Pharmacotherapy of adult ADHD - Dodson, W.W. (Journal of Clinical Psychology, 2005)
Although attention deficit hyperactivity disorder (ADHD) has been officially recognized as persisting into adulthood for more than 25 years, only recently has the condition been studied in adults. There is great syndromatic continuity between childhood and adult ADHD, and thus much of the medication management of adults with ADHD can be based on the experience gained from treating children and adolescents. Stimulant medications remain the treatment of choice and are generally as effective in adults as they are in children. Several extended-release delivery systems that improve convenience and compliance have become available. Several second-line medications are also reviewed. The medications must be fine-tuned to the needs of the individual patient in regard to the dose and timing of dose that achieve optimal therapeutic benefit. Medication adjustment must be done by trial and error because no parameter yet identified predicts the molecule or dose that will provide optimal performance. © 2005 Wiley Periodicals, Inc.
Keywords: amfebutamone; amphetamine; antidepressant agent; atomoxetine; cocaine; desipramine; dexamphetamine; dexmethylphenidate; ephedrine; imipramine; methylphenidate; methylphenidate; noradrenalin uptake inhibitor; paroxetine; pemoline magnesium; pseudoephedrine; psychostimulant agent; sedative agent; serotonin uptake inhibitor; sertraline; tricyclic antidepressant agent; valproate semisodium; addiction; adolescent; adult; anorexia; anxiety disorder; attention deficit disorder; behavior therapy; child; child behavior; clinical practice; clinical trial; cocaine dependence; community care; comorbidity; constipation; controlled clinical trial; controlled study; depression; drug approval; drug contraindication; drug cost; drug delivery system; drug efficacy; drug formulation; drug overdose; drug safety; dysphoria; Food and Drug Administration; glaucoma; group therapy; headache; heart arrhythmia; heart palpitation; human; hyperactivity; hypertension; impulsiveness; irritability; isomer; lactation; liver failure; meta analysis; mood; narcolepsy; nervousness; orthostatic hypertension; patient compliance; patient monitoring; practice guideline; pregnancy; psychopharmacotherapy; review; side effect; somnolence; substance abuse; sustained release formulation; systematic review; treatment outcome; tremor; urine retention; adderall xr; benzedrine; concerta; cylert; depakote; dexedrine spansules; focalin; metadate cd; metadate er; methylin er; paxil; ritalin la; ritalin sr; ritalin; strattera; wellbutrin sr; zoloft

Utilization of clinical pathways in the care of patients undergoing vitreous surgery - Oshita, T.; Kusaka, S.; Makino, R.; Fujii, K.; Tanaka, M. (Folia Ophthalmologica Japonica, 2005)
Purpose: To evaluate the effectiveness of clinical pathways used in the care of patients undergoing vitreous surgery. Methods: Two clinical pathways were used in the care of 48 patients who underwent vitreous surgery at Osaka General Medical Center between September 2002 and December 2002. One of the clinical pathways was used for patients who underwent vitrectomy with gas tamponade. The other was used for patients who underwent vitrectomy without gas tamponade. At the end of each patient's procedure, surgeons decided which clinical pathway would be used for that patient. The postoperative complications that occurred with either pathway were recorded by chart review, with consideration of patients' concurrent systemic disorders, and the effectiveness of pathways was evaluated by reviewing the responses to questionnaires completed by nurses. Results: Postoperative complications included back pain (33%) from the face-down position, sleeplessness (31%), transient elevated intraocular pressure (10%), and need for reoperation (12%). The results of questionnaire review revealed that use of the clinical pathways resulted in nurses having a better understanding of patients' postoperative status and in more immediate treatment of postoperative complications. Conclusion: Using clinical pathways in the care of patients undergoing vitreous surgery seems to be effective for improving the management and standardization of care for these patients.
Keywords: article; backache; clinical article; clinical pathway; controlled study; health care utilization; human; insomnia; intraocular hypertension; patient care; postoperative complication; professional practice; questionnaire; reoperation; vitrectomy

The effect of combination pharmacotherapy on the prescription trends of glaucoma medications - Kaiserman, I.; Kaiserman, N.; Nakar, S.; Vinker, S. (Journal of Glaucoma, 2005)
Purpose: To describe prescription trends within a managed care setting for glaucoma medications and to examine the effect of introduction of Cosopt®-a fixed combination of dorzolamide and timolol. Patients and Methods: All prescriptions dispensed to any of the 470,350 members of an Israeli health maintenance organization were monthly scanned for patients treated for glaucoma, between January 2000 and May 2003. The monthly mean number of glaucoma patients was 3899 ± 104 (mean ± SD). All topical glaucoma prescriptions were documented, and the monthly prescription rate of each medication was calculated and plotted. The monitored glaucoma medications were: β-adrenergic antagonists, dorzolamide, latanoprost, pilocarpine, brimonidine, Cosopt®, and others. Results: β-adrenergic antagonists were the top prescribing drug (>35% of all glaucoma prescriptions). The prescription rates of pilocarpine and β-adrenergic antagonists were in constant decline, while latanoprost and brimonidine increased steadily. The introduction of Cosopt® changed the prescription trends of dorzolamide from increasing to rapidly decreasing, and accelerated the long-term decline of β-adrenergic antagonists. Concomitant with the introduction of Cosopt® the prescription rate of β-adrenergic antagonists temporarily increased. This was due to a total increase in glaucoma prescriptions. When Cosopt® was introduced, 37.5% of patients were prescribed Cosopt® together with β-adrenergic antagonists, and 16.5% also received dorzolamide. Thereafter the co-prescription decreased steadily. Conclusions: Introduction of a combination drug should be accompanied by physicians', pharmacists', and patients' education to prevent its inappropriate usage together with its components. Copyright © 2005 by Lippincott Williams & Wilkins.
Keywords: alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; betaxolol; brimonidine; carbonate dehydratase inhibitor; dorzolamide; dorzolamide plus timolol; latanoprost; levobunolol; pilocarpine; prostaglandin F2 alpha derivative; timolol; article; clinical education; clinical protocol; drug choice; drug formulation; drug utilization; glaucoma; health maintenance organization; human; Israel; major clinical study; managed care; medical record; patient compliance; patient education; pharmacist; physician; prescription; priority journal; cosopt

Ocular findings seen among the staff of an institution in Lagos, Nigeria - Ashaye, A.O.; Asuzu, M.C. (West African Journal of Medicine, 2005)
Background: The degree to which ocular morbidity affects workers productivity in the developing countries has not been studied adequately. A federal government research institute based in Lagos introduced an annual health screen for all its workers, which included eye tests. This provided an opportunity to study the pattern of ocular conditions among workers who were 30 years and above, and to determine the effect of eye diseases on the workers productivity. Study design: Detailed eye examination including refraction, was done on every respondent at the institution's clinic by an ophthalmologist. A questionnaire on ocular health status and occupational history was administered independently by an ophthalmic nurse. Sickness absenteeism, use of the clinic were obtained from clinic records, and the results were analysed. Results: The common ocular conditions were uncorrected or poorly corrected refractive error, uncorrected or poorly corrected presbyopia and allergic conjunctivitis. Glaucoma, maculopathy and optic atrophy were causes of severe visual impairment or blindness in 1.9% of the subjects. Absenteeism and clinic use were more common in subjects with ocular morbidity than those with non-ocular morbidity. Subjects with ocular morbidity had more illnesses, absenteeism and used the clinic more. Conclusion: Ocular problems which reduce worker's productivity are prevalent among the staff of the institution studied. They are mostly unrecognised.
Keywords: absenteeism; adult; age distribution; allergic conjunctivitis; anamnesis; article; blindness; controlled study; developing country; disease severity; eye disease; eye refraction; female; glaucoma; government; health care personnel; health care utilization; health status; human; male; medical record; medical research; medical specialist; Nigeria; occupational disease; ophthalmology; optic nerve atrophy; presbyopia; prevalence; productivity; questionnaire; refraction error; retina maculopathy; screening test; visual impairment; visual system examination

Compliance and persistency in glaucoma follow-up treatment - Schwartz, G.F. (Current Opinion in Ophthalmology, 2005)
Purpose of review: To summarize research published between 1980 and October 2004 regarding compliance (the extent to which patients' behaviors correspond with providers' recommendations) and persistency (total time on therapy) in patients diagnosed with open-angle glaucoma or ocular hypertension; to suggest approaches ophthalmologists might consider to improve compliance and persistency; and to identify areas warranting future research. Recent findings: Medication compliance, the focus of most compliance-related research, has been measured using a variety of methods including patient self-reports, the medication possession ratio, and electronic monitoring. Noncompliance rates of at least 25% commonly have been reported. The primary obstacles to medication compliance appear to be situational/environmental (e.g., being away from home or a change in routine) or related to the medication regimen (e.g., side effects or complexity). Persistency with ocular hypotensive therapies has been found to be poor. Retrospective cohort studies using survival analyses have reported that fewer than 25% of patients are persistent over 12 months. Summary: Accurately assessing patient compliance and persistency is important to optimizing patient care. Physicians may mistake either medication noncompliance or lack of persistency with poor efficacy. Such errors would likely increase health care costs if they result in unnecessary changes to a patient's therapeutic regimen or in surgery. © 2005 Lippincott Williams & Wilkins.
Keywords: antihypertensive agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; prostaglandin; accuracy; cohort analysis; disease course; environmental factor; follow up; glaucoma; health care cost; human; intraocular hypotension; medical research; patient care; patient compliance; priority journal; retrospective study; review; self report; survival

The medical management of glaucoma: What we have learned from clinical research trials to aid us in choosing first-line therapy - Schacknow, P.N. (Clinical and Surgical Ophthalmology, 2005)
Glaucoma clinicians have numerous medications from which to select initial therapy for their patients. What are the preferred characteristics for such a drug? Consider these two factors when evaluating glaucoma medications: 1) a drug should prove efficacious in preserving visual function (i.e., it works) and 2) the drug should be "patient friendly" to ensure good compliance (i.e., patients will use it).
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; betaxolol; brimonidine; memantine; miotic agent; prostaglandin; timolol; breathing disorder; cardiotoxicity; clinical research; conference paper; drug choice; drug efficacy; drug hypersensitivity; drug use; erythema; evidence based medicine; eye irritation; eye pain; fatigue; gastrointestinal disease; glaucoma; hallucination; human; hyperemia; hyperpigmentation; impotence; intraocular pressure; malaise; metabolic disorder; myopia; neuroprotection; patient compliance; primary health care; side effect; tachyphylaxis; taste disorder; treatment outcome

Trabeculectomy around the globe - Diamond, J.P. (Eye, 2005)
Keywords: prostaglandin; cataract; disease severity; editorial; ethnic difference; geography; glaucoma; health care access; health care availability; human; hypothesis; intraocular pressure; medical decision making; Black person; outcomes research; postoperative complication; prediction; prevalence; resource allocation; risk assessment; surgical technique; trabeculectomy; treatment failure; visual field defect

Management of glaucoma: Focus on pharmacological therapy - Marquis, R.E.; Whitson, J.T. (Drugs and Aging, 2005)
Glaucoma represents a major cause of vision loss throughout the world. Primary open-angle glaucoma, the most common form of glaucoma, is a chronic, progressive disease often, though not always, accompanied by elevated intraocular pressure (IOP). In this disorder, retinal ganglion cell loss and excavation of the optic nerve head produce characteristic peripheral visual field deficits. Patients with normal-tension glaucoma present with typical visual field and optic nerve head changes, without a documented history of elevated IOP. A variety of secondary causes, such as pigment dispersion syndrome and ocular trauma, can result in glaucoma as well. Treatment of all forms of glaucoma consists of reducing IOP. With proper treatment, progression of this disease can often be delayed or prevented. Treatment options for glaucoma include medications, laser therapy and incisional surgery. Laser techniques for the reduction of IOP include argon laser trabeculoplasty and selective laser trabeculoplasty. Both techniques work by increasing outflow of aqueous humour through the trabecular meshwork. Surgical options for glaucoma treatment include trabeculectomy, glaucoma drainage tube implantation and ciliary body cyclodestruction. While each of these types of procedures is effective at lowering IOP, therapy usually begins with medications. Medications lower IOP either by reducing the production or by increasing the rate of outflow of aqueous humour within the eye. Currently, there are five major classes of drugs used for the treatment of glaucoma: (i) cholinergics (acetylcholine receptor agonists); (ii) adrenoceptor agonists; (iii) carbonic anhydrase inhibitors (CAIs); (iv) β-adrenoceptor antagonists; and (v) prostaglandin analogues (PGAs). Treatment typically begins with the selection of an agent for IOP reduction. Although β-adrenoceptor antagonists are still commonly used by many clinicians, the PGAs are playing an increasingly important role in the first-line therapy of glaucoma. Adjunctive agents, such as α-adrenoceptor agonists and CAIs are often effective at providing additional reduction in IOP for patients not controlled on monotherapy. As with any chronic disease, effective treatment depends on minimising the adverse effects of therapy and maximising patient compliance. The introduction of a variety of well tolerated and potent medications over the past few years now allows the clinician to choose a treatment regimen on an individual patient basis and thereby treat this disorder more effectively.
Keywords: acetazolamide; epinephrine; adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbachol; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; brimonidine plus timolol; dipivefrine; dorzolamide; dorzolamide plus timolol; ecothiopate iodide; timolol plus travoprost; latanoprost; latanoprost plus timolol; levobunolol; mannitol; methazolamide; metipranolol; normoglaucon; pilocarpine; prostaglandin derivative; timolol; timolol maleate; timolol maleate gel forming solution; travoprost; unindexed drug; unoprostone isopropyl ester; urea; acidosis; agranulocytosis; allergic blepharoconjunctivitis; allergic conjunctivitis; anxiety disorder; aplastic anemia; aqueous humor outflow; argon laser; bitter taste; blepharitis; bone marrow depression; bradycardia; browache; central nervous system depression; ciliary body; ciliary body cyclodestruction; clinical feature; clinical trial; congestive heart failure; conjunctival hyperemia; cornea decompensation; cornea disease; diarrhea; disease exacerbation; drug choice; drug efficacy; drug tolerability; dry nose; eye burning; eye disease; eye foreign body sensation; eye injury; eye irritation; eye stinging sensation; eye surgery; eyelid retraction; fatigue; glaucoma; glaucoma drainage implant; glaucoma surgery; headache; heart palpitation; human; hyperhidrosis; hypersalivation; hypertension; hypokalemia; hyponatremia; hypotension; intraocular pressure; lacrimation; low level laser therapy; monotherapy; mydriasis; nausea; nephrolithiasis; low tension glaucoma; ocular pruritus; open angle glaucoma; optic nerve; paresthesia; patient compliance; pigment dispersion syndrome; pigment epithelium

Pediatric rheumatology for the adult rheumatologist I: Therapy and dosing for pediatric rheumatic disorders - DeWitt, E.M.; Sherry, D.D.; Cron, R.Q. (Journal of Clinical Rheumatology, 2005)
Treatment of children with rheumatic diseases has advanced with novel therapeutics and the use of early aggressive treatment to achieve better long-term functional outcome. Many of the current treatments in pediatric rheumatology are based on studies in adults on medications without U.S. Food and Drug Administration labeling for pediatric use. This is not ideal because the pharmacokinetics (absorption, distribution, metabolism, and elimination) of many medications when used in children vary according to age, somatic growth, sexual maturity, and ontogeny of drug-metabolizing enzymes. Special dosing, administration considerations, and toxicity screening are reviewed for the more commonly used medications. Vaccinations for children on antirheumatic drugs are also discussed. Continued study of the long-term impact of medications and biologic treatments on children is necessary, but given the paucity of children with rheumatic diseases, this will require multicentered trials and collaborations. Lastly, this article reviews recent regulatory and legislative action on pediatric drug testing. Passage of the Pediatric Research Equity Act of 2003, which requires 'testing of pharmaceuticals in children, will facilitate more rational use of drugs in pediatric rheumatic diseases in the future.
Keywords: acetylsalicylic acid; celecoxib; choline magnesium trisalicylate; cotrimoxazole; deflazacort; diclofenac; disease modifying antirheumatic drug; drug metabolizing enzyme; etanercept; etodolac; hydroxychloroquine; ibuprofen; indometacin; infliximab; etodolac; meloxicam; methotrexate; methylprednisolone sodium succinate; nabumetone; naproxen; nonsteroid antiinflammatory agent; prednisolone sodium phosphate; oxaprozin; prednisolone sodium phosphate; piroxicam; prednisolone; rofecoxib; salazosulfapyridine; sulindac; tolmetin; trimethoprim; tumor necrosis factor antibody; unclassified drug; unindexed drug; abdominal pain; acne; allergic pneumonitis; anaphylaxis; anorexia; asthma; blood clotting disorder; body growth; bullous skin disease; cardiovascular disease; cataract; central nervous system disease; chickenpox; cholecystitis; corticosteroid induced osteoporosis; Cushing syndrome; cytopenia; diabetes mellitus; drug absorption; drug bioavailability; drug distribution; drug dose regimen; drug elimination; drug hypersensitivity; drug metabolism; drug potentiation; drug screening; drug use; duodenum injury; eye toxicity; fatty liver; Food and Drug Administration; gastrointestinal symptom; glaucoma; growth retardation; headache; histoplasmosis; human; hypertension; immunoglobulin deficiency; kidney disease; legal aspect; listeriosis; liver cell carcinoma; liver cirrhosis; liver disease; liver fibrosis; lymphoma; mood disorder; obesity; opportunistic infection; optic nerve disease; osteopenia; pancytopenia; patient compliance; photosensitivity disorder; phototoxicity; pneumocystosis; priority journal; pseudoporphyria; retinopathy; review; Reye syndrome; rheumatic disease; seizure; sepsis

Current and emerging medical therapies for glaucoma - Tsai, J.C.; Kanner, E.M. (Expert Opinion on Emerging Drugs, 2005)
Glaucoma is a multifactorial optic neuropathy in which there is a characteristic acquired loss of retinal ganglion cells, at levels beyond normal age-related baseline loss, and corresponding atrophy of the optic nerve. Although asymptomatic in its earlier stages, the disease is nevertheless one of the leading global causes of irreversible blindness. Although elevated intraocular pressure (IOP) is one of the most important risk factors and lowering of IOP is the only proven treatment so far, the definition of glaucoma has evolved from a disease caused by increased IOP to one characterised by an IOP-sensitive, progressive optic neuropathy. In recent years, safer and better tolerated topical medications have been developed to control IOP more effectively, thereby limiting the need for surgery. New research has also noted the importance of diurnal IOP variation as a critical risk factor for progression of glaucomatous optic neuropathy (GON) and subsequent visual field loss. Moreover, new discoveries have further elucidated the basic pathophysiological and genetic mechanisms underlying the elevated levels of IOP, as well as the cellular mechanisms of GON. As our understanding of these complex pathways continues to improve, development opportunities for new therapeutic modalities will be enhanced.
Keywords: 11beta hydroxysteroid dehydrogenase inhibitor; 2,3 dihydro 5 methyl 3 (morpholinomethyl) 6 (1 naphthoyl)pyrrolo[1,2,3 de][1,4]benzoxazine; acetazolamide; epinephrine; adrenergic receptor stimulating agent; alpha adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; betaxolol; bimatoprost; brimonidine; brinzolamide; carbenoxolone; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; dipivefrine; dorzolamide; dorzolamide plus timolol; enzyme inhibitor; latanoprost; latanoprost plus timolol; levobunolol; memantine; methazolamide; metipranolol; nimodipine; prostaglandin derivative; serotonin 2 agonist; timolol; timolol maleate; travoprost; unclassified drug; unoprostone isopropyl ester; acidosis; aging; blindness; burning sensation; circadian rhythm; clinical feature; clinical trial; closed angle glaucoma; conjunctival hyperemia; conjunctivitis; disease activity; disease exacerbation; drug contraindication; drug cost; drug dose regimen; drug efficacy; drug safety; drug tolerability; electrolyte disturbance; eye blood flow; eye color; eyelash growth; follicular conjunctivitis; genetic predisposition; heart arrhythmia; human; hyperpigmentation; hypertension; intraocular pressure; kidney dysfunction; liver dysfunction; neuroprotection; nonhuman; open angle glaucoma; optic nerve atrophy; optic nerve disease; paresthesia; patient compliance; review; risk factor; secondary glaucoma; side effect; systematic review; urolithiasis; visual field defect; alphagan; betagan; betimol; betoptic s; betoptic; cosopt; lumigan; ocupress; optipranolol; rescula; timoptic xe; timoptic; travatan; xalacom; xalatan

