; conference paper; follow up; human; intraocular pressure; iridotomy; patient compliance; Philippines; population distribution; population research; risk assessment

Preventing blindness from angle closure glaucoma - Foster, P. (Asian Journal of Ophthalmology, 2005)
Keywords: anterior eye chamber depth; blindness; closed angle glaucoma; conference paper; cost of illness; disease course; early diagnosis; evidence based medicine; health care access; health care cost; human; medical examination; morbidity; primary prevention; quality control; risk benefit analysis; risk factor; risk reduction; screening

Letter to the editor: patient persistency with glaucoma therapy. - Fiscella, R.; Stewart, W.C. (Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics, 2005)
Keywords: antihypertensive agent; analysis of variance; drug effect; glaucoma; human; intraocular pressure; note; pathophysiology; patient compliance; statistics; treatment outcome

World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, Part 1: Acute treatment of schizophrenia - Falkai, P.; Wobrock, T.; Lieberman, J.; Glenthoj, B.; Gattaz, W.F.; Möller, H.-J.; Altamura, A.C.; Andreasen, N.; Barnes, T.R.E.; Beckmann, H.; Ciprian-Ollivier, J.; Crow, T.; et al. (World Journal of Biological Psychiatry, 2005)
These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating people with schizophrenia. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia, as well as from meta-analyses, reviews and randomised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence (A-D). This first part of the guidelines covers disease definition, classification, epidemiology and course of schizophrenia, as well as the management of the acute phase treatment. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication, other pharmacological treatment options, electroconvulsive therapy, adjunctive and novel therapeutic strategies) of adults suffering from schizophrenia. © 2005 Taylor & Francis.
Keywords: amisulpride; anticonvulsive agent; antidepressant agent; aripiprazole; benzodiazepine derivative; chlorpromazine; clozapine; flupentixol; fluphenazine; haloperidol; lithium salt; mesoridazine; mood stabilizer; neuroleptic agent; olanzapine; pecazine; perazine; perphenazine; pimozide; promazine; promethazine; quetiapine; risperidone; sertindole; sulpiride; thioridazine; unindexed drug; ziprasidone; zotepine; zuclopenthixol; accommodation paralysis; adjuvant therapy; agranulocytosis; akathisia; amenorrhea; anticholinergic syndrome; ataxia; autonomic dysfunction; body weight disorder; breast cancer; cardiotoxicity; cardiovascular disease; catalepsy; cataract; clinical trial; Cochrane Library; cognitive defect; confusion; consensus development; constipation; cornea edema; cornea opacity; delirium; depression; disease classification; disease course; drug absorption; drug blood level; drug choice; drug competition; drug efficacy; drug elimination; drug fever; drug hypersensitivity; drug metabolism; drug receptor binding; drug response; drug tolerability; dry eye; dyslipidemia; dysmenorrhea; dysphoria; dystonia; ECG abnormality; electroconvulsive therapy; evidence based medicine; extrapyramidal symptom; galactorrhea; glaucoma; gynecomastia; health care cost; heart muscle conduction disturbance; heart ventricle fibrillation; hematologic disease; human; hyperglycemia; hyperlipidemia; hyperprolactinemia; hypersalivation; hypertriglyceridemia; leukocytosis; leukopenia; liver toxicity; low drug dose; medical society; Medline; memory disorder; meta analysis; metabolic disorder; motor dysfunction

Orthokeratology for myopic children: Wolf in sheep's clothing? - Kwok, L.S.; Pierscionek, B.K.; Bullimore, M.; Swarbrick, H.A.; Mountford, J.; Sutton, G. (Clinical and Experimental Ophthalmology, 2005)
Orthokeratology attempts to reduce myopia by remoulding the corneal shape with contact lenses. A recent resurgence is predicated on new contact lens designs with a prefigured back contact surface and higher oxygen transmissibility. This Clinical Controversy presents an analysis of the risk factors associated with orthokeratology and its suitability for children, followed by commentaries from specialists who have an interest in the method. Some state that there is a lack of data on relative risks of corneal infection and that there is a need for large-scale randomized controlled studies; however, opinion is expressed by others that orthokeratology is a clinically safe procedure using modern lenses. It is noted that the physiological and biophysical bases of orthokeratology are virtually unknown, and further research on the human cornea is indicated to scientifically establish the safety of orthokeratology. Prospective patients, and their parents in the case of children, should be fully informed of the risks. © 2005 Blackwell Publishing Ltd.
Keywords: Acanthamoeba keratitis; article; child; cornea; cornea disease; cornea epithelium; cornea injury; cornea ulcer; correlation analysis; equipment design; evidence based medicine; eye care; hard contact lens; human; hypoxia; incidence; infection risk; long term exposure; mechanical stress; myopia; orthokeratology lens; patient compliance; patient safety; prevalence; Pseudomonas aeruginosa; risk factor; risk reduction