The Groningen longitudinal glaucoma study. I. Baseline sensitivity and specificity of the frequency doubling perimeter and the GDx nerve fibre analyser - Heeg, G.P.; Blanksma, L.J.; Hardus, P.L.L.J.; Jansonius, N.M. (Acta Ophthalmologica Scandinavica, 2005)
Purpose: To describe the baseline data of a large cohort of patients included for follow-up with perimetry using the frequency doubling technique (FDT) and with quantification of the retinal nerve fibre layer as assessed by GDx, and to calculate the sensitivity and specificity of both devices from these baseline data. Methods: Regular visitors to our glaucoma service were included. All subjects were followed for at least 4 years with FDT in full-threshold mode, GDx and conventional perimetry. Patients were classified as having either glaucoma or suspect glaucoma, according to baseline perimetry results. In addition, a group of healthy subjects was recruited outside the hospital. Results: A total of 452 glaucoma patients, 423 glaucoma suspects and 237 healthy subjects were incorporated into the analyses. Sensitivities for both FDT and GDx were fixed at 0.90. For the group as a whole, the specificity was 0.81 for FDT, using number of depressed test-points p < 0.01 in the total deviation probability plot with a cut-off point > 1, and 0.78 for GDx, using the Number, with a cut-off point > 29. The area under the receiver operating characteristic (ROC) curve was 0.92 for FDT and 0.94 for GDx. Of the subjects with suspect glaucoma, 75% showed normal FDT test results and 52% showed normal GDx results. Unlike FDT, GDx failed to detect some moderate/severe glaucoma cases. Conclusions: The performances of FDT and GDx are approximately equivalent in terms of sensitivity, specificity and area under the ROC curve. In glaucoma suspects, GDx in particular yielded a rather high percentage of positive test results. The majority of these positive test results are presumably false-positive results rather than results indicating preperimetric glaucoma. Copyright © Acta Ophthalmol Scand 2005.
Keywords: adolescent; adult; aged; ambulatory care; article; calculation; cohort analysis; controlled study; devices; diagnostic error; disease severity; female; follow up; glaucoma; human; intermethod comparison; longitudinal study; major clinical study; male; nerve fiber; patient coding; perimetry; plots and curves; priority journal; probability; quantitative analysis; receiver operating characteristic; reference value; retina nerve cell; sensitivity and specificity; visual threshold; FDT version 2.60; GDx version 2.0.10; Goldmann perimetry; Humphrey Field Analyser 30-2 Sita Fast

Evaluation of topical brinzolamide switched from dorzolamide for glaucoma - Hasegawa, K.; Takahashi, T.; Kawase, K. (Japanese Journal of Clinical Ophthalmology, 2005)
We evaluated the comfort and compliance of brinzolamide twice daily switched from dorzolamide thrice daily in 25 eyes of 25 glaucoma patients. The series comprised primary open-angle glaucoma 17 eyes, normal-tension glaucoma 3 eyes, capsular glaucoma 1 eye, primary closed-angle glaucoma 1 eye, and late-onset developmental glaucoma 3 eyes. All had been treated by multiple medications. After 8 weeks of brinzolamide, 20 patients preferred brinzolamide and 5 patients preferred dorzolamide. Both medications showed stickiness and white eyelid secretion, dorzolamide was less irritable. Better compliance resulted from use of brinzolamide because of lesser frequency of instillation.
Keywords: brinzolamide; dorzolamide; adult; aged; article; clinical article; closed angle glaucoma; drug instillation; evaluation study; eye irritation; eyelid; female; glaucoma; human; male; open angle glaucoma; patient compliance; side effect

Editor's desk: Multiple medications (Trauma, 2005)
Keywords: beta adrenergic receptor blocking agent; eye drops; aging; asthma; diet therapy; disease exacerbation; drug blood level; drug dose regimen; drug elimination; drug induced disease; drug labeling; drug metabolism; drug safety; drug utilization; dyspnea; editorial; glaucoma; human; kidney function; kinesiotherapy; liver function; patient compliance; patient education; physiotherapy; polypharmacy; prescription; risk benefit analysis; symptom; wheezing

Present status of eye care in India - Thomas, R.; Paul, P.; Rao, G.N.; Muliyil, J.P.; Mathai, A. (Survey of Ophthalmology, 2005)
India, the second most populous country in the world, is home to 23.5% of the world's blind population. In 1976 India became the first country in the world to start a national program for control of blindness. All surveys in the country have shown that cataract is the most common cause of blindness and all prevention of blindness programs have been "cataract-oriented." However, it has recently been recognized that the visual outcome of the cataract surgeries as well as the training of ophthalmologists has been less than ideal. There is now increasing emphasis on high-quality surgery and up-gradation of skills among ophthalmologists. Other important causes of blindness are refractive errors, childhood blindness, corneal blindness, and glaucoma. The definitions, magnitude, and present status of each of these causes of blindness, as well as efforts at control, are discussed. © 2005 Elsevier Inc. All rights reserved.
Keywords: antiglaucoma agent; mitomycin; blindness; cataract; cataract extraction; childhood disease; cornea opacity; cornea transplantation; cost of illness; diagnostic procedure; disease association; economic aspect; eye bank; follow up; geographic distribution; glaucoma; government; health care management; health care organization; health care quality; health care utilization; health program; health promotion; health service; health survey; human; incidence; India; medical education; medical expert; morbidity; prevalence; priority journal; prophylaxis; refraction error; review; screening; surgical technique; treatment failure; treatment outcome; visual acuity; visual disorder

Effects of topical antiglaucoma medications on the ocular surface - Asbell, P.A.; Potapova, N. (Ocular Surface, 2005)
The side effects of topical antiglaucoma medications and their preservatives range from ocular discomfort to sight-threatening alterations of the ocular surface. Conjunctival hyperemia, decreased tear production and function, and superficial punctate keratitis are among the most common signs seen on routine clinical examination. Squamous cell metaplasia and changes in cell morphology have been demonstrated by impression cytology studies and evaluation of biopsy specimens, and inflammatory effects are documented by the presence of inflammatory markers. The adverse effects of topical antiglaucoma eyedrops interfere with the treatment of glaucoma on two levels: first, the discomfort produced by the eye drops discourages patient compliance; and, second, long-term treatment with eyedrops is associated with a higher failure of filtration surgery. The detailed mechanism of inflammatory response and/or direct toxicity of eye drops has yet to be determined, but it may vary with the different classes of eye drops, different preservatives, and durations of treatments. Upcoming multicenter trials for new antiglaucoma eye drops should specifically evaluate ocular surface effects. © 2005 Ethis Communications, Inc.
Keywords: epinephrine; brimonidine; antiglaucoma agent; betaxolol; betaxolol; bimatoprost; brimonidine; brinzolamide; cytokine; dipivefrine; dorzolamide; dorzolamide plus timolol; drug preservative; eye drops; HLA DR antigen; intercellular adhesion molecule 1; interleukin 4; latanoprost; levobunolol; major histocompatibility antigen class 2; pilocarpine; prostaglandin F2 alpha; timolol; timolol maleate; unoprostone isopropyl ester; article; burning sensation; cell structure; clinical examination; clinical feature; clinical trial; conjunctiva disease; conjunctival hyperemia; cornea disease; cytology; disease marker; drug classification; drug efficacy; drug hypersensitivity; dry eye; eye disease; eye irritation; filtering operation; glaucoma; human; inflammation; intraocular foreign body; lacrimal duct; nonhuman; patient compliance; protein expression; pruritus; punctate keratitis; squamous cell metaplasia; tissue culture; treatment failure; alphagan p; alphagan; azopt; betagan; betoptic s; cosopt; lumigan; propine; rescula; timoptic xe; timoptic; trusopt; uf 021; xalatan

The use of topical corticosteroids in atopic dermatitis in children - Cambazard, F. (Annales de Dermatologie et de Venereologie, 2005)
Introduction. Topical corticosteroids are the treatment of reference in atopic dermatitis in children, but their administration may lead to a certain number of side effects. Methods. They are based on a review of the literature and the author's personal experience. Results. Topical corticosteroids are classed in four groups: weak, moderate, strong and very strong, depending on their efficacy. Their side effects are usually proportional to their efficacy. The complications with topical corticosteroids are well known, not only on local but also systemic level. Appropriate use of such topicals avoids these side effects, which depend on the product used, the age of the child and the extent and age of the lesions. Discussion. For the past 50 years, topical corticosteroids represent the most effective treatment in the management of atopic dermatitis in children. When used correctly, they are safe. Failures are related to corticosteroid phobia and poor compliance, and their complications to inappropriate use. The modalities of their withdrawal and the interest of immunosuppressive macrolides are discussed.
Keywords: corticosteroid; acne; atopic dermatitis; cataract; child; conference paper; drug efficacy; drug mechanism; drug safety; eczema; glaucoma; granuloma; human; hypertrichosis; infection; patient compliance; phobia; pigment disorder; skin atrophy; systematic review

Intraocular pressure control and persistence on treatment in glaucoma and ocular hypertension - Tingey, D.; Bernard, L.M.; Grima, D.T.; Miller, B.; Lam, A. (Canadian Journal of Ophthalmology, 2005)
Background: The purpose of this study was to characterize current patterns of treatment of glaucoma and ocular hypertension and to examine the effect of those patterns on intraocular pressure (IOP) control and persistence on therapy. Methods: A retrospective chart review was conducted at 3 ophthalmology practices in Alberta. Data were collected for patients who had begun therapy for newly diagnosed primary open-angle glaucoma or ocular hypertension between May 1, 1998, and Sept. 30, 1999 (phase I), and for patients who had begun second-line therapy after initial therapy with a β-blocker had failed (phase 2). Data were collected for a minimum of 24 months for phase I and a minimum of 18 months for phase 2. Results: We included 115 patient charts in phase I and 93 in phase 2. In each phase, the patients for whom latanoprost had been prescribed in unfixed combination with a β-blocker had the greatest mean percentage reduction in IOP at month 24, and the patients for whom latanoprost had been prescribed alone or in combination with a β-blocker were more likely to still be on initial therapy at month 24; the difference in persistence on therapy was statistically significant only in phase I (p = 0.001). The mean number of switches in therapy was smaller in phase I than in phase 2 in all therapy groups. Interpretation: Compared with other first- and second-line forms of therapy, treatment with latanoprost, alone or in combination with a β-blocker, was associated with greater reductions in IOP, better therapeutic persistence, fewer therapy switches and fewer ophthalmologist visits over a 2-year period.
Keywords: beta adrenergic receptor blocking agent; betaxolol; brimonidine; dorzolamide; dorzolamide plus timolol; latanoprost; levobunolol; timolol maleate; adult; aged; Canada; cardiovascular disease; comorbidity; controlled study; diabetes mellitus; drug efficacy; female; gonioscopy; health care utilization; human; hypertension; intraocular hypertension; intraocular pressure; major clinical study; male; open angle glaucoma; optic nerve; perimetry; prescription; respiratory tract disease; retrospective study; review; slit lamp; tonometry; visual acuity; alphagan; betagan; betoptic; cosopt; timoptic xe; trusopt; xalatan

Evaluation of an eye drop guide to aid self-administration by patients experienced with topical use of glaucoma medication - Salyani, A.; Birt, C. (Canadian Journal of Ophthalmology, 2005)
Background: Methods to improve patient compliance with prescribed topical use of glaucoma medication are sorely needed. A guide for the topical administration of ocular medication was suggested as such a tool. We investigated whether eye drop self-administration would be improved with use of the guide. Methods: An eye drop guide, a funnel-shaped device designed to fit within the contour of the orbital margins, was offered to 114 patients for use at home with their glaucoma medication. A questionnaire asking about the ease of eye drop self-administration was administered before and after 1 week's use of the device. Results: Of the 111 patients who accepted the guide, 93 returned a usable completed questionnaire. Seventy-four percent said that they found it easier to administer their eye drops without the guide and preferred to do so (χ2 = 21.77, p < 0.01). Patients using more doses per day found it more difficult to administer their drops using the guide (r = -0.233, p < 0.05), and those who had been using drops longer preferred not to continue using the guide (r = -0.222, p < 0.05). Patients who found the written instructions clearer found it easier to administer their drops using the guide (r = 0.329, p < 0.05). Interpretation: Although intended to ease the administration of eye drops, the guide proved to be counterproductive. Further work is necessary to investigate other methods of improving patient compliance with prescribed topical use of ocular medications.
Keywords: antiglaucoma agent; eye drops; adult; aged; article; cataract; closed angle glaucoma; controlled study; devices; drug delivery system; drug self administration; eye drop guide; female; follow up; glaucoma; human; intraocular hypertension; intraocular pressure; low tension glaucoma; major clinical study; male; open angle glaucoma; patient compliance; questionnaire; secondary glaucoma; visual acuity; visual field

12-Week study comparing the fixed combination of brimonidine and timolol with concomitant use of the individual components in patients with glaucoma and ocular hypertension - Goñi, F.J. (European Journal of Ophthalmology, 2005)
PURPOSE. To evaluate the efficacy and safety of fixed-combination brimonidine tartrate 0.2%/timolol 0.5% ophthalmic solution dosed BID and demonstrate non-inferiority to concomitant use of brimonidine tartrate 0.2% BID and timolol 0.5% BID in glaucoma and ocular hypertension patients with intraocular pressure (IOP) uncontrolled on monotherapy. METHODS. Randomized, multicenter, double-masked, parallel-group study involving 371 patients with inadequate IOP control (IOP from 22 to 34 mmHg) after ≥3 weeks of run-in on any monotherapy. Patients were treated with fixed-combination brimonidine/timolol BID (fixed-combination group, n=188) or concomitant brimonidine BID and timolol BID (concomitant group, n=183). IOP was assessed pre-dose and 2 hours after morning dosing at weeks 2, 6, and 12. RESULTS. A total of 355 patients (96%) completed the study. Patient demographics, run-in monotherapy, and baseline mean IOP on monotherapy were comparable between treatment groups. During follow-up, the mean reduction from baseline IOP was significant (p<0.001) at all time points and ranged from 4.4 to 5.3 mmHg in each group. Brimonidine/timolol fixed combination was as effective as concomitant therapy with respect to mean IOP and mean change from baseline IOP at all time points and visits. Between-group differences were ≤0.35 mmHg for mean IOP and ≤0.30 mmHg for mean change from baseline IOP; none were significant. No unexpected side effects were associated with the fixed combination. Both treatments were well tolerated with no difference in adverse events between groups. CONCLUSIONS. Brimonidine/timolol fixed-combination therapy is as safe and effective as concomitant treatment with the individual components. Its simplified dosing regimen has the potential to improve compliance. © Wichtig Editore, 2005.
Keywords: brimonidine; eye drops; timolol; adult; aged; allergic conjunctivitis; article; asthenia; clinical trial; closed angle glaucoma; controlled clinical trial; controlled study; demography; dose response; double blind procedure; drug efficacy; drug safety; drug tolerability; eye burning; eye pain; female; headache; human; hyperemia; hypertension; intraocular hypertension; intraocular pressure; major clinical study; male; monotherapy; multicenter study; ocular pruritus; open angle glaucoma; patient compliance; priority journal; randomized controlled trial; somnolence; treatment outcome; visual disorder; xerostomia

Continuous light increment perimetry compared to full threshold strategy in glaucoma - Wabbels, B.K.; Diehm, S.; Kolling, G. (European Journal of Ophthalmology, 2005)
PURPOSE. Continuous light increment perimetry (CLIP) is an improved testing strategy for automated static perimetry designed to save test time and enhance patient compliance. CLIP uses a modified ramp stimulus where stimulus intensity is continuously increased according to patient reaction time, starting from a subthreshold intensity until recognition. The test is constantly modified according to patient performance. As CLIP showed good results in normal subjects in previous studies, the authors now compared CLIP to the standard 4/2-full threshold (4/2) strategy in glaucoma patients. METHODS. Fifty-two patients with glaucomatous visual field defects (mean sensitivities 2.9 to 18.4 dB), all with perimetric experience, were tested with CLIP (three times) and 4/2 in a randomized fashion. Tests were performed at 55 test locations within the central 30° visual field (24-2 area) using the Twinfield perimeter. RESULTS. Average mean sensitivity was significantly higher for CLIP than for 4/2 (t test, p<0.0001). Absolute scotomas and extension of scotomas were comparable for both strategies, whereas CLIP found less deep relative scotomas in some cases. Mean test time was significantly shorter for CLIP (5.6 min) compared to 4/2 (8.9 min) (Wilcoxon signed rank test, p<0.0001). Patient acceptance was better for CLIP than for 4/2. CONCLUSIONS. CLIP showed comparable results to 4/2 with excellent patient acceptance. Mean sensitivities are 1.8 dB higher than for 4/2; similar results were found previously in normal subjects. CLIP was able to save a mean 38% of test time compared to full threshold strategy with good reproducibility. © Wichtig Editore, 2005.
Keywords: adult; aged; article; continuous light increment perimetry; controlled study; glaucoma; human; intermethod comparison; major clinical study; patient compliance; performance; perimetry; priority journal; reproducibility; reaction time; scotoma; sensitivity and specificity; visual field defect; Twinfield perimeter

Two memorable patients - Bhat, L. (Qatar Medical Journal, 2005)
Keywords: cataract extraction; community care; doctor patient relationship; eye disease; glaucoma; health care access; human; India; letter; ophthalmology; prognosis; age related macular degeneration; screening test; United Kingdom; visual acuity

Strategies for managing the side effects of treatments for multiple sclerosis - Langer-Gould, A.; Moses, H.H.; Murray, T.J. (Neurology, 2004)
Disease-modifying therapies for multiple sclerosis (MS) are a mainstay of treatment. All of these agents are associated with side effects, most of which are easily managed with only minimal additional pharmacotherapy. Appropriate patient education and physician support are critical to achieve the best medical outcome and to maximize patient compliance with long-term therapies for this debilitating condition. Although many side effects subside shortly after initiation of treatment, such as flu-like symptoms with interferon treatment, some side effects are cumulative and can become life-threatening if they are unrecognized (e.g., cardiotoxicity with mitoxantrone). Therefore, physicians must be aware of appropriate laboratory monitoring schedules to prevent serious toxicities and to become familiar with less serious but more common side effects that often threaten patient compliance. Patients should be encouraged to communicate with their physicians so that side effects can be managed promptly. This article describes and provides management strategies for side effects associated with MS treatments.
Keywords: antacid agent; beta1a interferon; corticosteroid; glatiramer; histamine H2 receptor antagonist; beta1b interferon; methylprednisolone; mitoxantrone; acne; alopecia; amenorrhea; anxiety disorder; aseptic necrosis; bone metabolism; cardiotoxicity; cataract; clinical trial; congestive heart failure; depression; diabetes mellitus; erythema; fertility; flu like syndrome; glaucoma; headache; hirsutism; human; hyperglycemia; hypertension; hypokalemia; infection; inflammation; insomnia; irritability; leukopenia; lipoatrophy; liver disease; liver toxicity; long term care; lymphadenopathy; lymphocytopenia; menstruation disorder; metabolic disorder; monitoring; multiple sclerosis; myalgia; myopathy; necrosis; neutropenia; obesity; osteopenia; osteoporosis; pain; patient compliance; patient education; peptic ulcer; physician; priority journal; psychosis; review; side effect; somnolence; suicide attempt; thorax pain; toxicity; treatment outcome; body weight gain; avonex; betaseron; copaxone; glatiramer acetate; novantrone; rebif

Outcomes associated with inhaled corticosteroid use in asthma and COPD: An update - Bhosle, M.J.; Shenolikar, R.A.; Kulkarni, A.S.; Balkrishnan, R. (Expert Review of Pharmacoeconomics and Outcomes Research, 2004)
The aim of this review is to report the updates in the medical literature on the outcomes associated with inhaled corticosteroid use. This update finds that inhaled corticosteroids remain a frontline choice as controller therapy in the treatment of asthma. Adherence to medications, especially inhaled corticosteroids used as controller medications, is responsible for a decrease in hospital, emergency room and physician visits. All of these translate to reduced asthma-related healthcare costs and an increase in health-related quality of life. There is a need for further research on the role of inhaled corticosteroids in chronic obstructive pulmonary disease outcomes. © 2004 Future Drugs Ltd.
Keywords: beclometasone; beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; budesonide; ciclesonide; corticosteroid; cortisone; cromoglycate disodium; flunisolide; fluticasone propionate; fluticasone propionate plus salmeterol; formoterol; leukotriene receptor blocking agent; long acting drug; montelukast; nedocromil; nonsteroid antiinflammatory agent; placebo; salbutamol; short acting drug; triamcinolone acetonide; zafirlukast; adrenal cortex disease; asthma; bone metabolism; cataract; chronic obstructive lung disease; clinical trial; concentration response; congenital malformation; cost effectiveness analysis; diabetes mellitus; drug choice; drug cost; fracture; glaucoma; growth retardation; health care cost; health economics; hoarseness; hospital admission; human; hypertension; long term care; low drug dose; monotherapy; myopathy; osteoporosis; patient compliance; quality of life; review; side effect; skin contusion; systematic review; throat disease; thrush; treatment outcome; aerobid; azmacort; beclovent; vanceril

Patient and ophthalmologist attitudes concerning compliance and dosing in glaucoma treatment - Stewart, W.C.; Konstas, A.G.P.; Pfeiffer, N. (Journal of Ocular Pharmacology and Therapeutics, 2004)
Aim: The aim of this study was to identify research avenues that might improve patient compliance with glaucoma therapy. Methods: 500 patients and physicians were interviewed by telephone in 5 European countries, and the results were compiled and evaluated by 2 independent physicians. Results: Most physicians believed that pressure reduction is useful (UK (96%), France (94%), Spain (80%), Italy (72%), and Germany (70%), p < 0.0001). The majority of physicians believed that noncompliance exists in 0%-25% of patients, whereas 34% of patients admitted to noncompliance. Physicians believed patients would prefer once-daily dosing (92%) and that it would help compliance, whereas 60% of patients preferred once-daily dosing, and 20% of patients believed it would help compliance. Physicians (94%) believed that noncompliance could lead to visual loss and, while this information concerned most physicians, this was less likely in Germany (52%) (p < 0.0001). Most patients received information concerning dosing of their medicines (79%), and, accordingly, waited an average of 10 minutes between doses; but only half of the patients had been told to wait at least 5 minutes between instilling preparations. Approximately 2 of 3 patients knew that missing medicines could cause visual loss. Conclusions: Once-daily dosing to increase patient satisfaction and/or dosing convenience and providing patient education are potential clinical techniques that could be further evaluated as a means to increase compliance.
Keywords: beta adrenergic receptor blocking agent; brimonidine; carbonate dehydratase inhibitor; dorzolamide; latanoprost; pilocarpine; timolol; article; controlled study; doctor patient relationship; drug dose regimen; glaucoma; health survey; human; interview; intraocular pressure; major clinical study; medical practice; monotherapy; patient compliance; patient education; patient satisfaction; physician attitude; practice guideline; treatment outcome; visual impairment

Two-year follow-up of latanoprost 0.005% monotherapy after changing from previous glaucoma therapies - Bayer, A.; Weiler, W.; Oeverhaus, U.; Skrotzki, F.-E.; Stewart, W.C. (Journal of Ocular Pharmacology and Therapeutics, 2004)
Aim: The aim of this study was to evaluate the long-term follow-up of patients who were changed to latanoprost from previous glaucoma therapies. Methods: Primary open-angle, exfoliative or chronic angle-closure glaucoma, or ocular hypertensive patients who switched to latanoprost therapy with a 2-year follow-up, were evaluated for efficacy, safety, and continuance of therapy. Results: In 1,571 patients, the intraocular pressure (IOP) across all treatment groups of 21.3 ± 4.1 was reduced to 17.6 ± 3.2 mm Hg after switching to latanoprost. Latanoprost reduced the IOP from previous monotherapies, including nonselective beta-adrenergic blockers, topical carbonic anhydrase inhibitors, alpha-adrenergic agonists and pilocarpine (p < 0.0001) and adjunctive therapies, including the fixed combinations of dorzolamide and timolol, pilocarpine and timolol, and pilocarpine and metipranolol, and the unfixed combination of dorzolamide and timolol and dorzolamide and clonidine (p < 0.0028). Latanoprost further reduced the IOP across all diagnostic groups (p < 0.0001). The most common ocular adverse event was ocular irritation (n = 25; 1.6%), which was also the most common reason given for patients who discontinued latanoprost because of an adverse event (n = 20; 1.3%). Conclusions: The mean IOP was maintained at an acceptable level throughout the 2-year follow-up period on latanoprost. Latanoprost generally provides further reduction of IOP when switched from previous mono- and adjunctive therapies, with a low rate of side effects and discontinuations.
Keywords: epinephrine; alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; betaxolol; brimonidine; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; clonidine; dipivefrine; dorzolamide; latanoprost; levobunolol; metipranolol; pilocarpine; timolol; adult; aged; article; closed angle glaucoma; conjunctival hyperemia; controlled study; drug efficacy; drug safety; pseudoexfoliation; eye inflammation; eye irritation; female; follow up; glaucoma; human; intraocular hypertension; intraocular pressure; intraocular pressure abnormality; major clinical study; male; monotherapy; open angle glaucoma; patient compliance; treatment outcome; treatment withdrawal; visual impairment; xalatan

Management of ocular hypertension and glaucoma (Asian Journal of Ophthalmology, 2004)
Keywords: alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; betaxolol; brimonidine; carbonate dehydratase inhibitor; dorzolamide; latanoprost; pilocarpine; prostaglandin derivative; timolol; apoptosis; clinical practice; clinical trial; conference paper; disease severity; follow up; glaucoma; human; intraocular hypertension; intraocular pressure; optic disk; patient compliance; perimetry; quality of life; retina ganglion cell; retina nerve cell; visual field; visual impairment

Utilization of eye care services by Victorians likely to benefit from eye care - Bylsma, G.W.; Le, A.; Mukesh, B.N.; Taylor, H.R.; McCarty, C.A. (Clinical and Experimental Ophthalmology, 2004)
Aim: To assess the utilization of eye care services by Australians most likely to benefit from eye assessment. Methods: The Melbourne Visual Impairment Project was a population-based study that collected demographic, health and vision-related information including use of eye care services. A standardized detailed ophthalmic examination was performed. Utilization of eye care services by those who might most benefit from eye care was assessed and compared to the general population. These participants include those with undiagnosed glaucoma, unoperated visually significant cataract, undercorrected refractive error, diabetes mellitus, age-related macular degeneration and visual acuity < 6/12. Sociodemographic characteristics were assessed for their influence on eye care utilization among these participants. Results: A total of 4744 urban and rural residents participated (86% of those eligible) and 4612 (83% of total eligible) of these had a complete data set for the use of eye care services and were included. There were 933 participants (20.2%) who did not report eye assessment in the previous 5 years, and 891 participants (19.3%) had one or more aforementioned conditions potentially benefiting from eye care. Of these, between 34.4% and 59.4% reported no examination in the previous year and between 9% and 25% reported no examination within the previous 5 years. These participants were more likely to seek eye care within the short term (1 year) if they had a family history of eye disease, otherwise a noticed change in vision was the main influence in the longer term (2-5 years). Male participants, younger participants and those whose main spoken language was not English were less likely to seek eye care in the longer term. Conclusions: In Victoria 19% of those >40 years of age have potentially unmanaged eye disease including glaucoma, unoperated visually significant cataract, undercorrected refractive error, age-related macular degeneration, diabetes mellitus or visual acuity < 6/12. A substantial proportion of these report no eye assessment in the previous 1, 2 or 5 years or ever before. Younger age, male sex and main language other than English make assessment less likely. Many may have these conditions despite having had a recent eye assessment.
Keywords: adult; aged; article; Australia; cataract; demography; diabetes mellitus; eye disease; family history; female; glaucoma; health care utilization; health service; human; language; major clinical study; male; ophthalmology; patient care; refraction error; age related macular degeneration; rural area; sex difference; urban area; visual acuity

Visual disabilities and quality of life in glaucoma patients - Goldberg, I. (Clinical and Experimental Ophthalmology, 2004)
Introduction: The most important goal of glaucoma treatment is to preserve quality of vision and quality of life (QOL). Long before they progress to blindness, glaucoma patients experience diminished QOL associated with their visual disabilities. Decreases in peripheral vision, contrast sensitivity and depth perception in earlier stages of the disease negatively impact the ability of patients to perform everyday activities. Methods: Review of studies focusing on quality of vision and QOL. Results: Studies using vision-targeted QOL surveys have shown that glaucoma patients experience a decrease in QOL particularly with respect to daily activities involving light and dark adaptation, glare, or peripheral vision. This decrease in QOL is positively correlated with the severity of visual field loss. Glaucoma patients report difficulty in performing everyday tasks such as walking without bumping into or tripping over objects, reading a newspaper, and crossing a road. In self-assessments of their QOL, glaucoma patients have expressed particular concern about their difficulties with reading and driving. Glaucoma patients frequently are anxious about their visual disabilities and the prospect of becoming blind. In a reported utility analysis, glaucoma patients on average would give up 6.1% of their remaining life span to have perfect vision. Visual disabilities associated with earlier stages of glaucoma can have serious repercussions, and glaucoma patients are at increased risk of car crashes and falls. Discussion: A growing body of evidence suggests that even modest changes in the visual field can have detrimental effects on the visual functioning and QOL of glaucoma patients. Conclusions: The goal of glaucoma treatment should be not only to avoid blindness, but also to avoid visual disabilities that negatively impact patient QOL. Appropriately aggressive treatment to prevent or halt visual field loss is desirable to preserve visual function and QOL of glaucoma patients.
Keywords: antiglaucoma agent; eye drops; accident proneness; blindness; contrast sensitivity; daily life activity; dark adaptation; depth perception; disease course; driving ability; evidence based medicine; falling; glare; glaucoma; high risk population; human; light adaptation; patient compliance; peripheral vision; prevalence; quality of life; reading; review; side effect; traffic accident; visual acuity; visual disorder; visual field defect

Reducing intraocular pressure: Is surgery better than drugs? - Shaarawy, T.; Flammer, J.; Haefliger, I.O. (Eye, 2004)
Reducing IOP is presently the evidence based, most accepted and most practised therapeutical approach for glaucoma patients. Currently topical ocular hypotensive medications, with its different classes, as well as filtering surgery (trabeculectomy and non-penetrating glaucoma surgery) are in the forefront of therapeutic modalities for IOP reduction. This article looks at the potential advantages and disadvantages of topical medications versus filtering surgery. It does not directly address the question of initial treatment of glaucoma, or what is the better treatment of glaucoma, as other review articles had, but rather looks in a more specific on the pros and the cons of each in relation to IOP reduction. In other words this article deals with the situation once the decision has been made to reduce IOP. © 2004 Nature Publishing Group All rights reserved.
Keywords: alpha adrenergic receptor stimulating agent; antihypertensive agent; antimetabolite; beta adrenergic receptor blocking agent; betaxolol; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; dorzolamide; fluorouracil; latanoprost; mitomycin; prostaglandin; timolol; article; blood dyscrasia; bradycardia; cataract; circadian rhythm; clinical trial; confusion; cost benefit analysis; depression; dyspnea; evidence based medicine; fatigue; filtering operation; gastrointestinal symptom; glaucoma; glaucoma surgery; headache; heart palpitation; human; hypokalemia; hypotension; impotence; intraocular pressure; libido disorder; long term care; nausea and vomiting; nephrolithiasis; paresthesia; patient compliance; peripheral vascular disease; polyuria; rash; reduction (chemistry); respiratory arrest; systematic review; trabeculectomy; xerostomia; betoptic

Gold standard medical therapy for glaucoma: Defining the criteria identifying measures for an evidence-based analysis - Obstbaum, S.A.; Cioffi, G.A.; Krieglstein, G.K.; Fennerty, M.B.; Alm, A.; Araie, M.; Carassa, R.G.; Greve, E.L.; Hitchings, R.A.; Kaufman, P.L.; Kitazawa, Y.; Pongpun, P.R.; et al. (Clinical Therapeutics, 2004)
Background: Over the past decade, several new medical therapies have become available for the treatment of primary open-angle glaucoma (POAG). A systematic evidence-based approach for identifying an optimal therapeutic agent is lacking. Objectives: The aims of this review were to critically evaluate published treatment recommendations for POAG and, based on a systematic review of the literature, to develop criteria that would define a "gold standard" medical therapy that reflects new treatment advances and established therapeutic goals. Methods: A MEDLINE search spanning the years 1966 to 2002 and using the search terms gold standard, drug of choice, agent of choice, benchmark, ophthalmology, eye, and glaucoma was conducted and the results reviewed by a panel of 15 experts in the field of glaucoma. Published treatment recommendations for POAG were discussed. Criteria, anchored to medical evidence, for distinguishing a standard of medical therapy for POAG were defined. Results: The terms connoting a gold standard therapy were found in only 258 of ∼368,000 ophthalmology-related citations and 53 of almost 23,000 glaucoma citations, validating the need to define therapeutic standards. The lack of recommendations for the use of new classes of ocular hypotensive agents was acknowledged. Criteria identified to evaluate intraocular pressure (IOP)--lowering agents as gold standards included the following: efficacy in reducing IOP consistently over a 24-hour period to a level that will preserve the visual field and protect the optic nerve without inducing tachyphylaxis and tolerance, paucity of local and systemic adverse effects, promotion of patient compliance, and applicability in diverse patient populations. Conclusions: These criteria should be employed as measures for evidence-based analyses to evaluate available and future IOP-lowering medical therapies for POAG. The conceptual framework presented may be applicable to other therapeutic areas. Copyright © 2004 Excerpta Medica, Inc.
Keywords: acetylsalicylic acid; aciclovir; epinephrine; adrenergic receptor stimulating agent; alpha adrenergic receptor stimulating agent; alteplase; amphotericin B; antiglaucoma agent; antihypertensive agent; apraclonidine; beta adrenergic receptor blocking agent; botulinum toxin; brinzolamide; carbachol; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; dipivefrine; high density lipoprotein cholesterol; levodopa; methotrexate; nifedipine; omeprazole; pilocarpine; prostaglandin derivative; proton pump inhibitor; sumatriptan; tamoxifen; timolol; artery thrombosis; blood clot lysis; bradycardia; breast cancer; cholesterol blood level; chronic disease; clinical trial; cost effectiveness analysis; drug contraindication; drug efficacy; drug hypersensitivity; drug safety; epidemiological data; evidence based medicine; face disorder; gastroesophageal reflux; genital herpes; glaucoma; health economics; human; intraocular pressure; juvenile rheumatoid arthritis; lung function; medical decision making; medical literature; Medline; mental disease; migraine; open angle glaucoma; ophthalmology; optic nerve; Parkinson disease; patient compliance; patient education; practice guideline; publication; quality of life; review; risk benefit analysis; risk factor; scleroderma; side effect; standardization; systematic review; tachyphylaxis; thorax pain; validation process; visual field; aspirin

The utilization of eye care services by persons with glaucoma in rural South India - Robin, A.L.; Nirmalan, P.K.; Krishnadas, R.; Ramakrishnan, R.; Katz, J.; Tielsch, J.; Thulasiraj, R.D.; Friedman, D.S. (Transactions of the American Ophthalmological Society, 2004)
Purpose: To determine utilization of eye care services, in particular those relating to glaucoma, in a rural population of southern India aged 40 years or older. Methods: A total of 5,150 subjects aged 40 years or older selected through a random cluster sampling technique from three districts in southern India underwent detailed ocular examinations for vision impairment, blindness, and ocular morbidity. Information regarding previous use of eye care services was collected from this population through a questionnaire administered by trained social workers prior to ocular examinations. Results: One thousand eight hundred and twenty-seven persons (35.5%) gave a history of prior eye examinations, primarily from a general hospital (n = 1,073, 58.7%). Increasing age and education were associated with increased utilization of eye care services. Among the 3,323 persons who had never sought eye care, 912 (27.4%) had felt the need to have an eye examination but did not do so. Only one third of persons with vision impairment, cataracts, refractive errors, and glaucoma had previously utilized services. Of the 64 subjects diagnosed as having primary open-angle glaucoma, 32 (50%) had previously seen an ophthalmologist, but none had had an eye examination within 1 year before the study. Only six (19%) of the 32 had been diagnosed as having glaucoma (9% of all subjects found to have glaucoma in the survey). Thirteen (20.3%) of the 64 subjects were blind in either eye due to glaucoma, including one person who was bilaterally blind. Conclusions: A large proportion of persons in a rural population of southern India who require eye care are currently not utilizing existing eye care services. Strategies to improve the uptake of services are required to reduce the burden of blindness due to glaucoma in southern India.
Keywords: adult; age distribution; aged; article; blindness; cataract; controlled study; education; female; general hospital; glaucoma; health care utilization; health service; human; India; male; morbidity; ophthalmology; prevalence; priority journal; questionnaire; refraction error; rural area; sampling; social worker; visual impairment

Comparison of once-daily nonpreserved timolol and timolol maleate gel-forming solution associated with latanoprost - Bron, A.; Velasque, L.; Rebica, H.; Pouliquen, P.; Elena, P.-P.; Rouland, J.-F. (Journal Francais d'Ophtalmologie, 2004)
Aim: To compare the efficacy and safety of a single daily instillation of nonpreserved timolol to a timolol maleate gel-forming solution in patients with chronic glaucoma or ocular hypertension already treated with latanoprost. Patients and methods: A randomized, prospective, multicenter, open, parallel-group clinical trial was undertaken with 73 patients with chronic glaucoma treated with latanoprost and a timolol maleate gel-forming solution. In 36 patients, the previous regimen was substituted by nonpreserved timolol given instead of timolol maleate gel for 3 months. The changes in intraocular pressure (IOP) were recorded as well as local and systemic tolerance and patient compliance. Results: At 3 months, both regimens were found equivalent in maintaining IOP control between DO and D84. The difference with baseline was -0.08 ±2.22mmHg and -0.38 ±2.41mmHg in the nonpreserved timolol group and in the timolol maleate gel-forming solution group, respectively (CI 95% [-0.79; 1.38]). After 84 days of treatement, blurred vision (5.9%) and eyelid deposits (5.9%) were reduced in the preservative-free timolol group compared to the other group (respectively, 33.3% and 24.2%). These differences were statistically significant for both signs (blurred vision: p<0.0001 and for eyelid deposits: p=0.03). Conclusion: This short-term study has demonstrated the equivalence of nonpreserved timolol to timolol maleate gel-forming solution in terms of IOP control. Moreover, the local tolerance of nonpreserved timolol was better.
Keywords: antiglaucoma agent; latanoprost; timolol; timolol maleate; adult; aged; article; clinical trial; confidence interval; controlled clinical trial; controlled study; drug efficacy; drug safety; drug tolerability; eyelid disease; female; gel; glaucoma; human; information processing; intermethod comparison; intraocular pressure; major clinical study; male; multicenter study; patient compliance; phase 4 clinical trial; randomized controlled trial; statistical significance; time; treatment outcome; visual impairment; timabak; timoptol; xalatan

Add-on therapy options in asthma not adequately controlled by inhaled corticosteroids: A comprehensive review - Kankaanranta, H.; Lahdensuo, A.; Moilanen, E.; Barnes, P.J. (Respiratory Research, 2004)
Many patients with persistent asthma can be controlled with inhaled corticosteroids (ICS). However, a considerable proportion of patients remain symptomatic, despite the use of ICS. We present systematically evidence that supports the different treatment options. A literature search was made of Medline/PubMed to identify randomised and blinded trials. To demonstrate the benefit that can be obtained by increasing the dose of ICS, dose-response studies with at least three different ICS doses were identified. To demonstrate whether more benefit can be obtained by adding long-acting β2-agonist (LABA), leukotriene antagonist (LTRA) or theophylline than by increasing the dose of ICS, studies comparing these options were identified. Thirdly, studies comparing the different "add-on" options were identified. The addition of a LABA is more effective than increasing the dose of ICS in improving asthma control. By increasing the dose of ICS, clinical improvement is likely to be of small magnitude. Addition of a LTRA or theophylline to the treatment regimen appears to be equivalent to doubling the dose of ICS. Addition of a LABA seems to be superior to an LTRA in improving lung function. However, addition of LABA and LTRA may be equal with respect to asthma exacerbations. However, more and longer studies are needed to better clarify the role of LTRAs and theophylline as add-on therapies. © 2004 Kankaanranta et al; licensee BioMed Central Ltd.
Keywords: beclomethasone dipropionate; beta 2 adrenergic receptor blocking agent; budesonide; budesonide plus formoterol; corticosteroid derivative; flunisolide; fluticasone propionate; formoterol; glucocorticoid; hydrocortisone; leukotriene receptor blocking agent; long acting drug; mometasone furoate; montelukast; osteocalcin; placebo; pranlukast; salbutamol; salmeterol; theophylline; triamcinolone acetonide; zafirlukast; add on therapy; antiinflammatory activity; asthma; behavior disorder; bronchodilating activity; candidiasis; cataract; clinical trial; Cochrane Library; disease exacerbation; dose response; drug efficacy; drug hypersensitivity; drug megadose; drug safety; dysphonia; extrasystole; forced expiratory volume; glaucoma; growth retardation; atrial fibrillation; hoarseness; human; hydrocortisone blood level; hydrocortisone urine level; infection risk; intraocular hypertension; low drug dose; lung biopsy; lung function; lung lavage; Medline; meta analysis; metered dose inhaler; muscle cramp; osteoporosis; patient compliance; peak expiratory flow; pharyngitis; pharynx disease; powder inhaler; quality of life; review; risk assessment; risk factor; side effect; skin contusion; skin disease; sore throat; supraventricular tachycardia; sustained drug release; symptomatology; systematic review; treatment withdrawal; symbicort

Utilisation of eye care services in rural south India: The Aravind Comprehensive Eye Survey - Nirmalan, P.K.; Katz, J.; Robin, A.L.; Krishnadas, R.; Ramakrishnan, R.; Thulasiraj, R.D.; Tielsch, J. (British Journal of Ophthalmology, 2004)
Aim: To determine utilisation of eye care services in a rural population of southern India aged 40 years or older. Methods: 5150 subjects aged 40 years and older selected through a random cluster sampling technique from three districts in southern India underwent detailed ocular examinations for vision impairment, blindness, and ocular morbidity. Information regarding previous use of eye care services was collected from this population through a questionnaire administered by trained social workers before ocular examinations. Results: 3476 (72.7%) of 5150 subjects examined required eye care examinations. 1827 (35.5%) people gave a history of previous eye examinations, primarily from a general hospital (n = 1073, 58.7%). Increasing age and education were associated with increased utilisation of eye care services. Among the 3323 people who had never sought eye care, 912 (27.4%) had felt the need to have an eye examination but did not do so. Only one third of individuals with vision impairment, cataracts, refractive errors, and glaucoma had previously utilised services. Conclusions: A large proportion of people in a rural population of southern India who require eye care are currently not utilising existing eye care services. Improved strategies to improve uptake of services is required to reduce the huge burden of vision impairment in India.
Keywords: adult; age; aged; aging; anamnesis; article; blindness; cataract; clinical examination; cluster analysis; eye; female; general hospital; glaucoma; health care utilization; health survey; human; India; major clinical study; male; morbidity; priority journal; questionnaire; randomization; refraction error; rural health care; rural population; social worker; visual impairment