Sodium bicarbonate in the treatment of blepharitis [6] - Pettinger, D. (Clinical and Experimental Ophthalmology, 2005)
Keywords: ammonia; bicarbonate; mercury; shampoo; steroid; blepharitis; eyelid; glaucoma; human; letter; medical specialist; ointment; patient compliance; personal hygiene; satisfaction

Preventing blindness from glaucoma - Henson, D.B.; Thampy, R. (British Medical Journal, 2005)
Keywords: blindness; editorial; glaucoma; health care access; human; intraocular pressure; mass screening; open angle glaucoma; perimetry; priority journal; slit lamp; tonometry

The probability of blindness in patients treated for glaucoma - Chang, L.-C.; Teng, M.-C.; Chang, H.-W.; Lai, I.-C.; Lin, P.-W.; Tsai, J.-C. (Chang Gung Medical Journal, 2005)
Background: To investigate the risk factors and probability of blindness in patients treated for glaucoma. Methods: The study design was a retrospective, hospital-based, clinical chart, review study. Medical records were reviewed from patients seen between January 2003 and December 2003 at the Kaohsiung Chang Gung Memorial Hospital eye clinic, who had been diagnosed with glaucoma in 1986 or later and who had been treated for at least 2 years for glaucoma. Results: A total of 186 charts were reviewed, which included 66 patients who were blind in at least one eye from glaucoma on presentation. A total of 172 patients and 290 eyes were followed-up for a mean duration of 10.6 ± 4.67 years. Twenty seven patients and 31 eyes developed blindness from glaucoma during follow-up. The Kaplan-Meier survival estimate at 16 years was 28.6% for glaucoma-related blindness in at least one eye. A worse visual field on presentation, older age, and poor compliance during therapy were significantly associated with the development of blindness. Glaucoma type, a gender difference, systemic disease, greater intraocular pressure fluctuation in the last year of therapy and blindness in one eye on presentation did not show a significant relationship with the rate of development of blindness. Conclusion: Blindness from treated glaucoma is considerable. Our results gave a 28.6% probability of blindness at 16 years in at least one eye. An older age, poor compliance and a worse visual field on presentation were significant risk factors.
Keywords: adult; aged; blindness; controlled study; female; follow up; glaucoma; human; intraocular pressure; major clinical study; male; optic nerve lesion; patient compliance; probability; retrospective study; review; risk factor; sex difference; survival; visual acuity; visual field

Increasing compliance with glaucoma therapy: "So, convince me I have something wrong with my eyes." - Shaw, M.E. (Insight - Journal of the American Society of Ophthalmic Registered Nurses, 2005)
Successful management of primary open-angle glaucoma (POAG) depends heavily on patient compliance with the treatment plan. Studies have clearly shown that early treatment will slow the progress of the POAG. Despite this fact, and even when treatment plans are negotiated with the patient, patient behavior may not be conducive to conserving vision in later life. Poor compliance results from a variety of causes, including lack of understanding of the diagnosis and the progress of POAG. As POAG is a "silent" condition, unless they are aware of visual loss at the point of presentation, POAG patients need to be convinced that there is actually something wrong with them. This paper explores how health care professionals can better understand their patients' response to a diagnosis of POAG.
Keywords: article; female; human; male; nursing; open angle glaucoma; patient care planning; patient compliance

Response from the authors [2] - Dannelly, H.K.; Waworuntu, R. (Eye and Contact Lens, 2005)
Keywords: cornea ulcer; education; human; incidence; keratitis; letter; patient; patient compliance; priority journal

Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension: An evidence-based review - Olthoff, C.M.G.; Schouten, J.S.A.G.; Van De Borne, B.W.; Webers, C.A.B. (Ophthalmology, 2005)
Objective: To summarize the available scientific evidence to support clinical decisions on how to deal with noncompliance in glaucoma patients. Clinical Relevance: Insufficient reduction of intraocular pressure and progression of visual field (VF) loss in glaucoma patients due to noncompliance with topical treatment may result in unnecessary therapy, with additional risks and costs. Methods/Literature Reviewed: We conducted a literature search in the databases MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane and reference lists. Thirty-four articles describing 29 original quantitative studies, in English, German, French, or Dutch, were included. Studies on noncompliance in drug trials were excluded. Two investigators independently selected the articles and abstracted their content, before negotiating their inclusion or exclusion. Results: The proportions of patients who deviate from their prescribed medication regimen ranged from 5% to 80%. The impact of noncompliance on clinical outcome has not yet been established. There are no determinants sensitive and specific enough to identify potential noncompliers accurately. Patient knowledge and dose frequency can be used as starting points to improve compliance. A combination of patient education and prevention of forgetting doses seems to be successful in enhancing patient compliance. Conclusion: Noncompliance with hypotensive treatment is common among glaucoma patients. However, there is no strong evidence supporting a relation between noncompliance and progression of VF loss. Only a few guidelines for clinicians can be derived from the currently available literature. Future research should be guided by clinically relevant questions. © 2005 by the American Academy of Ophthalmology.
Keywords: pilocarpine; timolol; accuracy; awareness; clinical trial; Cochrane Library; data base; disease course; drug exposure; Embase; glaucoma; human; intraocular hypertension; intraocular pressure; Medline; patient compliance; patient education; practice guideline; prescription; prevalence; priority journal; PsycINFO; quantitative analysis; rating scale; review; sensitivity and specificity; technical aid; treatment outcome; visual impairment; Prescript Time Cap

Visual impairment in elderly patients with hip fracture: Causes and associations - Cox, A.; Blaikie, A.; MacEwen, C.J.; Jones, D.; Thompson, K.; Holding, D.; Sharma, T.; Miller, S.; Dobson, S.; Sanders, R. (Eye, 2005)
Aims: To evaluate the current visual status and ophthalmic history of a sample of elderly patients with fractured neck of femur and to study the relationship between visual status and demographic factors. Methods: A four-centre study of all patients admitted to hospital with fractured neck of femur. The setting was two district (Ayr, Dunfermline) and two teaching (Glasgow, Dundee) hospitals in Scotland. The study examined 537 patients aged 65 years and over admitted with acute fractured neck of femur to hospital. Results: Bilateral visual impairment (binocular visual acuity worse than 6/12) was found in 239 of 518 patients (46%). Of this group, the principal causes for visual deficit were untreated cataract (49%), macular degeneration (21%), uncorrected refractive error (17%), and glaucoma (3%). The visually impaired group were more likely to have symptomatic visual complaints (58 vs 26%), however, were less likely to be under optometric care (71 vs 85%). A higher proportion of the group with visual impairment lived in areas of social deprivation (40 vs 26%). Conclusions: Patients with fractured neck of femur represent a frail elderly group that have poorer vision than that documented in any other elderly population. The visual defect was potentially remediable in the majority of cases but this group of individuals are not generally in touch with the ophthalmic services. Social deprivation appears to be associated with this groups' inability to access ophthalmic care. © 2005 Nature Publishing Group All rights reserved.
Keywords: acute disease; aged; anamnesis; article; cataract; controlled study; demography; disease association; female; femoral neck fracture; glaucoma; health care access; health status; hip fracture; hospital admission; human; major clinical study; male; medical documentation; population research; refraction error; macular degeneration; social isolation; symptomatology; teaching hospital; United Kingdom; visual acuity; visual field defect; visual impairment; visual system examination