New molecular entity: Cymbalta®, Eli Lilly Duloxetine (Geriatrics, 2004)
Keywords: duloxetine; fluvoxamine; monoamine oxidase inhibitor; quinoline derived antiinfective agent; thioridazine; agitation; akathisia; anxiety; appetite; closed angle glaucoma; coma; constipation; delirium; diabetes mellitus; diarrhea; disease exacerbation; dizziness; fatigue; heart ventricle arrhythmia; hostility; hot flush; human; hyperthermia; hypomania; impulsiveness; insomnia; irritability; kidney function; liver failure; major depression; mania; mental health; mydriasis; myoclonus; nausea; neuropathic pain; panic; patient compliance; rigidity; short survey; somnolence; sudden death; suicidal behavior; sweating; xerostomia; cymbalta

Intraocular pressure and safety in glaucoma patients switching to latanoprost/timolol maleate fixed combination from mono- and adjunctive therapies - Konstas, A.G.P.; Bányai, L.; Blask, K.-D.; Väth, J.; Kozobolis, V.P.; Trüb, P.R.; Tsironi, S.; Maloutas, S.; Teus, M.A.; Stewart, W.C. (Journal of Ocular Pharmacology and Therapeutics, 2004)
Purpose: The aim of this study was to evaluate the efficacy and safety in ocular hypertensive or open-angle glaucoma patients changed to a latanoprost/timolol fixed combination (LTFC) from previous therapy. Methods: We employed a retrospective, multicenter, active-controlled study evaluating patients who had a previous therapy substituted with LTFC and had a 3-month follow-up. Results: In the 168 patients included in the trial, LTFC reduced the intraocular pressure (IOP) after switching from previous therapies: timolol (22.8 ± 3.5 to 19.0 ± 3.9 mmHg, N = 49, p < 0.001), latanoprost (21.2 ± 3.8 to 18.3 ± 2.5 mmHg, N = 54, p < 0.001), and a dorzolamide/timolol fixed combination (20.9 ± 2.4 to 20.0 ± 2.7 mmHg, N = 32, p = 0.03). In switching from a latanoprost and timolol unfixed combination, the pressure changed from 18.3 ± 3.8 to 18.9 ± 3.0 mmHg (N = 33, p = 0.38). LTFC was persistent in 131 (78%) patients within the 3-month treatment period. The most common adverse event with LTFC was conjunctival hyperemia, which occurred in patients not previously treated with latanoprost therapy (N = 16, 10%). Conclusions: LTFC generally provides reduced IOP and limited side effects when substituted for other common glaucoma therapies, while providing similar pressure when switched from its own individual components.
Keywords: antiglaucoma agent; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; timolol maleate; unclassified drug; adult; aged; allergic reaction; article; conjunctival hyperemia; controlled study; drug efficacy; drug safety; dyspnea; erythema; eye disease; female; follow up; human; intraocular foreign body; intraocular hypertension; intraocular pressure; lacrimation; major clinical study; male; monotherapy; ocular pruritus; open angle glaucoma; patient compliance; retina pigment epitheliopathy; retrospective study; side effect; superficial punctate epitheliopathy; cosopt; timoptic; xalacom; xalatan

A persistency and economic analysis of latanoprost, bimatoprost, or beta-blockers in patients with open-angle glaucoma or ocular hypertension - Day, D.G.; Schacknow, P.N.; Sharpe, E.D.; Ellyn, J.C.; Kulze III, J.C.; Threlkeld, A.B.; Jones, E.D.; Brown, R.H.; Jenkins, J.N.; Stewart, W.C. (Journal of Ocular Pharmacology and Therapeutics, 2004)
Purpose: The aim of this study was to evaluate differences in the persistency and treatment costs for latanoprost, bimatoprost, or beta-blockers in open-angle glaucoma or ocular hypertensive patients. Methods: This study was a retrospective, multicenter, parallel, active-controlled comparison of patients who were prescribed with ocular hypotensive monotherapy between September 1996 and August 2002. Results: 1,182 patients were included. The Kaplan Meier life table analysis showed that latanoprost was continued longest among the groups for the first year of therapy (p = 0.02). A significant difference existed between groups in the final intraocular pressure for latanoprost(17.3 ± 3.9, N = 357), for bimatoprost (18.0 ± 3.6, N = 146), and for the beta-blockers (17.9 ± 3.7, N = 335) (p = < 0.0001). The average number of visits was statistically higher for beta-blockers (3.3), compared to latanoprost (2.9) and bimatoprost (3.1) (p = 0.01). Further, the mean number of medicine changes was greater for bimatoprost (0.45) and beta-blockers (0.47) than for latanoprost (0.27) (p = 0.0008). The cost of visits and medications was lowest for beta-blockers ($119.3 ± $78.9) and highest for bimatoprost ($163.8 ± $51.2) (p < 0.001). Conclusions: Patients were more persistent with latanoprost and demonstrated lower intraocular pressure, fewer visits, and fewer medicine changes when compared to bimatoprost or beta-blocker therapy. In contrast, the beta-blocker group provided lower overall cost.
Keywords: beta adrenergic receptor blocking agent; betaxolol; bimatoprost; carteolol; latanoprost; levobunolol; metipranolol; timolol; timolol maleate; adult; aged; allergic reaction; article; blepharitis; conjunctival hyperemia; controlled study; cost benefit analysis; cost of illness; drug safety; economic aspect; eye burning; eye irritation; female; human; intraocular hypertension; intraocular pressure; Kaplan Meier method; major clinical study; male; monotherapy; ocular pruritus; open angle glaucoma; parallel design; patient compliance; retrospective study; visual impairment

Point-of-care monitoring of anticoagulant therapy by rural community pharmacists: Description of successful outcomes - Jackson, S.L.; Peterson, G.M.; House, M.; Bartlett, T. (Australian Journal of Rural Health, 2004)
Warfarin is a recognised high-risk drug for adverse events. Patients from rural and remote regions are at increased risk of these events because of problems of access to health care providers and services, and there is some reluctance to prescribe warfarin to patients in rural areas because of the difficulties in monitoring anticoagulated patients. The availability of portable international normalised ratio (INR) monitors is particularly attractive in rural or remote settings because of the lack of access to pathology services. Pharmacists and other health professionals in rural areas are ideally placed to assist general practitioners in the management of their anticoagulated patients through the use of portable INR monitors. The present article describes three cases of successful outcomes of pharmacist-assisted anticoagulation monitoring in the rural setting. Innovative service delivery models like these are needed to meet the needs of the increasing number of rural Australians requiring warfarin therapy.
Keywords: anticoagulant agent; bimatoprost; candesartan; digoxin; pantoprazole; simvastatin; warfarin; anticoagulant therapy; aortic valve replacement; arthritis; article; Australia; case report; drug dose reduction; drug dose regimen; drug monitoring; dyspepsia; female; glaucoma; health care delivery; health care need; atrial fibrillation; human; hypercholesterolemia; hypertension; international normalized ratio; male; monitor; nonbiological model; patient care; patient compliance; pharmacist; priority journal; rural health care; rural population; cerebrovascular accident; thrombosis; treatment outcome; CoaguChek S

The Advanced Glaucoma Intervention Study (AGIS): 13. Comparison of treatment outcomes within race: 10-year results - Ederer, F.; Shields, M.B. (Evidence-Based Eye Care, 2004)
Keywords: antiglaucoma agent; ambulatory care; argon laser; blindness; Caucasian; clinical trial; controlled study; deterioration; disease control; disease severity; drug use; financial management; follow up; functional assessment; glaucoma; glaucoma surgery; human; incidence; intermethod comparison; intraocular pressure; major clinical study; monotherapy; Black person; optic disk anomaly; outcomes research; patient monitoring; patient selection; pressure measurement; priority journal; race difference; randomized controlled trial; short survey; statistical significance; time; trabeculectomy; trabeculoplasty; treatment failure; United States; vision; visual acuity; visual field defect

Adverse corneal events associated with corneal reshaping: A case series - Lang, J.; Rah, M.J. (Eye and Contact Lens, 2004)
Purpose. This case series presents the first documented cases of infectious ulcers associated with overnight orthokeratology in North America and other less serious complications associated with overnight corneal reshaping. Case Reports. Five cases of adverse corneal events associated with corneal refractive therapy are described: two cases of microbial keratitis, one case of infiltrates, one case of toxic keratitis, and one corneal abrasion. Conclusions. Corneal compromise and poor compliance can cause adverse events with corneal reshaping. The need for ongoing patient education is important not only for pediatric contact lens patients, but also for adults. © 2004 Contact Lens Association of Ophthalmologists, Inc.
Keywords: artificial tear; ciprofloxacin; cyclopentolate; dexamethasone plus tobramycin; gatifloxacin; moxifloxacin; ofloxacin; polytrim; adult; article; case report; cell infiltration; contact lens; cornea disease; cornea edema; cornea refractive therapy; eye refraction; female; human; keratitis; male; patient compliance; priority journal; prosthesis infection; school child; polytrim; tobradex; Focus; Paragon

Update in glaucoma management. From The Association for Research in Vision and Ophthalmology Annual Meeting, Fort Lauderdale Florida, USA, 2-7 May 2004 (Asian Journal of Ophthalmology, 2004)
Keywords: adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; carbonate dehydratase inhibitor; caspase 3; cyclic GMP dependent protein kinase inhibitor; glatiramer; latanoprost; melanin; mitogen activated protein kinase inhibitor; phosphatidylinositol 3 kinase inhibitor; protein kinase C inhibitor; streptozocin; timolol; travoprost; age; cataract; closed angle glaucoma; conference paper; dose response; drug efficacy; drug mechanism; drug response; ethnology; glaucoma; human; intraocular pressure; iridotomy; low level laser therapy; neuroprotection; open angle glaucoma; patient compliance; retina nerve cell; streptozotocin-induced diabetes mellitus; trabecular meshwork; Cop 1

A review of medication side effects and treatment adherence in bipolar disorder - Anderson, T.R.; Goldberg, J.F.; Harrow, M. (Primary Psychiatry, 2004)
How do the tolerability and adverse-effect profiles of newer psychotropic drugs for bipolar disorder balance against their enhanced therapeutic benefits? The growing range of pharmacotherapy options across all phases of bipolar illness should, ideally, enhance the ability of clinicians to provide optimal treatments while considering differential adverse effects and drug tolerability. Such approaches help to increase medication adherence in patients who might otherwise discontinue treatment due to adverse effects. Clinically diverse, often significant adverse effects are evident with both older and newer drug therapies for bipolar illness. Most notably, problems related to gastrointestinal upset, weight gain, glucose dysregulation, sexual dysfunction, cognitive impairment, dermatologic reactions, and central nervous system effects are a potential liability with numerous compounds. Strategies exist for either minimizing or counteracting the adverse effects of most psychotropic agents. These include slow-dose escalations, preferential use of delayed-release formulations, and adjunctive treatments with additional agents. Clinical decisions to switch primary medications due to adverse effects-rather than treat through adverse effects-must reflect careful balancing of drug efficacy (benefits) versus side-effect liability (costs).
Keywords: amantadine; amfebutamone; anticonvulsive agent; aripiprazole; atypical antipsychotic agent; buspirone; carbamazepine; clozapine; Ginkgo biloba extract; granisetron; lamotrigine; lithium; methylphenidate; mirtazapine; nefazodone; olanzapine; oral contraceptive agent; placebo; propranolol; psychotropic agent; quetiapine; risperidone; serotonin uptake inhibitor; sildenafil; topiramate; unindexed drug; valproate semisodium; valproic acid; yohimbine; ziprasidone; anorgasmia; bipolar disorder; clinical trial; closed angle glaucoma; cognitive defect; cost benefit analysis; delayed release formulation; diarrhea; dose response; drowsiness; drug choice; drug dose reduction; drug efficacy; drug formulation; drug safety; drug tolerability; dyslipidemia; enteric coated tablet; erectile dysfunction; gastrointestinal symptom; glucose intolerance; human; hyperandrogenism; hyperglycemia; hyperlipoproteinemia; hypertriglyceridemia; intraocular hypertension; libido disorder; mania; medical decision making; menstruation disorder; metabolic disorder; nausea; nephrolithiasis; neurotoxicity; non insulin dependent diabetes mellitus; obesity; ovary polycystic disease; paresthesia; patient compliance; patient counseling; psychopharmacotherapy; rash; review; schizophrenia; sedation; sexual dysfunction; side effect; skin manifestation; Stevens Johnson syndrome; teratogenesis; tremor; vomiting; body weight gain

An update on bimatoprost (Lumigan®) in glaucoma therapy - Noecker, R.J.; Earl, M.L. (Therapy, 2004)
The prostamide bimatoprost (Lumigan®, Allergan Inc.) has been proven highly effective as monotherapy, adjunctive, and replacement therapy for lowering intraocular pressure (IOP) and providing good diurnal control of IOP in patients with open-angle glaucoma and ocular hypertension. Target pressure results from large, randomized, multicenter clinical trials comparing bimatoprost with timolol, latanoprost (Xalatan®, Pharmacia & Upjohn), travoprost (Travatan®, Alcon laboratories), fixed combination timolol/dorzolamide (Cosopt®, Merck Inc.) or latanoprost and timolol gel have been analyzed. In each of the analyses, patients were more likely to achieve low target pressures with bimatoprost than with the other medications. Patients on bimatoprost therapy achieve low IOP levels that are maintained throughout the day and night, and long-term trials have shown that the efficacy of bimatoprost is sustained. Bimatoprost has been proven to be safe and well tolerated in postmarketing surveillance and, as a once-daily drug, allows for patient convenience resulting in better treatment compliance. Bimatoprost may be the most effective medication available for protecting the visual field in patients with glaucoma or ocular hypertension. 2004 © Future Drugs Ltd.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; dorzolamide; dorzolamide plus timolol; latanoprost; pilocarpine; prostaglandin; timolol; travoprost; clinical trial; disease control; drug efficacy; drug safety; drug tolerability; eye protection; glaucoma; heart disease; human; hyperemia; hyperpigmentation; intraocular hypertension; intraocular pressure; lung disease; monotherapy; open angle glaucoma; patient compliance; postmarketing surveillance; review; visual field; alphagan; azopt; cosopt; lumigan; travatan; trusopt; xalatan

Nanoparticle contact lenses deliver ophthalmic drugs - Coppola, D. (Pharmaceutical Technology, 2004)
Keywords: eye drops; nanoparticle; contact lens; cornea; drug delivery system; drug release; drug targeting; eyelid reflex; glaucoma; note; patient compliance; soft contact lens

Telematic-assisted self-tonometry (TAS) - Lämmer, R.; Groh, M.E.M.; Michelson, G. (Ophthalmologe, 2004)
Background. Close supervision of intraocular pressure (IOP) means monitoring an important risk factor for glaucoma. Method. After instruction in its use, patients measure their own IOP several times a day with the Dräger self-tonometer. The measurements are subsequently transmitted to a server via the telephone keypad and recorded separately for each patient. The software enables statistical evaluation of the pressure levels collected. Results. Up to now 30 of 35 patients transmit measurements or had done so for at least 6 months. Registration of measurement levels covering months and years provides the opportunity for optimizing treatment and hence can be considered a start toward quality assurance in the treatment of glaucoma patients. Conclusion. TAS is a cost-efficient method for obtaining long-term profiles of eye pressure. Thus, the possibility exists for early therapeutic intervention in patients at risk. The compliance gained by the close relationship between the physician and the patient represents a positive prognostic factor.
Keywords: article; software; cost effectiveness analysis; glaucoma; health care quality; human; intraocular pressure; patient compliance; patient monitoring; prognosis; quality control; registration; self evaluation; statistical analysis; telecommunication; telematic assisted self tonometry; telephone; tonometer; tonometry; Ocuton S

The efficacy and safety of once-daily versus once-weekly latanoprost treatment for increased intraocular pressure - Kurtz, S.; Shemesh, G. (Journal of Ocular Pharmacology and Therapeutics, 2004)
We evaluated the efficacy and safety of latanoprost eye drops once-weekly, compared to once-daily for improving patient compliance. Twenty (20) patients (11 women and 9 men), 12 with ocular hypertension and 8 with early glaucoma, were studied after washout of the antiglaucoma treatment. One (1) group was treated with latanoprost once-daily (control). The other group was treated once-weekly (study group). Intraocular pressure (IOP) was measured at baseline and on the 2nd, 4th, 6th, and 9th day after the last drop in the study group, and for 3 months on the same schedule thereafter. The mean baseline IOP was 24.3 ± 3.9 mmHg in the study group (range, 18-29) and 24.4 ± 4.4 mmHg in the control group (range, 17-32). The average IOP at all time points of post-treatment was 17.7 ± 1.5 mmHg (range, 14-23) and 16.9 ± 2.30 mmHg (range, 13-21), respectively. Latanoprost significantly lowered IOP in both groups (study group, p = 0.005; controls, p = 0.0019). The difference between post-treatment IOP was insignificant in both groups at each time point. The study group had fewer minor side effects than the control group (1/10 versus 6/10, respectively). Latanoprost treatment once-weekly was as effective, and bore fewer minor side effects, as once-daily treatment after 3 months of follow-up.
Keywords: eye drops; latanoprost; adult; aged; article; clinical article; controlled study; drug dose regimen; drug efficacy; drug safety; eye burning; female; follow up; foreign body; glaucoma; human; intraocular hypertension; intraocular pressure; male; ocular pruritus; patient compliance; patient satisfaction; xalatan

Is more always better? - Tuulonen, A. (Acta Ophthalmologica Scandinavica, 2004)
Keywords: antiglaucoma agent; clinical trial; cost effectiveness analysis; drug cost; early diagnosis; editorial; glaucoma; health care cost; health care delivery; health care organization; human; intraocular hypertension; intraocular pressure; Italy; low level laser therapy; medical decision making; medical literature; patient compliance; prescription; prevalence; priority journal; professional practice; quality of life; reimbursement; side effect; treatment indication

Prostaglandin-related drugs in glaucoma management - Sarkisian Jr., S.R.; Netland, P.A. (Clinical and Surgical Ophthalmology, 2004)
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: adrenergic receptor stimulating agent; alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimaprost plus timolol; bimatoprost; brimonidine; carbonate dehydratase inhibitor; dipivefrine; dorzolamide; dorzolamide plus timolol; timolol plus travoprost; latanoprost; latanoprost plus timolol; latanoprost plus timolol; pilocarpine; prostaglandin derivative; timolol; timolol plus travoprost; travoprost; unclassified drug; unoprostone isopropyl ester; aqueous humor formation; burning sensation; clinical trial; conjunctival hyperemia; drug efficacy; drug mechanism; drug potentiation; drug synthesis; evidence based medicine; eye pain; glaucoma; human; hypertrichosis; intraocular pressure; iris pigmentation; lacrimation; patient compliance; pigment disorder; pruritus; review; side effect; treatment outcome; visual impairment; extravan; lumigan; rescula; travatan; xalacom; xalatan

Association between nocturnal blood pressure reduction and progression of visual field defect in patients with primary open-angle glaucoma or normal-tension glaucoma - Tokunaga, T.; Kashiwagi, K.; Tsumura, T.; Taguchi, K.; Tsukahara, S. (Japanese Journal of Ophthalmology, 2004)
Purpose: To assess prospectively the relationship between nocturnal blood pressure reduction (dip) and progression of the visual field defect in patients with normal-tension glaucoma (NTG) or primary open-angle glaucoma (POAG). Patients and Methods: The subjects studied were 38 patients with glaucoma (23 patients with NTG, 15 patients with POAG), in whom 48-h ambulatory blood pressure monitoring was conducted, who were followed for at least 4 years, and in whom reliable visual field tests were performed at least 5 times. The progression was determined by the mean deviation (MD) slope analysis system installed in the Humphrey field analyzer Statpac program. Glaucoma patients with a dip of <10% were assigned to the nondipper group, those with a dip of 10%-20% to the tipper group, and those with a dip of >20% to the extreme dipper group. The dipper group was defined as physiologic dippers, while the nondipper and the extreme dipper groups were defined as nonphysiologic dippers, to study the relationship between the disturbance of the dip and progression of the visual field defect. Results: Thirteen patients showed significant progression, while 25 patients did not. There were no significant differences in the mean intraocular pressure and follow-up period between the patients with progression and those without progression. Half (7/14) of the nondippers, 20% (4/20) of the dippers, and 50% (2/4) of the extreme dippers showed progression, indicating a tendency of progression in the nondipper and the extreme dipper groups. The nonphysiologic dippers had a higher incidence of progression compared with the physiologic dippers (P = 0.05). Among the glaucoma patients in the nondipper and dipper categories only, those with progression had significantly smaller dips (P = 0.02). Conclusion: These results suggest that disturbance in the physiologic dip may be involved in the progression of glaucoma. © Japanese Ophthalmological Society 2004.
Keywords: adult; aged; ambulatory monitoring; article; blood pressure monitoring; blood pressure regulation; circadian rhythm; clinical article; disease association; disease course; eye blood flow; female; follow up; glaucoma; human; intraocular pressure; male; open angle glaucoma; pathogenesis; priority journal; prospective study; reliability; visual field defect

An update of the leukotriene modulators for the treatment of asthma - Riccioni, G.; Di Ilio, C.; D'Orazio, N. (Expert Opinion on Investigational Drugs, 2004)
Bronchial asthma is a chronic inflammatory airway disease involving many cells and mediators. Chronic inflammation constitutes an important predisposing condition for airway remodelling with secondary irreversible airflow obstruction. Current approaches for asthma treatment involve many classes of drugs, adequate patient education for their correct use, environmental exposure control and daily monitoring of pulmonary function. Unfortunately, the use of multiple therapies complicates treatment regimens, thus leading to a reduced compliance to therapy. Available evidence from randomised clinical trials and real-word experience derived from managing patients with asthma justifies a broader role for leukotriene receptor antagonist drugs in asthma management than that recommended in the National Asthma Education and Prevention Programme and National Health Lung and Blood Institute Treatment Guidelines. While a low dose of inhaled corticosteroids remains the reference drug as a controller in mild-to-moderate persistent asthma, oral therapy with an leukotriene-receptor antagonist drug represents a good option providing the clinical efficacy requested in common clinical practice. For this reason the recent Global Initiative for Asthma Guidelines allocate this drug to the second and third steps of asthma treatment. 2004 © Ashley Publications Ltd.
Keywords: acetylsalicylic acid; alzaire; antihistaminic agent; antiinflammatory agent; azelastine; beclometasone; beta 2 adrenergic receptor stimulating agent; cetirizine; corticosteroid; corticotropin; hydrocortisone; leukotriene receptor blocking agent; long acting drug; montelukast; nonsteroid antiinflammatory agent; placebo; pranlukast; salmeterol; short acting drug; theophylline; theophylline derivative; warfarin; zafirlukast; zileuton; abdominal pain; adrenal suppression; airway obstruction; allergic disease; allergic rhinitis; asthenia; asthma; atopic dermatitis; cataractogenesis; chronic inflammation; chronic urticaria; Churg Strauss syndrome; clinical practice; clinical trial; corticosteroid induced osteoporosis; coughing; diarrhea; disease exacerbation; disease predisposition; drug absorption; drug efficacy; drug indication; drug mechanism; drug potentiation; dyspepsia; dysphonia; environmental exposure; evidence based medicine; exercise induced asthma; flushing; gastrointestinal disease; glaucoma; growth disorder; headache; hoarseness; human; infection; influenza; laryngitis; liver toxicity; low drug dose; lung function; metabolic disorder; migraine; mycosis; nausea; neuroendocrine disease; nonhuman; otitis; pain; paranasal sinus disease; patient compliance; patient education; patient monitoring; pharyngitis; practice guideline; respiratory tract inflammation; review; rhinitis; rhinosinusitis; side effect; sinusitis; skin manifestation; tachyphylaxis; teratogenicity; throat disease; thrush; virus infection; accolate; alzaire; aspirin; onon; singulair; ultair; zyflo

Ten years of glaucoma blindness in Fife 1990-99 and the implications for ophthalmology, optometry and rehabilitation services. - Sinclair, A.; Hinds, A.; Sanders, R. (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 2004)
The aim of this study was to determine the characteristics of the patients in Fife who were registered as blind with a main diagnosis of glaucoma between 1990 and 1999. The case notes of 87 people were studied. The average age at registration was 78 years (S.D. = 14). By the time of first referral to hospital, more than half were already aware of visual loss. Forty-five per cent of referrals had no optometry input. Compliance with treatment was poor in at least 26% of patients. Only 44% had glaucoma surgery. There were significant findings with regard to mental health, particularly dementia, which was eventually present in 24%. At least one-third of patients had a hearing impairment. One-third of those registered as blind could have been registered earlier. However, staff from the local provider of rehabilitation and social work services for the blind were shown to have provided prompt and helpful support to 95% of those registered. Consideration should be given to the way in which elderly patients with advanced glaucoma are managed, with awareness of mental health and hearing problems and emphasis on early referral to rehabilitation services.
Keywords: aged; article; blindness; dementia; glaucoma; health service; hearing disorder; human; nurse; ophthalmology; optometry; organization and management; patient compliance; social support; United Kingdom

Medical illness and the risk of suicide in the elderly - Juurlink, D.N.; Herrmann, N.; Szalai, J.P.; Kopp, A.; Redelmeier, D.A. (Archives of Internal Medicine, 2004)
Background: Suicide is a leading cause of death, and rates are especially high among the elderly. Medical illnesses may predispose to suicide, but few controlled studies have examined the association between specific diseases and suicide. We explored the relationship between treatment for several illnesses and the risk of suicide in elderly patients using a population-based approach. Methods: All Ontario residents 66 years or older who committed suicide between January 1, 1992, and December 31, 2000, were identified from provincial coroners' records. Their prescription records during the preceding 6 months were compared with those of living matched controls (1:4) to determine the presence or absence of 17 illnesses potentially associated with suicide. Results: During the 9-year study period, we identified 1354 elderly patients who died of suicide. The most common mechanisms involved firearms (28%), hanging (24%), and self-poisoning (21%). Specific illnesses associated with suicide included congestive heart failure (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.33-2.24), chronic obstructive lung disease (OR, 1.62; 95% CI, 1.37-1.92), seizure disorder (OR, 2.95; 95% CI, 1.89-4.61), urinary incontinence (OR, 2.02; 95% CI, 1.29-3.17), anxiety disorders (OR, 4.65; 95% CI, 4.07-5.32), depression (OR, 6.44; 95% CI, 5.45-7.61), psychotic disorders (OR, 5.09; 95% CI, 3.94-6.59), bipolar disorder (OR, 9.20, 95% CI, 4.38-19.33), moderate pain (OR, 1.91; 95% CI, 1.66-2.20), and severe pain (OR, 7.52; 95% CI, 4.93-11.46). Treatment for multiple illnesses was strongly related to a higher risk of suicide. Almost half the patients who committed suicide had visited a physician in the preceding week. Conclusions: Many common illnesses are independently associated with an increased risk of suicide in the elderly. The risk is greatly increased among patients with multiple illnesses. These data may help clinicians to identify elderly patients at risk of suicide and open avenues for prevention.
Keywords: allopurinol; antiandrogen; antidepressant agent; antiglaucoma agent; benzodiazepine; beta adrenergic receptor stimulating agent; bromocriptine; cholinergic receptor blocking agent; dipeptidyl carboxypeptidase inhibitor; furosemide; glucocorticoid; histamine H2 receptor antagonist; hydroxymethylglutaryl coenzyme A reductase inhibitor; levodopa; levothyroxine; lithium carbonate; morphine; neuroleptic agent; nitrate; nonsteroid antiinflammatory agent; oral antidiabetic agent; oxybutynin; phenytoin; pramipexole; proton pump inhibitor; selegiline; serotonin uptake inhibitor; tamoxifen; theophylline; unindexed drug; aged; aging; anxiety disorder; article; bipolar disorder; breast cancer; cause of death; chronic disease; chronic obstructive lung disease; congestive heart failure; controlled study; depression; diabetes mellitus; dyslipidemia; female; firearm; gastrointestinal disease; geriatric patient; glaucoma; gout; hanging; health care utilization; human; hypothyroidism; major clinical study; male; mental disease; pain; Parkinson disease; population research; prescription; priority journal; prostate cancer; psychosis; rheumatoid arthritis; risk factor; seizure; self poisoning; suicide; urine incontinence

Medication compliance after starting a long-term therapy - Hugtenburg, J.G.; Blom, A.T.G.; Kisoensingh, S.U. (Pharmaceutisch Weekblad, 2004)
Keywords: anticoagulant agent; anticonvulsive agent; antidepressant agent; antidiabetic agent; antiglaucoma agent; antihypertensive agent; bisphosphonic acid derivative; estrogen; article; chronic disease; depression; diabetes mellitus; epilepsy; glaucoma; human; long term care; long term exposure; Netherlands; patient compliance; psychopharmacology; thrombosis; treatment planning

Health pros get prescribing powers (Occupational Health, 2004)
Keywords: analgesic agent; antiglaucoma agent; backache; general practitioner; glaucoma; government; health care access; health care delivery; human; multiple sclerosis; national health service; note; nurse; optometry; patient care; pharmaceutical care; pharmacist; physiotherapist; podiatry; prescription; professional practice; radiologist; workload

Establishing Low Vision Services at Secondary Level - Minto, H.; Awan, H. (Community Eye Health, 2004)
Keywords: albinism; blindness; cataract; diabetic retinopathy; glaucoma; health care access; health care need; health care personnel; health promotion; health service; human; refraction error; retina degeneration; retina dystrophy; review; visual acuity; visual disorder

Glaucoma case finding: A cluster-randomised intervention trial - Theodossiades, J.; Murdoch, I.; Cousens, S. (Eye, 2004)
Purpose. To assess the effect of an intervention comprising training in optic disc assessment, explicit referral criteria and ophthalmologist feedback on referred patients, on the number of optometrist referrals for suspected glaucoma seen at a referral site and the positive predictive value of those referrals. Methods. Optometric practices routinely referring to the Ealing Hospital Eye Clinic were randomly divided into two groups taking into consideration those practices, which shared an optometrist (a cluster) and the number of optometrist days worked per week. One group of practices acted as controls, while the other practices were invited to receive the intervention. Data on 397 new patients referred and presenting to Ealing Hospital with suspected glaucoma were collected over a 20-month period. The data on patients who had failed to attend their appointment were collected over 7 months of this period. The number of referrals seen, the positive predictive value of those referrals, and the attendance rate were calculated. Optometrist's opinions of the intervention were assessed qualitatively. Data relating to optometrist compliance with the intervention were also collected. Results. The number of glaucoma referrals presenting to Ealing Hospital from the intervention practices was almost double that from the control practices (210 vs 119). When cluster randomisation, the number of optometrist days per cluster and the number of assessed referrals in the preintervention period are taken into consideration, it is estimated that the intervention is associated with a 52% increase in the number of referrals reaching Ealing Hospital. However, the design effect resulting from the cluster randomisation was unexpectedly high (of the order of 13-14) and so the confidence intervals around the estimate of 52% are very wide (95% c.i. 35% decrease to 253% increase, P = 0.34). There was no evidence of an association between optometrist compliance with the intervention and the number of referrals seen at Ealing Hospital. The positive predictive value (PPV) of referrals was similar for the intervention (0.49 (95% c.i. 0.42, 0.55)) and control groups (0.46 (95% c.i. 0.33, 0.60)). Optometrist opinions of the intervention were largely favourable. All expressed a willingness to participate in future programmes. Conclusion. A large difference in the number of referrals between the practice groups was observed. Since the PPV of referral was unchanged, the potential impact of the intervention in terms of numbers of new cases of glaucoma detected in the community is substantial. However, because of its large design effect, this trial does not provide conclusive evidence of an impact of the intervention on referral numbers. A considerably larger trial will be required to produce conclusive evidence of an effect. © 2004 Nature Publishing Group All rights reserved.
Keywords: article; case finding; confidence interval; controlled study; correlation analysis; data analysis; glaucoma; human; information processing; major clinical study; optic disk; optometry; patient compliance; patient referral; prediction; professional practice; qualitative analysis; randomization

Idiopathic generalized epilepsy - Sullivan III, J.E.; Dlugos, D.J. (Current Treatment Options in Neurology, 2004)
Successful treatment of idiopathic generalized epilepsy begins with accurate seizure classification. Seizure types, such as absence, myoclonic, and primary generalized tonic-clonic seizures (PGTCS), often can be classified based on a detailed history and inter-ictal electroencephalogram (EEG). Ideally, patients can be classified into specific epilepsy syndromes, such as childhood absence epilepsy, juvenile myoclonic epilepsy (JME), or generalized tonic-clonic seizures on awakening. Idiopathic generalized epilepsy should be distinguished from focal epilepsy with rapid secondary generalization. If this distinction is not clear after history, physical examination, and routine interictal EEG, then ambulatory EEG, video EEG monitoring, or neuroimaging studies may be needed. Ethosuximide, valproate, or lamotrigine are all appropriate first-line choices in the treatment of childhood absence epilepsy. The specific medication should be chosen based on the side effect profiles, dosing formulations, and titration schedules of the medications. The available evidence best supports valproate as the first-line choice in the treatment of JME, although lamotrigine and topiramate may be appropriate choices in this setting. More data specific to JME are needed to clarify the role of medications such as levetiracetam and zonisamide in the treatment of JME. The available evidence to guide the treatment of PGTCS is limited, because most trials did not rigorously exclude patients with focal-epilepsy with rapid secondary generalization. Available evidence suggest that valproate is an appropriate first-line choice for PGTCE. Lamotrigine or topiramate also may be appropriate choices. More data are needed to clarify the role of levetiracetam and zonisamide in the treatment of PGCTS. If it is unclear whether a patient has idiopathic generalized epilepsy or focal epilepsy with secondary generalization, then a broad-spectrum anticonvulsant, including valproate, lamotrigine, or topiramate, should be considered. More data are needed to support the broad-spectrum efficacy of levetiracetam and zonisamide. Copyright © 2004 by current Science Inc.
Keywords: acetylsalicylic acid; ammonia; anticonvulsive agent; benzodiazepine derivative; carbamazepine; clonazepam; ethosuximide; etiracetam; fluoxetine; folic acid; lamotrigine; oral contraceptive agent; phenobarbital; phenytoin; placebo; topiramate; trimethadione; valproic acid; zonisamide; absence; acidosis; alopecia; ambulatory monitoring; amnesia; anamnesis; anorexia; ataxia; benign childhood epilepsy; blood dyscrasia; body weight disorder; central nervous system disease; clinical feature; clinical trial; closed angle glaucoma; cognitive defect; delayed release formulation; diagnostic accuracy; diagnostic imaging; diarrhea; differential diagnosis; diplopia; disease classification; dizziness; dose response; drug blood level; drug contraindication; drug cost; drug dose regimen; drug efficacy; drug eruption; EEG abnormality; electroencephalography; evidence based medicine; fatigue; focal epilepsy; generalized epilepsy; headache; human; hyperammonemia; idiopathic disease; increased appetite; lethargy; liver toxicity; menstruation disorder; multicenter study; myoclonus epilepsy; myoclonus seizure; nausea; nephrolithiasis; neural tube defect; pancreatitis; paresthesia; photosensitivity; physical examination; psychosis; randomization; review; sedation; side effect; Stevens Johnson syndrome; tablet formulation; thrombocyte dysfunction; thrombocytopenia; tonic clonic seizure; tremor; vomiting

Glaucoma in southern India [1] (multiple letters) - Thomas, R.; Garudadri, C.; Mandal, A.K.; Kumar, R.S.; Robin, A.L.; Katz, J.; Tielsch, J.M.; Friedman, D.S.; Ramakrishnan, R.; Krishnadas, R.; Nirmalan, P.K.; Thulasiraj, R.D. (Ophthalmology, 2004)
Keywords: closed angle glaucoma; diagnostic procedure; glaucoma; gonioscopy; health care utilization; human; India; information processing; intraocular pressure; letter; normal distribution; optic disk cup; perimetry; prevalence; priority journal; screening; visual field; visual field defect

Sterility of Glaucoma Medications among Chronic Users in the Community - Porges, Y.; Rothkoff, L.; Glick, J.; Cohen, S. (Journal of Ocular Pharmacology and Therapeutics, 2004)
Purpose: To evaluate the sterility of topical glaucoma medications among chronic glaucoma medication users in the community. Setting: Glaucoma service, Sanz Medical Center, Laniado Hospital, Netanya. Research mode: Cross-sectional laboratory and clinical study, Patients and Methods: Chronic glaucoma patients were asked to submit their topical glaucoma preparations to the microbiology laboratory at Laniado hospital, Samples taken from the interior of the bottle and the tip were cultured using MacConkey agar, blood agar, and chocolate agar plates. Results: Sixty-two bottles of topical glaucoma medications used by 27 patients were tested. Bacterial growth was detected in eight (12.9%) preparations, three of which revealed Pseudomonas aeruginosa, three Staphylococcus epidermidis, one Streptococcus viridans, and one Klebsiella. During the study, acute conjunctivitis was found in one patient, possibly due to the use of infected drops. In another case, two identical medications, which had been used simultaneously for more than 6 weeks by the same patient, were found to be infected. Conclusions: Glaucoma topical preparations are generally found safe in terms of sterility, though bacterial growth may be found in a small percentage. In most cases, the cause of the loss of sterility could not be determined. However, in two preparations, contamination was related to the noncompliance of the patient who continued using the same preparation longer than instructed. It is imperative to increase the awareness of glaucoma patients to the fact that improper use can lead to eye-drop contamination.
Keywords: agar; antiglaucoma agent; beta adrenergic receptor blocking agent; betaxolol; brimonidine; brinzolamide; dipivefrine; dorzolamide; dorzolamide plus timolol; latanoprost; timolol maleate; pilocarpine; timolol maleate; timolol maleate; unclassified drug; vioptic; adult; aged; alpha hemolytic Streptococcus; article; bacterial growth; bacterium culture; chronic patient; clinical article; conjunctivitis; culture medium; drug contamination; drug safety; drug sterility; drug use; female; glaucoma; human; Israel; Klebsiella; long term care; male; microbiology; patient compliance; Pseudomonas aeruginosa; Staphylococcus epidermidis; alphagan; azopt; betoptic; cosopt; pilocarpine; propine; trusopt; vioptic; xalatan

Risk and risk factors for blindness from glaucoma - Chen, P.P. (Current Opinion in Ophthalmology, 2004)
Purpose of review: Estimates of blindness from glaucoma and risk factors for blindness remain of interest for all ophthalmologists. Recent findings: Long-term retrospective studies of patients with open-angle glaucoma in developed countries have noted that progression to bilateral blindness among treated patients is relatively uncommon. Risk factors for development of blindness include advanced visual field loss at presentation and noncompliance with the treatment regimen. Age is a risk factor in some studies. Many of those with blindness are blind at presentation. Untreated rates of blindness are higher. Population-based studies of glaucoma in developing countries have highlighted the obstacles to prevention of blindness in such settings, with astonishingly high rates of blindness noted. Summary: The risk of blindness from glaucoma is very high among patients in developing countries, the vast majority of whom do not know they are afflicted. When considering all glaucoma worldwide, the greatest risk factor for blindness is almost certainly being an average citizen of a developing country. Among those with open-angle glaucoma in developed countries, more advanced visual field loss at presentation and noncompliance are risk factors for development of blindness, as well as advanced age. Effective public education about glaucoma and targeted screening of those most likely to have glaucoma are necessary if the number of blind from glaucoma is to be reduced worldwide. Better treatment options for those in developing countries must also be developed.
Keywords: age; blindness; clinical feature; developing country; human; medical specialist; open angle glaucoma; patient compliance; patient education; priority journal; review; risk; risk factor; screening test; visual field

An evaluation of the fixed-combination of latanoprost and timolol for use in open-angle glaucoma and ocular hypertension - Feldman, R.M. (Expert Opinion on Pharmacotherapy, 2004)
Glaucoma is one of the leading causes of irreversible blindness worldwide. Although there is no cure for this chronic disease, medical treatment is aimed at reducing levels of intraocular pressure (IOP) using ocular hypotensive agents. Very often, patients require more than one IOP-reducing drug, resulting in complex medication regimens that may be difficult to maintain and that can lead to non-compliance. A fixed-combination (FC) ophthalmic solution consisting of the prostaglandin, latanoprost (0.005%), and the β-blocker, timolol (0.5%), is now available. The primary mechanism of action of latanoprost is to increase uveoscleral outflow whereas timolol lowers IOP levels by decreasing the formation of aqueous humor in the ciliary epithelium. Due to the unique mechanism of action of latanoprost, once-daily dosing of one drop of FC latanoprost/timolol results in additional IOP reduction compared with either drug administered separately. FC latanoprost/timolol is well-tolerated and has a safety profile similar to that of its individual components. This combination drug provides a safe, effective and convenient alternative for the treatment of patients with elevated IOP levels uncontrolled with monotherapy. 2004 © Ashley Publications Ltd.
Keywords: epinephrine; adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; carbachol; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; brimonidine plus timolol; cyclic AMP; dipivefrine; dorzolamide; dorzolamide plus timolol; eye drops; latanoprost; latanoprost plus timolol; matrix metalloproteinase; normoglaucon; pilocarpine; prostaglandin derivative; protein c fos; protein c jun; timolol maleate; travoprost; unoprostone isopropyl ester; aqueous humor flow; area under the curve; cataract; ciliary body epithelium; clinical trial; conjunctiva; conjunctival hyperemia; dose response; drug absorption; drug bioavailability; drug blood level; drug efficacy; drug half life; drug mechanism; drug metabolism; drug safety; drug synthesis; drug tolerability; eye color; eye irritation; eyelash; flu like syndrome; hair disease; headache; human; hyperemia; hypertension; hypertrichosis; intraocular hypertension; intraocular pressure; monotherapy; open angle glaucoma; patient compliance; review; structure activity relation; upper respiratory tract infection; vertigo; visual disorder; visual field defect; visual impairment; combigan; cosopt; normoglaucon; timpilo; xalacom