Clinical application of objective perimetry using multifocal visual evoked potentials in glaucoma practice - Graham, S.L.; Klistorner, A.I.; Goldberg, I. (Archives of Ophthalmology, 2005)
Objectives: To evaluate the role of objective perimetry using multifocal visual evoked potentials (mVEPs) in glaucoma practice, and to assess its utility in patients with inconclusive standard automated perimetry findings. Method: A retrospective case series of 436 consecutive subjects referred for glaucoma investigation who underwent testing with the AccuMap V1.3 mVEP system (ObjectiVision Pty, Ltd, Sydney, New South Wales, Australia) within a defined 12-month period. Sensitivity was determined by comparing this testing with that of standard automated perimetry and that used in a subgroup in whom masked stereoscopic optic disc photographs were used as an alternative reference standard. Overall clinical diagnostic outcomes were assessed. Results: The mVEP changes were correlated with the stage of disease and Humphrey mean deviation (r=0.78). The overall sensitivity for detecting glaucoma with established subjective field loss was 97.5% (early glaucoma, 95.0%), whereas 92.2% of low-risk suspects had normal mVEPs. When masked disc assessment alone was used for diagnosis of abnormality, sensitivity of mVEP (80.6%) and Humphrey visual field results (81.9%) were similar, but mVEP specificity was better (89.2% vs 79.5%). The mVEP was particularly useful in assessing excessive subjective field loss (45 eyes) by showing a much closer correlation with the clinical picture. Conclusions: Multifocal VEP is an effective method for detecting visual field loss in glaucoma. It provides a valuable aid to the clinician in categorizing patients with unreliable, variable, unconfirmed, or excessive subjective field loss. ©2005 American Medical Association. All rights reserved.
Keywords: article; automation; controlled study; correlation analysis; diagnostic accuracy; diagnostic value; visual evoked potential; glaucoma; health care utilization; human; major clinical study; multifocal lens; optic disk; outcomes research; perimetry; photography; priority journal; retrospective study; sensitivity analysis; staging; standard; statistical analysis; stereoscopic vision; visual field; visual field defect; visual impairment

Medical treatments and practices. Ascertaining maximal drug treatment - Cochereau, I. (Journal Francais d'Ophtalmologie, 2005)
Maximal drug treatment can be absolute, using all the combinations possible if no surgery can reasonably be undertaken, or relative, with surgery as the next step. The drug treatment is chosen in collaboration with the patient, who should always receive attentive explanations, detailing the prescription and adapting it to each situation so as to achieve maximum compliance. © Masson, Paris, 2005.
Keywords: acetazolamide; alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; brimonidine; brinzolamide; carbonate dehydratase inhibitor; carpilo; cholinergic receptor stimulating agent; dorzolamide; dorzolamide plus timolol; fluorometholone; hydroxymethylglutaryl coenzyme A reductase inhibitor; latanoprost; latanoprost plus timolol; mannitol; memantine; pilobloc; prostaglandin; timolol; allergy; bradycardia; chronic inflammation; depression; drug contraindication; eye irritation; fatigue; glaucoma; glaucoma surgery; headache; human; hypokalemia; hypotension; iris disease; kidney colic; libido disorder; miosis; myopia; neuroprotection; patient compliance; prescription; review; alphagan; azopt; carpilo; cosopt; diamox; pilobloc; trusopt; xalacom

Surgical controversy. Combined surgery in one procedure - Hamard, P. (Journal Francais d'Ophtalmologie, 2005)
Combined surgery (phacoemulsification and penetrating or nonpenetrating filtering surgery) has the advantage of treating two distinct disorders in a single operation, with the objective of improving visual acuity and controlling ocular hypertension. In addition, it improves patient comfort and compliance to treatment. It lowers intraocular pressure more than simple lens surgery and the same as surgery carried out in two steps, notably with nonpenetrating filtering surgery, whereas the incidence of complications is lower. Our personal experience with 35 patients, operated on for phacoemulsification and deep sclerectomy with external trabeculectomy in the same operation confirms that this com-bined surgery in a single operation is effective in controlling ocular pressure in glaucoma subjects (mean reduction in tension, 23%), with few complications. © Masson, Paris, 2005.
Keywords: cataract; clinical article; filtering operation; glaucoma; human; intraocular hypertension; intraocular pressure; lens implant; patient compliance; phacoemulsification; postoperative complication; review; sclerectomy; trabeculectomy; visual acuity

Pharmacological management of allergic rhinitis in the elderly: Safety issues with oral antihistamines - Hansen, J.; Klimek, L.; Hörmann, K. (Drugs and Aging, 2005)
An increasing number of elderly persons in our society experience allergic rhinoconjunctivitis. Different agents are used in the pharmacological treatment of allergic rhinitis, with histamine H1 receptor antagonists (antihistamines) being the most frequently prescribed class. However, drug therapy of aged persons differs to a degree from that in other age groups primarily because of quantitative pharmacotherapeutic problems. The main problems are co-morbidities and polymedication, which may lead to drug-drug interactions. H1 receptor antagonists block the action of histamine at specific receptors and are available for both topical and systemic administration. First-generation H1 receptor antagonists are lipophilic and therefore may cross the blood-brain barrier; they also lack specificity for the H1 receptor. Second-generation H1 receptor antagonists have reduced capacity to cross the blood-brain barrier and greater specificity for the H1 receptor. Use of first-generation H1 receptor antagonists in the elderly should be considered carefully because of the large number of adverse effects and potential for interactions with these agents. Second-generation Hi receptor antagonists such as desloratadine, levocetirizine and ebastine provide good selective H1 receptor blockade without anticholinergic or α-adrenoceptor antagonist activity. Furthermore, they inhibit proinflammatory cytokines and are safe. Second-generation H1 receptor antagonists also offer therapeutic possibilities in patients with severe liver and/or renal dysfunction. © 2005 Adis Data Information BV. All rights reserved.
Keywords: adrenergic receptor stimulating agent; alpha adrenergic receptor blocking agent; antacid agent; antiarrhythmic agent; anticoagulant agent; antihistaminic agent; azelastine; bepridil; budesonide; cetirizine; chlorpromazine; cholinergic receptor blocking agent; cimetidine; cisapride; clemastine; cromoglycate disodium; cytochrome P450; cytokine; desloratadine; dexchlorpheniramine; dimetindene; diphenhydramine; diuretic agent; ebastine; emedastine; endothelial leukocyte adhesion molecule 1; erythromycin; ethanolamine derivative; ethylenediamine derivative; eye drops; fexofenadine; fluticasone propionate; glucocorticoid; granulocyte macrophage colony stimulating factor; halofantrine; histamine; histamine H1 receptor antagonist; immunoglobulin E receptor; intercellular adhesion molecule 1; interleukin 1beta; interleukin 3; interleukin 5; ketoconazole; laxative; leukotriene; levocabastine; levocetirizine; lithium; lodoxamide; loratadine; macrolide; meclozine; mibefradil; mineralocorticoid; mometasone furoate; monoamine oxidase inhibitor; nedocromil; neuroleptic agent; pentamidine; phenothiazine derivative; probucol; promethazine; propylamine; proteinase inhibitor; pyrrole derivative; sedative agent; serotonin uptake inhibitor; sparfloxacin; terfenadine; thrombocyte activating factor; tricyclic antidepressant agent; trimethoprim; tumor necrosis factor; vascular cell adhesion molecule 1; xylometazoline; zileuton; agitation; alertness; allergic rhinitis; alopecia; anaphylaxis; angioneurotic edema; anticholinergic effect; anxiety disorder; asthenia; blepharitis; blood brain barrier; chemosis; cholestasis; chronic disease; clinical trial; comorbidity; confusion; conjunctivitis; constipation; cornea disease; cornea erosion; depression; dizziness; drug absorption