Glaucoma therapy: Prescribing pattern and cost analysis - Sharma, R.; Khajuria, R.; Sharma, P.; Sadhotra, P.; Kapoor, B.; Kohli, K.; Sharma, C.L. (JK Science, 2004)
In the present study out of total 200 prescriptions of POAG (primary open angle glaucoma) studied 66% were found to be of monotherapy including timolol, brimonidine, pilocarpine, betaxolol, levobunolol, latanoprost and apraclonidine in 30%, 15%, 6%, 8%, 4%, 1% and 2% of the prescriptions respectively and 34% were found to be of polypharmacy with timolol+pilocarpine, timolol+acetazolamide, timolol+brimonidine and betaxolol+brimonidine in 13%, 4%, 8% and 9% of the prescriptions respectively. 10% drugs were prescribed by generic name. Written instruction to the patients regarding dose and dosing interval was mentioned in 100% prescriptions, but the proper method of instillation was mentioned only in 15% of the prescriptions. Results of the present study clearly indicated urgent need for prescribers to improve their communication skills, to give proper instructions to the patient regarding instillation of drug, as little bit of caution like instillation from the side of the eye in the supine position followed by rolling of the eyeball can decrease the wastage, decrease cost and improve compliance. However, in the present scenario cost of the traditional medications like beta-blockers, pilocarpine etc. is found to be much less than newer medications (prostaglandin analogues, brimonidine). Moreover, in presence of wide cost variation among various brands of the same drug our study could help the opthalmologist to use all possible measures of pharmacoeconomics while prescribing an antiglaucoma drug.
Keywords: acetazolamide; alfadrops; alpha adrenergic receptor; alpha adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; brimonidine; bulol; carbonate dehydratase inhibitor; carpo miotic; carteolol; cholinergic receptor stimulating agent; dipivefrine; dorzolamide; generic drug; imidazoline receptor; iobet; latanoprost; levobunolol; locarp; fluoxetine; ocubeta; oculan; timolol maleate; ocutim; optipres; optipres s; pilocarpine; pilomax; prostaglandin derivative; prostaglandin F2 alpha; teemol; timolel plus; timolem; timolet gfs; timolol; timolol; timopress; acidosis; article; bone marrow depression; cataract; cost benefit analysis; cost control; diuresis; dose response; drug cost; drug dose regimen; drug instillation; eye disease; gastrointestinal symptom; human; interpersonal communication; intraocular hypertension; intraocular pressure; monotherapy; myopia; nephrolithiasis; neuroprotection; night vision; open angle glaucoma; paresthesia; patient compliance; patient education; pharmacoeconomics; prescription; side effect; skill; supine position; tinnitus; visual acuity; visual field; alfadrops; alphagan; betagan; bulol; carpo miotic; iobet; latanoprost; locarp; nopres; ocubeta; oculan; ocupres; ocutim; optipres s; optipres; pilagan; pilocar; pilomax; propine; teemol; timolel plus; timolem; timolet gfs; timolo; timopress; xalatan

Hypotensive effect and subjective symptoms after substitution of 1% dorzolamide by 1% brinzolamide - Kobayashi, H.; Kobayashi, K.; Okinami, S. (Japanese Journal of Clinical Ophthalmology, 2004)
Purpose: To compare the hypotensive effect and comfort of 1% brinzolamide and 1% dorzolamide. Methods: A total of 60 eyes of 60 patients of primary open-angle glaucoma were enrolled in a prospective single-masked clinical study. They had been receiving 0.5% timolol, 0.005% latanoprost, and 1% dorzolamide for 3 months or longer. In 40 patients, dorzolamide was substituted by brinzolamide. The other 20 patients continued the regimen and served as control. No significant differences were present between the two groups regarding age, corrected visual acuity, mean deviation in Humphrey perimetry, or cupping/disc ratio. The baseline intraocular pressure (IOP) averaged 18.5±3.4 mmHg in brinzolamide group and 18.9±2.9 mmHg in control group. Results: There were no significant differences in IOP 4 and 8 weeks after substitution in either group. No differences were present between IOP levels in the two groups up to 8 weeks of observation. In brinzolamide group, 38 patients (95%) preferred brinzolamide 2. i. d. to dorzolamide 3. i. d. Conclusion: Same hypotensive effect was shown by 1% brinzolamide and 1% dorzolamide. Brinzolamide may improve compliance because of reduced frequency of instillation.
Keywords: brinzolamide; dorzolamide; latanoprost; timolol; adult; aged; article; clinical trial; controlled study; cupping disk ratio; drug substitution; female; glaucoma; human; Humphrey perimetry; hypotensive effect; intraocular hypotension; intraocular pressure; major clinical study; male; open angle glaucoma; optic disk; optic disk cup; patient compliance; patient satisfaction; perimetry; symptomatology; visual acuity

The Medical Management of Glaucoma: What We Have Learned from Clinical Research Trials to Aid Us in Choosing First-line Therapy - Schacknow, P.N. (Clinical and Refractive Optometry, 2004)
Glaucoma clinicians have numerous medications from which to select initial therapy for their patients. What are the preferred characteristics for such a drug? Consider these two factors when evaluating glaucoma medications: 1) a drug should prove efficacious in preserving visual function (i.e., it works) and 2) the drug should be "patient friendly" to ensure good compliance (i.e., patients will use it).
Keywords: acetazolamide; epinephrine; betaxolol; bimatoprost; brimonidine; brinzolamide; dorzolamide; latanoprost; memantine; methazolamide; timolol; travoprost; breathing disorder; burning sensation; cardiotoxicity; clinical research; clinical trial; conjunctival hyperemia; drug efficacy; erythema; eye irritation; eyelash; fatigue; glaucoma; hair growth; hallucination; human; hyperpigmentation; impotence; intraocular pressure; iris disease; myopia; ocular pruritus; orbit; patient compliance; review; side effect; trabeculectomy; treatment planning; vision

Whither the blade? - Walland, M.J. (Clinical and Experimental Ophthalmology, 2004)
Keywords: antifibrotic agent; antiglaucoma agent; cytotoxic agent; prostaglandin derivative; clinical trial; cost effectiveness analysis; editorial; filtering operation; glaucoma; human; intraocular pressure abnormality; patient compliance; quality of life; side effect; trabeculectomy; trabeculoplasty; treatment outcome; visual field; visual impairment; visual system examination

Antiepileptic drugs in migraine prophylaxis: State of the art - Capuano, A.; Vollono, C.; Mei, D.; Pierguidi, L.; Ferraro, D.; Di Trapani, G. (Clinica Terapeutica, 2004)
Antiepileptic drugs have proven their efficacy in the prophylactic treatment of migraine. Our study comprises a clinical trial that examines the efficacy of gabapentin and topiramate and a description of the pharmacologic characteristics and the efficacy of tiagabine, lamotrigine, levetiracetam and zonisamide. Antiepileptic drugs have multiple modes of action which can explain their efficacy in reducing neuronal excitability which is proven in epilepsy and postulated in migraine. The relationship between epilepsy and migraine has, in fact, been much debated but never convincingly proven. Antiepileptic drugs coud be useful in migraine prophylaxis as some of these have determined a reduction in the monthly frequency and intensity of crises in subjects suffering from migraine with and without aura. These are the aims that have been proposed by the U.S. Headache Consortium Evidence-Based Guidelines. Further double-blind placebo-controlled studies are necessary in order to assess their safety and efficacy.
Keywords: acetylsalicylic acid; acetylsalicylic acid; aciclovir; aciclovir; anticonvulsive agent; carbamazepine; carbamazepine; erythromycin; erythromycin; etiracetam; felbamate; felbamate; gabapentin; imipenem; imipenem; isoniazid; isoniazid; lamotrigine; oxacarbamazepine; oxacarbamazepine; paracetamol; paracetamol; phenobarbital; phenobarbital; phenytoin; phenytoin; primidone; primidone; rifampicin; rifampicin; sodium divalproate; sodium divalproate; tiagabine; topiramate; valproic acid; valproic acid; zonisamide; zonisamide; abdominal cramp; adjuvant therapy; agitation; alopecia; amnesia; anorexia; aphasia; ataxia; bleeding; brain depth stimulation; clinical trial; concentration loss; confusion; depression; diarrhea; diplopia; disease association; dose response; drug activity; drug bioavailability; drug dose increase; drug efficacy; drug mechanism; drug megadose; drug metabolism; drug safety; drug structure; drug tolerability; dysarthria; enzyme inhibition; epilepsy; pure red cell anemia; evidence based practice; fatigue; glaucoma; headache; hematocrit; human; infection; irritability; lack of energy; lack of energy; Lennox Gastaut syndrome; leukopenia; low drug dose; migraine; migraine aura; migraine with aura; monotherapy; morbidity; nausea; nausea and vomiting; nephrolithiasis; neuropathic pain; nystagmus; paresthesia; patient compliance; review; side effect; skin necrosis; somnolence; Stevens Johnson syndrome

Ophtalmology: Evaluation and treatment of glaucoma - Schnyder, C.C. (Medecine et Hygiene, 2004)
Glaucoma is a progressive multifactorial optic neuropathy caracterized by ganglion cell loss and their axons. Asymptomatic in most of cases, a preperimetric early diagnosis is mandatory because visual field loss is definitive. Studies have shown that glaucomatous damage to the retinal nerve fiber layer can precede functional loss by as much as five years. Intraocular pressure (IOP) is the only treatable risk factor with significant impact that can stabilize or stop glaucoma; a 30% decrease of IOP is necessary to be efficient; treatment of all other potential risk factors is important particularly those that may induce a vascular dysregulation of the optic nerve head. More effective medical treatments, selective laser trabeculoplasty and new surgical procedures have recently been developed and are the only potential treatments because neuroprotective and neuroregenerative therapies are under trials and genic therapy is not yet avalaible in humans.
Keywords: alpha 2 adrenergic receptor stimulating agent; antihypertensive agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin derivative; cell loss; clinical protocol; drug contraindication; drug effect; early diagnosis; evaluation study; glaucoma; human; intraocular pressure; low level laser therapy; nerve fiber; nerve regeneration; neuroprotection; optic nerve; outcomes research; patient care; patient compliance; patient selection; perimetry; pressure measurement; retinal neuroepithelial layer; review; risk factor; sclerectomy; surgical technique; symptom; trabeculoplasty; visual field defect

Preserving Vision in the Elderly: A Survey to Start a Quality Development Program in General Practice - Peltenburg, M.; Kiener, M.; Iseli, H.P.; Trüb, P.; Christen, P.; Hurni, R.; Aebi, B.; Steurer, J.; Gloor, B. (Schweizerische Rundschau fur Medizin - Praxis, 2004)
The study examined the rate of patients, who do not follow recommendations for routine screening, do not visit physicians for eye-symptoms and when suffering from diabetes or glaucoma do not adhere to follow-up. To what extent can primary care physicians impact on these deficits of ophthalmologic care? 4918 consecutive, ≥ 40 old patients of 107 primary care physicians of 9 networks participated. Of these patients 15% had never, 43% not within the last 3 years, consulted an ophthalmologist. 16% were diabetics, 7% had glaucoma and 46% had observed subjective eye symptoms. A quarter of these patients turn to their primary care physician, when having eye problems. Primary care physicians do not frequently suggest routine ophthalmologic controls nor do they use diagnostic tools like the Amsler-grid or the Swinging-Flash-Light Test.
Keywords: adult; aged; Amsler grid test; consultation; diabetes mellitus; diagnostic test; elderly care; eye disease; general practice; glaucoma; health care quality; health care utilization; human; major clinical study; ophthalmology; patient compliance; primary medical care; review; screening; swinging flash light test; symptom; vision

Persistency and tolerability of ocular hypotensive agents: population-based evidence in the management of glaucoma. - Schwartz, G.F. (American journal of ophthalmology, 2004)
Keywords: antihypertensive agent; eye drops; article; drug effect; glaucoma; human; intraocular pressure; patient compliance; safety

Contact lens-related corneal ulcers in compliant patients - Najjar, D.M.; Aktan, S.G.; Rapuano, C.J.; Laibson, P.R.; Cohen, E.J. (American Journal of Ophthalmology, 2004)
PURPOSE: To report a case series of contact lens-related corneal ulcers in compliant patients with no apparent predisposing factors. DESIGN: Retrospective case series. METHODS: Charts of 70 patients with contact lens-related corneal ulcers from July 1999 to June 2002 were reviewed. Lens care hygiene and method of disinfection, as well as frequency of lens replacement, were recorded. Only patients who followed recommended guidelines for contact lens wear were included in the study. RESULTS: Of the 70 patients, 21 (30%) developed corneal ulcers despite being compliant with the guidelines for contact lens wear. All patients used multipurpose solutions for cleaning, disinfecting, and storing daily wear soft contact lenses. CONCLUSION: Standard lens care hygiene does not seem to be sufficient in preventing the development of corneal ulcers in patients using conventional and frequent replacement daily wear soft contact lenses. © 2004 by Elsevier Inc. All rights reserved.
Keywords: antibiotic agent; contact lens solution; quinoline derived antiinfective agent; adolescent; adult; aged; article; cleaning; cornea ulcer; disinfection; female; human; hygiene; major clinical study; male; patient compliance; priority journal; soft contact lens; AcuToric; Acuvue; Focus

Introduction - Persistency and tolerability of ocular hypotensive agents: Population-based evidence in the management of glaucoma - Schwartz, G.F. (American Journal of Ophthalmology, 2004)
Keywords: antihypertensive agent; bimatoprost; brimonidine; dorzolamide; latanoprost; timolol; travoprost; cohort analysis; drug approval; drug efficacy; drug safety; drug tolerability; drug use; drug withdrawal; editorial; human; intraocular hypertension; intraocular pressure; open angle glaucoma; patient compliance; prescription; priority journal; randomization; retrospective study; survival; topical treatment; treatment outcome

Patient persistency with topical ocular hypotensive therapy in a managed care population - Reardon, G.; Schwartz, G.F.; Mozaffari, E. (American Journal of Ophthalmology, 2004)
PURPOSE: To evaluate persistency with topical ocular hypotensive therapies in patients new to pharmacological management of elevated intraocular pressure (IOP). DESIGN: Retrospective, cohort study; Protocare Sciences managed care database; approximately 3 million members in commercial health maintenance organizations and preferred provider organizations and in Medicare risk plans. METHODS: Patients were at least 20 years of age initiating therapy between July 1, 1996, and June 30, 2002, with betaxolol, bimatoprost, brimonidine, dorzolamide, latanoprost, timolol, or travoprost as monotherapy. Patients must have been continuously enrolled and not have received glaucoma surgery in the 180 days before the index prescription fill. Prescription refill records for all ocular hypotensive drugs were extracted through June 30, 2002. Outcome measures were (1) discontinuation of index drug, and (2) either discontinuation or change in index drug. Changing therapy was defined as switching to or adding another ocular hypotensive. Rates of discontinuation and discontinuation/change were compared using Cox regression models. RESULTS: In all, 28,741 patients met the inclusion criteria. Compared with latanoprost, those treated with other drugs were from 37% (timolol) to 72% (bimatoprost) more likely to discontinue and from 20% (timolol) to 58% (dorzolamide) more likely to discontinue/change therapy (P < .001 for all comparisons). At 12 months, 33% of patients treated with latanoprost and 19% of those receiving other ocular hypotensives had not discontinued therapy; 23% and 13%, respectively, had not discontinued or changed therapy. Compared with latanoprost, significantly higher percentages of patients treated with each alternate agent had only one fill of their index drugs (P < .001). CONCLUSIONS: Although persistency rates were low across agents, latanoprost-treated patients demonstrated significantly greater persistency than did those treated with other topical ocular hypotensive therapies. © 2004 by Elsevier Inc. All rights reserved.
Keywords: antihypertensive agent; betaxolol; bimatoprost; brimonidine; dorzolamide; hydroxymethylglutaryl coenzyme A reductase inhibitor; latanoprost; timolol; travoprost; adult; aged; article; cohort analysis; controlled study; data base; drug use; drug withdrawal; female; glaucoma; health maintenance organization; human; intraocular hypertension; major clinical study; male; managed care; medical record; medicare; monotherapy; outcomes research; patient compliance; population research; prescription; priority journal; regression analysis; retrospective study; topical treatment

Persistency with latanoprost or timolol in primary open-angle glaucoma suspects - Schwartz, G.F.; Reardon, G.; Mozaffari, E. (American Journal of Ophthalmology, 2004)
PURPOSE: To evaluate persistency of pharmacotherapy in primary open-angle glaucoma suspects (glaucoma suspects) treated with latanoprost and timolol. DESIGN: Retrospective, cohort study using the Protocare Sciences managed care database; approximately 3 million members in commercial health maintenance organizations and preferred provider organizations and in Medicare risk plans. METHODS: Patients 20 years of age or older beginning therapy between January 1, 1997, and June 30, 2002, with latanoprost or timolol monotherapy were included. Patients must have been continuously enrolled and not undergone glaucoma surgery in the year preceding the index prescription fill and had glaucoma suspect diagnoses before and after the index date. Prescription refill records for all ocular hypotensives were extracted through June 30, 2002. The two outcome measures were (1) discontinuation of index drug, and (2) either discontinuation or change in index drug. Changing therapy was defined as switching to or adding another ocular hypotensive. Rates of discontinuation and discontinuation/change were compared using Cox regression models. RESULTS: In all, 1,474 patients met the inclusion criteria. Latanoprost was prescribed for 583 patients (40%) and timolol for 891 (60%). Compared with latanoprost, those treated with timolol were 39% more likely to discontinue and 27% more likely to discontinue/change therapy (P < .001 for both comparisons). At 12 months, 39% of patients receiving latanoprost and 25% of those treated with timolol had not discontinued therapy; no discontinuation or change in therapy was seen in 30% and 18%, respectively. CONCLUSIONS: Latanoprost-treated glaucoma suspects demonstrated significantly greater persistency than did patients treated with timolol. The reasons for this difference and its impact on intraocular pressure control and disease progression require further research. © 2004 by Elsevier Inc. All rights reserved.
Keywords: betaxolol; bimatoprost; brimonidine; dorzolamide; latanoprost; timolol; travoprost; adult; aged; article; cohort analysis; controlled study; data base; drug use; drug withdrawal; female; glaucoma; health maintenance organization; human; intraocular pressure; major clinical study; male; managed care; medicare; monotherapy; open angle glaucoma; outcomes research; patient compliance; prescription; priority journal; regression analysis; retrospective study

Observed time between prescription refills for newer ocular hypotensive agents: The effect of bottle size - Platt, R.; Reardon, G.; Mozaffari, E. (American Journal of Ophthalmology, 2004)
PURPOSE: To describe prescription refill patterns of ocular hypotensive therapies and to measure differences among refill rates across bottle sizes. DESIGN: Retrospective, population-based, cohort study. METHODS: This study included patients dispensed bimatoprost, brimonidine, dorzolamide/timolol, latanoprost, timolol gel (XE) 0.5%, or travoprost between January 1, 1996, and March 30, 2002. The initial fill date was identified for the cohort-defining ocular hypotensive, and the number of days between each subsequent refill was calculated. The analysis was repeated in patients with at least four refills to evaluate potential bias. Descriptive and survival analyses evaluated differences in refill rates across bottle sizes. RESULTS: In the 27,387 patients contributing up to four evaluable refill sequences, the amount of drug contained in bottles did not predict the number of days between fills. Patients dispensed larger bottles typically refilled sooner than drop-count studies would predict; results for patients with at least four refills (n = 12,976) confirmed these findings. Survival analysis demonstrated that the bottle size trend held across classes of therapy. Compared with 5.0-ml bottles, patients dispensed 10.0-ml and 15.0-ml bottles returned for refills at approximately 1.5 times the expected rate. When average wholesale prices were applied to refill intervals for selected agents, a 45% excess cost per month was found for the larger bottle sizes (10.0 ml vs 5.0 ml or 5.0 ml vs 2.5 ml). CONCLUSIONS: Expected refill patterns predicted by bottle size and mean number of drops do not reflect observed refill patterns. Patients dispensed larger bottle sizes return for refills much sooner than expected, regardless of the class of therapy. © 2004 by Elsevier Inc. All rights reserved.
Keywords: antihypertensive agent; bimatoprost; brimonidine; dorzolamide; latanoprost; timolol; travoprost; aged; article; calculation; cohort analysis; container; controlled study; drug cost; drug use; female; human; intraocular hypertension; major clinical study; male; open angle glaucoma; patient compliance; population research; prediction; prescription; priority journal; retrospective study; survival

American Society of Consultant Pharmacists (Managed Care Interface, 2004)
The 34th annual meeting and exhibition of the American Society of Consultant Pharmacists was held in San Antonio, November 12-14, 2003. The concurrent educational sessions and industry symposia offered participants the chance to gain new clinical knowledge and skills, understand the influence of the marketplace and legislation on the state of health care, and implement new procedures to enhance their practice, all with one goal in mind - improving patient care.
Keywords: adrenergic receptor stimulating agent; antidepressant agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cardiovascular agent; cholinergic receptor stimulating agent; influenza vaccine; neuroleptic agent; prostaglandin derivative; aged; Alzheimer disease; cardiovascular disease; conference paper; daily life activity; dementia; geriatric care; geriatric patient; glaucoma; health care industry; high risk population; human; influenza; influenza vaccination; mental disease; nursing home; organization; patient care; patient compliance; pharmacist; prescription; residential care; United States