Assessing medication adherence in the elderly: Which tools to use in clinical practice? - MacLaughlin, E.J.; Raehl, C.L.; Treadway, A.K.; Sterling, T.L.; Zoller, D.P.; Bond, C.A. (Drugs and Aging, 2005)
Adherence to prescribed medication regimens is difficult for all patients and particularly challenging for the elderly. Medication adherence demands a working relationship between a patient or caregiver and prescriber that values open, honest discussion about medications, i.e. the administration schedule, intended benefits, adverse effects and costs. Although nonadherence to medications may be common among the elderly, fundamental reasons leading to nonadherence vary among patients. Demographic characteristics may help to identify elderly patients who are at risk for nonadherence. Inadequate or marginal health literacy among the elderly is common and warrants assessment. The number of co-morbid conditions and presence of cognitive, vision and/or hearing impairment may predispose the elderly to nonadherence. Similarly, medications themselves may contribute to nonadherence secondary to adverse effects or costs. Especially worrisome is nonadherence to 'less forgiving' drugs that, when missed, may lead to an adverse event (e.g. withdrawal symptoms) or disease exacerbation. Traditional methods for assessing medication adherence are unreliable. Direct questioning at the patient interview may not provide accurate assessments, especially if closed-ended, judgmental questions are posed. Prescription refill records and pill counts often overestimate true adherence rates. However, if elders are asked to describe how they take their medicines (using the Drug Regimen Unassisted Grading Scale or MedTake test tools), adherence problems can be identified in a nonthreatening manner. Medication nonadherence should be suspected in elders who experience a decline in functional abilities. Predictors of medication nonadherence include specific disease states, such as cardiovascular diseases and depression. Technological aids to assessing medication adherence are available, but their utility is, thus far, primarily limited to a few research studies. These computerised devices, which assess adherence to oral and inhaled medications, may offer insight into difficult medication management problems. The most practical method of medication adherence assessment for most elderly patients may be through patient or caregiver interview using open-ended, nonthreatening and nonjudgmental questions. © 2005 Adis Data Information BV. All rights reserved.
Keywords: alpha adrenergic receptor blocking agent; angiotensin receptor antagonist; antiasthmatic agent; anticonvulsive agent; antidepressant agent; antidiabetic agent; antiglaucoma agent; antihypertensive agent; antiinfective agent; antiretrovirus agent; antirheumatic agent; antithrombocytic agent; anxiolytic agent; atenolol; beta adrenergic receptor blocking agent; betaxolol; calcitonin; calcium channel blocking agent; cholinesterase inhibitor; digoxin; dipeptidyl carboxypeptidase inhibitor; diuretic agent; herbaceous agent; hydroxymethylglutaryl coenzyme A reductase inhibitor; influenza vaccine; neuroleptic agent; non prescription drug; paracetamol; Pneumococcus vaccine; unindexed drug; automation; breast cancer; cardiovascular disease; caregiver; chronic obstructive lung disease; clinical practice; cognitive defect; comorbidity; delirium; demography; devices; drug cost; drug delivery system; drug monitoring; elderly care; falling; glaucoma; hearing impairment; heart failure; hospitalization; human; interview; metered dose inhaler; nursing home; orthostatic hypotension; patient attitude; patient compliance; pharmacist; prediction; prescription; priority journal; reading; review; screening; self report; visual impairment; Beep N' Tell; CompuMed; Doser; Health Buddy; HealthWatch; Kind Remind; LogPad; MDILog; Med-ic; Med-Time; MEDGlider; MEMS; SmartMist; WatchMinder

Intraocular pressure variability in patients who reached target intraocular pressure - Malerbi, F.K.; Hatanaka, M.; Vessani, R.M.; Susanna Jr., R. (British Journal of Ophthalmology, 2005)
Aim: To assess the intraocular pressure (IOP) variability in patients with primary open angle glaucoma (POAG) under clinical treatment who reached an established target pressure based on isolated office readings. Methods: Retrospective analysis of 65 eyes from 65 POAG patients under clinical therapy who submitted to modified diurnal tension curve (mDTC) (measurements at every 3 hours between 8 am and 5 pm) followed by a water drinking test (WDT). All subjects had established target IOP ≤ 15 mm Hg at 11 am or 2 pm. IOP variability during mDTC or WDT was evaluated. Results: mDTC revealed IOP measurements ≥ 17 mm Hg in 16 of 65 eyes (24.6%). Nine eyes (13.8%) presented values & 18 mm Hg. The highest IOP detected by mDTC was 20 mm Hg in one patient (1.5%). WDT demonstrated IOP values ≥ 17 mm Hg in 32 of 65 eyes (49.2%). 22 eyes (33.8%) presented values ≥ 18 mm Hg after water ingestion. Moreover, IOP levels ≥ 20 mm Hg were observed in 14 eyes (21.5%). Conclusion: A great percentage of POAG patients undergoing clinical treatment and with IOP control based on single office measurement present significantly higher IOP measurements when performing mDTC and, especially, the WDT.
Keywords: adult; aged; ambulatory care; article; circadian rhythm; female; human; intraocular pressure; major clinical study; male; measurement; open angle glaucoma; priority journal; retrospective study; visual field defect; water loading (test)