Comparison of optometry vs digital photography screening for diabetic retinopathy in a single district - Tu, K.L.; Palimar, P.; Sen, S.; Mathew, P.; Khaleeli, A. (Eye, 2004)
Purpose. To compare (a) the clinical effectiveness and (b) cost effectiveness of the two models in screening for diabetic retinopathy. Methods. (a) Retrospective analysis of referral diagnoses of each screening model in their first respective years of operation and an audit of screen positive patients and a sample of screen negatives referred to the hospital eye service from both screening programmes. (b) Cost effectiveness study. Participants. (1) A total of 1643 patients screened in the community and in digital photography clinics; (2) 109 consecutive patients referred to the Diabetic Eye Clinic through the two existing models of diabetic retinopathy screening; (3) 55 screen negative patients from the optometry model; (4) 68 screen negative patients audited from the digital photography model. Results. The compliance rate was 45% for optometry (O) vs 50% for the digital imaging system (I). Background retinopathy was recorded at screening in 22% (O) vs 17% (I) (P = 0.03) and maculopathy in 3.8% (O) vs 1.7% (I) (P = 0.02). Hospital referral rates were 3.8 % (O) vs 4.2% (I) Sensitivity (75% for optometry, 80% for digital photography) and specificity (98% for optometry and digital photography) were similar in both models. The cost of screening each patient was £23.99 (O) vs £29.29 (I). The cost effectiveness was £832 (O) vs £853(I) in the first year. Conclusion. The imaging system was not always able to detect early retinopathy and maculopathy; it was equally specific in identifying sight-threatening disease. Cost effectiveness was poor in both models, in their first operational year largely as a result of poor compliance rates in the newly introduced screening programme. Cost effectiveness of the imaging model should further improve with falling costs of imaging systems. Until then, it is essential to continue any existing well-coordinated optometry model.
Keywords: article; cataract; clinical trial; controlled clinical trial; controlled study; cost effectiveness analysis; diabetic retinopathy; diagnostic accuracy; diagnostic imaging; diagnostic test; digital radiography; eye photography; glaucoma; human; imaging system; intermethod comparison; major clinical study; optometry; patient compliance; population research; retina maculopathy; retrospective study; screening test; sensitivity and specificity

Inhaled Corticosteroids: Why Do Physicians and Patients Fail to Comply with Guidelines for Managing Asthma? - Reed, C.E. (Mayo Clinic Proceedings, 2004)
Keywords: beta 2 adrenergic receptor stimulating agent; chlorofluorocarbon; corticosteroid; fluticasone; hydrocortisone; short acting drug; aerosol; airway obstruction; asthma; bone mineral; cataract; clinical trial; cost effectiveness analysis; disease classification; drug delivery system; drug efficacy; drug safety; dry deposition; dry powder; editorial; environmental exposure; evidence based medicine; glaucoma; health care cost; human; hydrocortisone blood level; hypothalamus hypophysis adrenal system; inflammation; lung function; medical literature; meta analysis; metered dose inhaler; mortality; patient compliance; patient education; peer review; practice guideline; prevalence; primary medical care; prospective study; publication; quality of life; self medication; spirometry

Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: Survival analysis - Broadway, D.C.; Bloom, P.A.; Bunce, C.; Thiagarajan, M.; Khaw, P.T. (Ophthalmology, 2004)
Purpose To report the outcome of 5-fluorouracil (5-FU)-augmented bleb needling revision of failed and failing filtration blebs and to identify risk factors for failure, indicators for success, and any complications of the procedure. Design Prospective, observational, noncomparative, interventional case series with survival analysis. Methods The results of 101 bleb needling procedures augmented with subconjunctival 5-FU injection were determined after a minimum follow-up of 9 months. Kaplan-Meier plots were constructed and a Cox proportional hazards regression analysis was performed to assess the association between study factors and time to failure. Main outcome measures Reduction in intraocular pressure (IOP) by 2 criteria (<22 mmHg, >30%), glaucoma medications, complications, and factors associated with outcome. Results At the time of their last follow-up visit, 60 eyes had an IOP <22 mmHg, mean IOP being reduced from 26.5 mmHg to 18 mmHg after a median of 1 needling procedure (mean, 1.6). The median interval between the "index" filtration surgery and the first (or only) needling procedure was 3.1 months, with a range of 10 days to 11 years. There was a reduction in mean number of topical antiglaucoma agents from 0.7 to 0.2 per successful eye and a median follow-up duration of 18.7 months (range, 9.3-52.0 months). Thus, the overall cross-sectional success rate of the procedure at the time of the last visit was 59.4%. Strong evidence was found for an association between the immediate attainment of a low IOP (<11 mmHg) and longer survival times. None of the other proposed factors that may have affected outcome were identified as having a statistically significant effect; however, this may have been the result of the low statistical power for some of the factors in this study. Conclusions These data suggest that bleb needling augmented with 5-FU is a safe and effective method by which a significant number of failed or failing filtration blebs can be rescued from failure. Attaining an immediate reduction in IOP to <11 mmHg seems to be a favorable factor with respect to reasonably long-term efficacy. © 2004 by the American Academy of Ophthalmology.
Keywords: antiglaucoma agent; bleb; fluorouracil; unclassified drug; adult; aged; article; case study; clinical trial; female; follow up; glaucoma; human; intraocular pressure; Kaplan Meier method; major clinical study; male; patient compliance; postoperative complication; priority journal; regression analysis; risk assessment; risk factor; statistical significance; surgical technique; survival; trabeculectomy; treatment failure

Enhancing vision care integration: 1. Development of practice algorithms - Persaud, D.D.; Jreige, S.; LeBlanc, R.P. (Canadian Journal of Ophthalmology, 2004)
Background: Appropriate access to the best quality of vision care is enhanced when patients receive eye care services from the right professional, at the right time, and in the right place. This paper, the first in a two-part series, describes the development of an integrated framework for vision care delivery. Specifically, two patient-centred vision care algorithms for the multidisciplinary management of diabetic retinopathy and the red eye are outlined, and the process that resulted in their development is described. Methods: The method used relies on a description of a multidisciplinary collaboration that occurred among ophthalmologists, optometrists, general practitioners and representatives of the Nova Scotia Department of Health with the aim of developing an integrated patient-focused multidisciplinary framework for vision care delivery. Results: The process of collaborative negotiation among the four groups resulted in the development of multidisciplinary algorithms for the screening of patients with diabetes mellitus and the treatment of those presenting with a red eye. Interpretation: Professional scope of practice has always been a contentious issue among health care prpfessions. However, where parties agree to work within an atmosphere of respect and to accept guidance in areas of disagreement from a third party respected by all, compromise is possible. The result was the development of two vision care algorithms and ongoing efforts on the development of other algorithms.
Keywords: algorithm; amblyopia; Canada; diabetes mellitus; diabetic retinopathy; eye disease; follow up; general practitioner; glaucoma; health care access; health care delivery; health care quality; human; medical practice; ophthalmology; optometry; patient care; patient education; red eye; review; strabismus; vision

Enhancing vision care integration: 2. Implementation of practice algorithms - Persaud, D.D.; Jreige, S.; LeBlanc, R.P. (Canadian Journal of Ophthalmology, 2004)
Background: Appropriate access to the best quality of vision care is enhanced when patients receive eye care services from the right professional, at the right time, and in the right place. In the preceding article the authors describe the development of two patient-centred vision care algorithms for the multidisciplinary management of diabetic retinopathy and red eye. Subsequently, a questionnaire survey was done to determine ophthalmologist, optometrist and general practitioner (GP) familiarity with and acceptance of the vision care algorithms. Methods: The survey was conducted in the summer of 2001 among all ophthalmologists, optometrists and GPs registered with their respective professional body in Nova Scotia to assess their knowledge and acceptance of the diabetes mellitus and red eye algorithms. They were also asked to indicate their preferred method(s) of education and dissemination regarding these and future algorithms. Results: Of the 740 practising GPs in Nova Scotia, 188 completed the questionnaire, for a response rate of 25.4%. The corresponding figures for optometrists and ophthalmologists were 73.6% (53/72) and 43.5% (20/46) respectively. Most of all three types of clinicians practise in Halifax County. More than 80% of the optometrists and ophthalmologists were aware of the algorithms, but less than 50% of the GPs were aware of them. A large majority of respondents in all three groups (77% to 98%) indicated that they were comfortable using the diabetes and red eye algorithms as presented. Interpretation: Ophthalmologists, optometrists and GPs indicated an understanding of and willingness to use the diabetes and red eye algorithms. However, they were not unanimous regarding the choice of implementation method. Therefore, six different strategies for implementing the vision care algorithms are currently being used and are described in the paper.
Keywords: antibiotic agent; antihistaminic agent; artificial tear; lubricating agent; algorithm; blindness; Canada; clinical practice; conjunctivitis; diabetes mellitus; diabetic retinopathy; dry eye; eye disease; eye injury; follow up; general practitioner; glaucoma; health care access; health care delivery; health care quality; health service; human; intraocular foreign body; iritis; keratitis; ophthalmology; optometry; orbit disease; questionnaire; red eye; review; vision

Maintaining remissions accross the lifespan: A roundtable with Crohn's disease experts - Lichtenstein, G.R.; Cuffari, C.; Kane, S.V.; Hanauer, S.; Present, D.H. (Inflammatory Bowel Diseases, 2004)
Moderator (Dr. Lichtenstein): In summary, where does mesalamine fit in our current treatment regimen of Crohn's disease in 2003? Dr. Present: Mesalamine is first-line therapy for mild-to-moderate disease - for induction of remission and, in patients who respond, for maintenance. I think this is quite clear. That's what most of us do in practice. For the average patient with mild-to-moderate disease, mesalamine is still the mainstay. Dr. Hanauer: I would say I totally agree with that statement. In addition, I think that there is evidence - it's not as strong, but evidence - of mesalamine's effect in delaying post-operative occurrence at the ileum after an ileal resection. The evidence becomes weaker as more of the colon is involved, probably with people with more penetrating complications. Dr. Kane: I think that community physicians are tempted to give the quick fix, so they start corticosteroids. They need to explain to the patient that they didn't get sick overnight, and we're not going to make them well overnight. They need to educate patients that if they stick with mesalamine, a very safe drug, then 2 to 6 weeks from now, they'll feel better. Dr. Lichtenstein: This has been discussed for a decade. I believe in the "don't burn bridges" concept. Don't use the more potent drugs when you don't need to because when you need them, they may not be there. The other concept is that "the punishment has to meet the crime." Don't punish patients with overtreatment if they've got mild disease. Dr. Cuffari: I agree. Treat with your least toxic medication initially, and then maintain remission, which is important to help improve quality of life, and potentially alter the course of the disease. Dr. Hanauer: Crohn's is not an 8-week disease. We have to think long-term and plan what we're going to do. And advise patients to stop smoking. Dr. Present: I think of induction of remission and maintenance. No matter what I'm using for induction, I'm still thinking of maintenance. If I can get them to be maintained on mesalamine, that's the best scenario. It's the safest drug. Dr. Kane: Advise patients to be patient and educate them on the reason for any particular medication you've prescribed. Dr. Present: And don't use corticosteroids. © Lippincott Williams & Wilkins.
Keywords: antibiotic agent; azathioprine; balsalazide; budesonide; ciprofloxacin; corticosteroid; cyclosporine; cytokine; immunoglobulin enhancer binding protein; immunomodulating agent; infliximab; interleukin 1; leukotriene; mesalazine; methotrexate; olsalazine; phytohemagglutinin; placebo; prednisone; prostaglandin; salazosulfapyridine; thrombocyte activating factor; abdominal pain; acne; alopecia; amenorrhea; article; aseptic necrosis; atherosclerosis; brain pseudotumor; cardiovascular disease; cataract; clinical feature; clinical trial; cognitive defect; Crohn disease; depression; diarrhea; disease classification; disease course; drug dose regimen; drug mechanism; edema; endocrine disease; enzyme inhibition; eosinopenia; esophagitis; exophthalmos; eye disease; eye infection; fetus disease; fistula; gastrointestinal disease; glaucoma; growth retardation; gynecologic disease; hair disease; hair loss; headache; hematologic disease; hirsutism; human; hyperglycemia; hyperlipidemia; hypertension; hypocalcemia; hypokalemic alkalosis; hypothalamus hypophysis adrenal system; ileum resection; immune deficiency; immunomodulation; intestine perforation; intraocular hemorrhage; leukocytosis; lifespan; long term care; lymphocytopenia; maintenance therapy; metabolic disorder; mood disorder; moon face; muscle atrophy; musculoskeletal disease; myalgia; myopathy; nausea; nephritis; obesity; osteoporosis; pancreatitis; patient compliance; patient education; peptic ulcer; peripheral neuropathy; pigment disorder; postoperative complication; practice guideline; prescription; priority journal; psychosis

Chronic open angle glaucoma: Patient awareness of the nature of the disease, topical medication, compliance and the prevalence of systemic symptoms - Deokule, S.; Sadiq, S.; Shah, S. (Ophthalmic and Physiological Optics, 2004)
Purpose: To study the awareness of the nature of the disease, compliance with treatment, and prevalence of systemic symptoms in a group of patients with chronic open angle glaucoma (COAG). Method: A structured questionnaire was designed and given to 260 consecutive COAG patients attending a general ophthalmology clinic. Questions related to the increased risk of COAG amongst family members, screening of family members, nature of field defects, variation in IOP, topical treatment and availability of a free eye test for a COAG patient in the UK were asked. Compliance and systemic symptoms were also assessed. Results: Forty-one per cent (107 of 260) of patients in the study group were aware of the increased risk of COAG in family members and 45.5% (118 of 260) of patient's family members had undergone screening for COAG. Seventy-three per cent (191 of 260) of the patients were aware of their own and their family members' entitlement to a free eye test. Seventy-seven per cent of patients claimed full compliance. Thirty per cent of patients were noted to have systemic symptoms. Conclusions: The awareness of the nature of COAG in this population was low and incidence of perceived drug related systemic symptoms very high. Both of these may contribute to poor compliance. © 2004 The College of Optometrists.
Keywords: agents acting on the eye; article; awareness; controlled study; human; major clinical study; open angle glaucoma; patient compliance; prevalence; priority journal; questionnaire; screening test; symptomatology; vision test; visual field defect

Patient Satisfaction and Change in Intraocular Pressure with a Change from Timolol Solution to Timolol in Gel-Forming Solution - Tokugawa, H.; Otori, Y.; Morimura, H.; Okada, M.; Tano, Y. (Folia Ophthalmologica Japonica, 2003)
Purpose: A questionnaire was used to assess patient satisfaction with a switch from 0.5% timolol solution (TM) to 0.5% timolol gel-forming solution (TMXE) and to determine the effects of changing the medication on intraocular pressure (IOP) in patients with glaucoma. Methods: Compliance, convenience, sensation, and overall satisfaction with the new medication were assessed by sending questionnaires to 40 patients (23 males and 17 females) with glaucoma who had been followed at an outpatient glaucoma clinic in Osaka University Hospital. We also measured the patients' IOP during this period. Results: At 3 and 12 months after switching from TM to TMXE, IOP was significantly lower compared to before switching (p< 0.001), by a mean of 1.5±0.61mmHg (3 months) and 2.5±0.37mmHg (12 months). Patients reported improved compliance with and convenience of treatment with TMXE; however, 73% of patients reported that they did not like the sensation of TMXE and preferred the sensation of TM. Conclusions: Although 74.3% of patients reported that they did not like the sensation of TMXE, most patients reported that they would likely continue treatment with TMXE because it was more convenient.
Keywords: timolol; article; clinical article; comparative study; controlled study; disease course; drug effect; drug indication; drug monitoring; drug screening; drug solution; female; follow up; gel; glaucoma; human; intraocular pressure; male; outpatient; outpatient department; patient attitude; patient compliance; patient satisfaction; questionnaire; sensation; university hospital

Tele-ophthalmology and conventional ophthalmology using a mobile medical unit in remote Greece. - Labiris, G.; Fanariotis, M.; Christoulakis, C.; Petounis, A.; Kitsos, G.; Aspiotis, M.; Psillas, K. (Journal of telemedicine and telecare, 2003)
We evaluated the quality of medical services delivered to remote glaucoma patients from a mobile unit. A four-wheel-drive vehicle containing the necessary equipment visited five different remote locations in Greece. During a three-year prospective study, 1205 patients were examined, of whom 230 had glaucoma. The majority of the subjects were examined by the unit's medical staff using the available instrumentation (e.g. slit-lamp and tonometer), while 56 glaucoma subjects were telemedically examined by consultants at the Patissia General Hospital, in Athens. Control data were obtained from a random sample of 260 urban glaucoma patients. A significantly greater proportion of the remote patients had an inadequate awareness of glaucoma (77%) compared with the urban patients (20%). Significantly more remote patients had poorer compliance (68%) in comparison with urban patients (23%). A significantly larger proportion of the remote patients had high intra-ocular pressure (21%) compared with the urban patients (5%). Technical difficulties occurred in the 13 of the 56 telemedical examinations. Mobile medical units can enhance access to medical services and contribute to the health-care of under-served populations.
Keywords: adult; aged; article; female; glaucoma; Greece; human; intraocular pressure; male; methodology; middle aged; organization and management; patient compliance; patient education; physiology; preventive health service; psychological aspect; rural health care; telemedicine

Comparison of Adverse Events with Daily Disposable Hydrogels and Spectacle Wear: Results from a 12-Month Prospective Clinical Trial - Sankaridurg, P.R.; Sweeney, D.F.; Holden, B.A.; Naduvilath, T.; Velala, I.; Gora, R.; Krishnamachary, M.; Rao, G.N. (Ophthalmology, 2003)
Objective: To evaluate the type and incidence of adverse events seen with daily disposable hydrogel contact lens wear compared with a control (spectacle) group over 12 months. Design: Prospective, randomized, observer-masked, comparative clinical trial. Participants: Two hundred eighty-one myopes with no prior contact lens wear experience were enrolled from August to December 1996. Subjects were 16 to 35 years old and had refractive errors ranging from a -0.75-diopter (D) sphere to a -6.00-D sphere with a cylinder less than -1.00 D. Intervention: Each subject was randomly assigned to wear either bilateral disposable hydrogels on a daily disposable wear schedule or spectacles. Main Outcome Measure: Type and incidence of adverse events from each group. Adverse events were categorized as serious, significant, and nonsignificant based on the potential to cause vision impairment, severity at event, and level of clinical concern. Results: At baseline, 1.6% of eyes had asymptomatic infiltrates that were nonsignificant. During the study, asymptomatic infiltrates were seen in both contact lens and spectacle groups at 20.5 events versus 11.3 events per 100 eyes per year of wear. No significant events were seen with the spectacle group. With the contact lens group, the type and incidence of significant events per 100 eyes per year of lens wear were corneal peripheral ulcer, 2.5 events; infiltrative keratitis, 1.5 events; and papillary conjunctivitis, 1 event. The incidence of both significant and nonsignificant events was greater with the contact lens group (P<0.05). No serious events (i.e., microbial keratitis) were seen in either group. A greater number of subjects were lost to follow-up or permanently discontinued from the contact lens group relative to the spectacle group (33% vs. 17%, P = 0.002). Lens-related problems such as dryness, discomfort, and difficulty with insertion and removal accounted for 27% of discontinuations from the contact lens group. Poor compliance (40%) was the greatest reason for discontinuations from the spectacle group. Conclusions: No clinically serious events were seen with either group. Only a small percentage of contact lens-wearing eyes presented with significant events, which is promising for daily disposable lens wear. Far more contact lens subjects were lost to follow-up or discontinued. Small, asymptomatic, subepithelial corneal infiltrates of unknown significance were seen in both contact lens-and spectacle-wearing eyes. © 2003 by the American Academy of Ophthalmology.
Keywords: adolescent; adult; article; clinical trial; contact lens; controlled clinical trial; controlled study; cornea ulcer; dry eye; eye disease; female; follow up; human; hydrogel; keratitis; major clinical study; male; myopia; papillary conjunctivitis; patient compliance; priority journal; randomized controlled trial; refraction error; retina detachment; spectacles; visual impairment; etafilcon A

Cost of Glaucoma in Canada: Analyses Based on Visual Field and Physician's Assessment - Iskedjian, M.; Walker, J.; Vicente, C.; Trope, G.E.; Buys, Y.; Einarson, T.R.; Covert, D. (Journal of Glaucoma, 2003)
Purpose: A longitudinal, retrospective study investigated the cost of primary open angle glaucoma (POAG). Methods: Patient files from two tertiary care glaucoma practices were reviewed. Patients diagnosed with POAG and ≥2.5 years of follow-up data were included. Data collected included visual field mean deviation, physician's assessment, and resource utilization (physician visits, procedures, and medications). Costs, reported in 2001 Canadian dollars, were compared between groups, based on initial visual field mean deviation, including mild (<5 dB), moderate (5 to <12 dB), and severe (≥12 dB), and based on physician's assessment, including controlled, uncontrolled, or patients initially uncontrolled for 12 months who become controlled. Results: Of 411 patient charts extracted, 265 were included; 35 were excluded for ocular comorbidities and 111 patients with insufficient follow-up. Mean (standard deviation) yearly costs overall (N = 265) and for mild (n = 90), moderate (n = 91), and severe (n = 84) groups were $508 ($278), $408 ($266), $512 ($288), and $609 ($243), respectively. Differences between mean yearly costs were statistically significant for all three groups (P < 0.05). Costs for controlled (n = 110), uncontrolled (n = 76), and uncontrolled then controlled group (n = 79) were $423 ($243), $594 ($314), and $542 ($256), respectively. The controlled group cost was significantly lower than both of the other groups (P < 0.05). Discussion and Conclusions: The cost of treating POAG increases with visual field mean deviation severity and uncontrolled disease. Many patients diagnosed with glaucoma had already progressed to later stages in the disease process. Early disease detection may provide a substantial cost savings to the health care system.
Keywords: adult; article; Canada; comorbidity; controlled study; cost control; disease course; disease severity; eye disease; female; follow up; glaucoma; health care cost; health care system; health care utilization; human; longitudinal study; major clinical study; male; medical record; open angle glaucoma; patient coding; priority journal; retrospective study; statistical analysis; visual field

Intraocular lens implantation during infancy: Perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members - Lambert, S.R.; Lynn, M.; Drews-Botsch, C.; DuBois, L.; Wilson, M.E.; Plager, D.A.; Wheeler, D.T.; Christiansen, S.P.; Crouch, E.R.; Buckley, E.G.; Stager Jr., D.; Donahue, S.P. (Journal of AAPOS, 2003)
Background: To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization. Methods: All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction. Results: In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization. Conclusions: Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.
Keywords: adolescent; adult; article; cataract extraction; child; clinical trial; comparative study; congenital cataract; contact lens; controlled clinical trial; controlled study; health survey; human; infancy; infant; inflammation; keratitis; lens implant; major clinical study; organization; parent; patient compliance; perception; postoperative complication; priority journal; randomized controlled trial; visual impairment

Intraocular pressure after replacement of current dual therapy with latanoprost monotherapy in patients with open angle glaucoma - Pillunat, L.E.; Larsson, L.-I. (British Journal of Ophthalmology, 2003)
Aims: To evaluate the efficacy and safety of replacing current dual ocular hypotensive therapy with latanoprost 0.005% monotherapy in patients with open angle glaucoma. Methods: This randomised, open label, parallel group, multinational study included 466 patients with open angle glaucoma currently on dual ocular hypotensive therapy, including a β adrenergic receptor antagonist. Patients were assigned (1:3) to ongoing dual therapy or a switch to monotherapy with latanoprost 0.005% once daily for 6 months. Intraocular pressure (IOP) was measured at 10 am and 5 pm at baseline, month 3, and month 6. Groups were compared for differences in diurnal IOP change, IOP success rates (IOP ≤ 22 mm Hg with ≤ 15% increase from baseline), and clinical success rates (not requiring change in therapy). Results: Baseline mean diurnal IOP was 17.8 (SD 2.0) mm Hg in the latanoprost group and 17.6 (2.1) mm Hg in the dual therapy group. After 6 months, mean diurnal IOP was reduced by 0.26 (0.18) (SEM 1.4%) mm Hg (p=0.153) in the group switched to latanoprost and by 0.37 (0.25) (2.1%) mm Hg (p=0.138) in those continuing dual therapy (difference: 0.11 mm Hg; p=0.641). Success rates defined by IOP criteria were 83% for latanoprost and 89% for continued dual therapy (difference: 6%; p=0.122). Clinical success rates were 97% for latanoprost and 99% for dual therapy (difference: 2%; p=0.161). Ocular adverse events were reported by 23% of patients in both treatment groups. Conclusion: Latanoprost monotherapy is a safe and effective alternative for many patients with open angle glaucoma requiring dual topical ocular hypotensive therapy for IOP control.
Keywords: acetazolamide; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; brimonidine; brinzolamide; clonidine; dipivefrine; dorzolamide; latanoprost; pilocarpine; adult; aged; arthritis; article; blepharitis; cataract; clinical trial; conjunctiva disease; conjunctivitis; cornea disease; drug efficacy; drug safety; eye irritation; female; gastrointestinal symptom; glaucoma; hair disease; headache; human; hyperemia; hypertension; infection; insomnia; intraocular pressure; major clinical study; male; multicenter study; myalgia; open angle glaucoma; patient compliance; priority journal; retina macula cystoid edema; skin disease; treatment outcome; uveitis; vein thrombosis; visual acuity; visual field defect

Switching to latanoprost from other monotherapy - Zimmerman, T. (Asian Journal of Ophthalmology, 2003)
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; carbonate dehydratase inhibitor; latanoprost; travoprost; burning sensation; conference paper; drug cost; drug efficacy; drug safety; drug tolerability; eye disease; follow up; human; hyperemia; intraocular hypertension; intraocular pressure; monotherapy; open angle glaucoma; open study; patient compliance; prospective study

Patient persistence with topical prostaglandin therapy - Schwartz, G.F. (Asian Journal of Ophthalmology, 2003)
Keywords: bimatoprost; latanoprost; prostaglandin derivative; travoprost; adult; cohort analysis; conference paper; controlled study; drug cost; drug efficacy; drug tolerability; drug withdrawal; glaucoma; human; intraocular hypertension; intraocular pressure; major clinical study; medical record; outcomes research; patient compliance; prescription; retrospective study; statistical analysis

Clinical comparison of the Ocuton self-tonometer with Goldmann tonometry - Wells, J.M.; Coster, D.J.; Craig, J.E. (Clinical and Experimental Ophthalmology, 2003)
Background: The purpose of the present paper was to compare intraocular pressure (IOP) measurements obtained in a clinical setting using the Ocuton S self-tonometer with Goldmann tonometry and to assess patient handling and reliability of the Ocuton S self-tonometer. Methods: A total of 85 patients was recruited to attempt self-tonometry with the Ocuton S self-tonometer, following IOP measurement with the Goldmann tonometer by one of the authors. Patients were verbally instructed in the use of the instrument and were observed while obtaining up to three measurements with the Ocuton S. A maximum of six attempts to obtain the three measurements was permitted, with no time limit. The mean of the three measurements was obtained and compared with the measurement obtained by Goldmann tonometry. Results: Eighty mean measurements were obtained from 70 patients. Fifteen patients were unable to obtain any measurement with the Ocuton S self-tonometer. The mean Ocuton S measurements correlated reasonably well with those obtained by Goldmann tonometry (r - 0.776, P < 0.001). The number of attempts required to obtain three measurements increased with age (P < 0.001), and there was a trend toward an increase in the proportion of patients with less than three measurements after six attempts, with increasing age. Conclusions: The Ocuton S self-tonometer is an instrument that is easily taught to most patients in the clinical setting. Handling and reliability decreases with age. The Ocuton S self-tonometer may be clinically useful as a means of phasing patients with presumed normal-tension glaucoma or primary open-angle glaucoma with field progression, despite acceptable IOP when measured in clinic, but further evaluation in the ambulatory setting is required.
Keywords: adult; age; aged; ambulatory care; cataract; clinical trial; comparative study; conference paper; controlled study; correlation function; health center; human; intraocular pressure; major clinical study; open angle glaucoma; reliability; age related macular degeneration; self evaluation; tonometer; tonometry; uveitis; visual field; Ocuton S

Difficult drug regimens, poor compliance and erratic attendance in chronic open-angle glaucoma - Brooks, A.M.V. (Clinical and Experimental Ophthalmology, 2003)
Keywords: acetazolamide; apraclonidine; betaxolol; brimonidine; dipivefrine; fluorouracil; latanoprost; pilocarpine; timolol; adult; argon laser; case report; chronic disease; clinical protocol; conference paper; diode laser; eye disease; human; intraocular hypertension; intraocular pressure; male; open angle glaucoma; optic disk; patient compliance; red eye; respiratory function; trabeculotomy; visual disorder; visual field; visual system examination; YAG laser

Compliance of medical treatment in primitive glaucoma open angle - Wane, A.M.; Ndiaye, M.R.; Wade, A.; Ndiaye, P.A.; Ba, E.A.; De Medeiros, M.E.; Ndoye, P.A.; Ndiaye, C.S.; Kameni, A. (Journal Francais d'Ophtalmologie, 2003)
Introduction: Compliance to medical treatment expresses the patient's perception of the disease and the treatment prescribed by the doctors. Lack of compliance endangers chronic glaucoma care, which explains the importance it has been given these last years. The objectives of this survey were to evaluate the compliance of adult patients suffering from primary open angle glaucoma to discover the influential factors. Materials and methods: We conducted a survey at the ophthalmology clinic of Le Dantec Hospital from January 1997 to May 1998 among 31 adults being treated for primary open angle glaucoma. An indirect evaluation of the patients' compliance was made on the basis of a questionnaire after examination of their medical files. It was deemed good, average, or bad depending on: regularity of the patient's visits to the doctors, regularity of the treatment, respect of the doctor's prescription and the prescribed times for taking the medicine. The Chi square independence test was used to study the influence of the following factors: age, sex, residence, socioeconomic status, duration of symptom progression, level of instruction, counseling, and treatment. Results: The patients' mean age was 60.5 years. Compliance was deemed good for 29% of the total cases, average for 32.3%, and bad for 38.7%. Only factors such as the regular visits to the doctor, the regularity of the treatment, and respect of the doctor's prescription and the prescribed times for taking the medicine were found to be influential (p<0.05). Conclusion: The medical treatment of primary open angle glaucoma, whether temporary or permanent, with a maximum of efficacy and a minimum of side-effects requires good compliance on the part of the patient. This compliance in turn requires a good doctor-patient relationship based on effective repeated counseling to educate patients, help them understand the disease, and act on the influential factors.
Keywords: acetazolamide; beta adrenergic receptor blocking agent; dipivefrine; pilocarpine; adult; aged; article; chronic disease; clinical article; doctor patient relationship; drug efficacy; female; human; male; open angle glaucoma; patient compliance; patient counseling; patient education; socioeconomics

Treatment of Acanthamoeba keratitis: Standard, problems, and new approaches - Walochnik, J.; Duchêne, M.; Eibl, H.; Aspöck, H. (Wiener Klinische Wochenschrift, Supplement, 2003)
Acanthamoeba keratitis is a corneal disease associated predominantly with contact lens wear. The occurrence of Acanthamoeba keratitis has been rising since 1990 in correlation to the growing number of contact lens wearers. To date approximately 2000 cases have been published around the world. Due to the complicated diagnostics, the elaborate treatment and the usually bad compliance of the patients, Acanthamoeba keratitis unfortunately very often takes a serious progression, which may lead to serious visual loss and perforating keratoplasty. Today, local treatment with a combination of polyhexamethylene biguanide (PHMB) and propamidine isethionate (Brolene) is considered the first line therapy for Acanthamoeba keratitis. Alternatively also a combination of propamidine and chlorhexidine or neomycine achieves good therapeutic results. However, the complicated mode of application consistently remains a problem. The intensive local treatment, i.e. hourly application of therapeutics during the first three days day and night makes hospitalization inevitable. Moreover, sufficient efficacy can not always be achieved, and also resistance against propamidine has already been observed. Recently propamidine has sometimes been replaced by hexamidine, which seems to have a greater cysticidal activity. A new path might be struck by the application of alkylphosphocholines. These are phosphocholines esterified to aliphatic alcohols. They exhibit in vitro and in vivo antineoplastic activity and have been shown to be cytotoxic against Leishmania donovani, Trypanosoma cruzi, and Entamoeba histolytica. A recent study has demonstrated that particularly hexadecylphosphocholine is highly effective also against various strains of Acanthamoeba.
Keywords: alexidine; azithromycin; chlorhexidine; clotrimazole; dibrompropamidine; dimethyl sulfoxide; diminazene aceturate; hexamidine; hexamidine isetionate; imidazole derivative; itraconazole; ketoconazole; miconazole; miltefosine; myristamidopropyl dimethylamine; neomycin; paromomycin; pentamidine isethionate; phenothiazine derivative; phosphorylcholine; poly(hexamethylenebiguanide); povidone iodine; propamidine; propamidine isethionate; unclassified drug; Acanthamoeba; Acanthamoeba keratitis; antineoplastic activity; conference paper; contact lens; cytotoxicity; drug dose regimen; drug resistance; Entamoeba histolytica; human; in vitro study; in vivo study; Leishmania donovani; patient compliance; penetrating keratoplasty; Trypanosoma cruzi; visual impairment; betadine; brolene

Herpes zoster opthalmicus in HIV/AIDS - Wiafe, B. (Community Eye Health, 2003)
Keywords: aciclovir; amitriptyline; antibiotic agent; antivirus agent; steroid; tricyclic antidepressant agent; acquired immune deficiency syndrome; age; blepharitis; blindness; chorioretinitis; clinical feature; conjunctivitis; disease course; drug indication; episcleritis; glaucoma; herpes zoster ophthalmicus; human; Human immunodeficiency virus infection; immunocompetence; impetigo; infection risk; keratitis; neuralgia; optic nerve disease; patient compliance; ptosis (eyelid); rash; retinitis; review; scleritis; skin manifestation; steroid therapy; superinfection; uveitis

Schizophrenia in the elderly: A special case requiring special management? - Altamura, C.; Elliott, T. (European Psychiatry, 2003)
Keywords: amisulpride; antacid agent; atypical antipsychotic agent; cholinergic receptor blocking agent; clozapine; gastrointestinal agent; haloperidol; ispagula; neuroleptic agent; olanzapine; phenothiazine; placebo; quetiapine; risperidone; ziprasidone; adverse drug reaction; aging; agranulocytosis; akathisia; article; body weight; cardiovascular disease; cognitive defect; comorbidity; confusion; constipation; delirium; delusional disorder; depression; diabetes mellitus; disease exacerbation; disease predisposition; drug metabolism; drug tissue level; dystonia; elderly care; extrapyramidal symptom; falling; glaucoma; human; hyperlipidemia; memory disorder; onset age; orthostatic hypotension; parkinsonism; patient compliance; polypharmacy; priority journal; prostatism; schizophrenia; sedation; side effect; tardive dyskinesia; tremor; urine retention; xerostomia; metamucil

Achieving low target pressures with today's glaucoma medications - Cantor, L. (Survey of Ophthalmology, 2003)
In the 21st century there are more highly effective medical management options for glaucoma than there were in the 1980s and 1990s. In deciding among them, the clinician's challenge is to select what is clinically relevant from the large amounts of available data. In evaluating different drugs the clinician must consider not only the mean intraocular pressure (IOP) of a trial population, but also the percentage of patients achieving clinically relevant low IOPs. The consistency of IOP control throughout the day and night is also critical. Other factors such as safety, tolerability, and cost-effectiveness must also be kept in mind, with an awareness (both in human and monetary terms) of the cost of treatment failure. This overview concludes that newer medical regimens for IOP lowering address efficacy and safety issues more successfully than older ones. © 2003 Elsevier Science Inc. All rights reserved.
Keywords: bimatoprost; brimonidine; dorzolamide; latanoprost; timolol; travoprost; clinical trial; cost effectiveness analysis; drug cost; drug efficacy; drug mechanism; drug safety; drug tolerability; glaucoma; high risk patient; human; intraocular hypertension; intraocular pressure abnormality; oculoplethysmography; patient compliance; priority journal; review; treatment failure

Glaucoma in Practices of Ophthalmologists - Heuer, J.; Kerek-Bodden, H.; Bertram, B.; Graubner, B.; Brenner, G. (Gesundheitswesen, 2003)
The aim of this study is to describe the prevalence of glaucoma among patients of office-based ophthalmologists on the basis of accounting data. The data can be taken from the so-called Patient-physician-panel for morbidity analysis (ADT panel) that has been developed by the Central Research Institute of Ambulatory Health Care in Germany. In this panel, the treatment data of patients treated by selected office-based physicians in North Rhine and Brandenburg are included. In both regions, 30 ophthalmologists were involved in the survey. The two random samples that have been performed, include the treatment data of nearly 55 000 patients from North-Rhine and of 58 000 patients from Brandenburg. The treatment prevalence of glaucoma with established diagnosis amounts to about 12% of the ophthalmologic patients in North Rhine and to about 13% in Brandenburg. If these figures are secondarily related to the total number of persons older than 39 years who are insured via social health insurance funds in these regions, the rates are 2.8 or 2.9% respectively. The majority of patients suffering from glaucoma (including suspected cases and exclusion diagnoses) underwent tonometry and it can be assumed that most of the patients received medical treatment. With the help of the morbidity panel, glaucoma patients with established diagnosis can be distinguished from those patients for whom this diagnosis has only been excluded and from cases where the suspicion remained unconfirmed. The standardised treatment prevalence of glaucoma almost amounts to the same rate in both regions. Ophthalmologists should use the additional specifications of the ICD-10 code more often (especially for cases of suspicion and exclusion). This would also lead to a higher significance of the ICD-10 terms indicated.
Keywords: ambulatory care; article; clinical practice; diagnostic approach route; disease classification; Germany; glaucoma; health care; health insurance; human; medical specialist; morbidity; prevalence

Evaluation of the Comfort of Alphagan® P Compared with Alphagan® in Irritated Eyes - Mundorf, T.; Wilcox, K.A.; Ousler III, G.W.; Welch, D.; Abelson, M.B. (Advances in Therapy, 2003)
The tolerability of brimonidine tartrate 0.15%-referred to as bromonidine-Purite® 0.15% in this study-was compared with brimonidine tartrate 0.2% in irritated eyes of healthy volunteers as well as patients with glaucoma or ocular hypertension (N=20) in a 2-week, single-center, randomized, double-masked, crossover study. Participants were evaluated at days 0, 7, 11, and 15. At day 0, they were exposed to a controlled adverse environment (CAE), in which humidity, temperature, and airflow was regulated, for up to 90 minutes. Participants who reported a sufficient level of bilateral ocular discomfort during exposure to the CAE were enrolled in this study and received 1 drop of brimonidine-Purite 0.15% in 1 eye and 1 drop of brimonidine tartrate 0.2% in the contralateral eye. Immediately following instillation, participants were asked to indicate their preference for either study medication. The study medications were not used between days 0 and 7. From day 7 to 10, participants administered either drug bilaterally. On day 11, the treatment was crossed over, and participants were asked to compare the preferred medication with their previous regimen. They continued to administer the drug bilaterally twice daily until day 15, when the preferred medication was again compared with the previous regimen. Following CAE exposure at visit 1, 70.6% of the participants preferred brimonidine-Purite 0.15% over brimonidine tartrate 0.2% and indicated that it was significantly more comfortable than brimonidine tartrate 0.2% (P=.009). When given brimonidine-Purite 0.15% first before switching to brimonidine tartrate 0.2%, 80% of participants preferred brimonidine-Purite 0.15% (P=.012). When given brimonidine tartrate 0.2% first before switching to brimonidine-Purite 0.15%, 85% preferred brimonidine-Purite 0.15% (P=.O01). The results of this study suggest that brimonidine-Purite 0.15% is significantly more comfortable than brimonidine tartrate 0.2% in patients with irritated eyes.
Keywords: brimonidine; benzalkonium chloride; brimonidine; brimonidine purite; bromonidine purite; preservative; purite; refresh tears; unclassified drug; adult; aged; allergic blepharoconjunctivitis; allergic conjunctivitis; article; burning sensation; clinical article; clinical trial; conjunctivitis; controlled clinical trial; controlled study; crossover procedure; double blind procedure; drowsiness; drug formulation; drug safety; drug tolerability; eye irritation; female; follicular conjunctivitis; glaucoma; headache; human; hyperemia; allergic reaction; intraocular hypertension; male; ocular pruritus; patient compliance; randomized controlled trial; visual impairment; xerostomia; alphagan p; alphagan; bromonidine purite; refresh tears

The medical management of glaucoma: What we have learned from clinical research trials to aid us in choosing first-line therapy - Schacknow, P.N. (Clinical and Surgical Ophthalmology, 2003)
Glaucoma clinicians have numerous medications from which to select initial therapy for their patients. What are the preferred characteristics for such a drug? Consider these two factors when evaluating glaucoma medications: 1) a drug should prove efficacious in preserving visual function (i.e., it works) and 2) the drug should be "patient friendly" to ensure good compliance (i.e., patients will use it).
Keywords: acetazolamide; epinephrine; alpha adrenergic receptor blocking agent; alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; dorzolamide; latanoprost; memantine; methazolamide; miotic agent; pilocarpine; prostaglandin derivative; timolol; travoprost; allergy; breathing disorder; cardiovascular disease; conference paper; conjunctival hyperemia; erythema; evidence based medicine; eye burning; eye irritation; fatigue; gastrointestinal disease; glaucoma; hallucination; human; hyperpigmentation; impotence; intraocular pressure; malaise; metabolic disorder; myopia; ocular pruritus; patient compliance; respiratory tract disease; taste disorder; vision; lumigan; namenda; travatan; xalatan

Canadian study of travatan as replacement therapy (CSTART): Switching to travatan can improve long-term care - Klein, T. (Clinical and Surgical Ophthalmology, 2003)
Keywords: acetazolamide; epinephrine; adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; dorzolamide plus timolol; latanoprost; pilocarpine; prostaglandin; timolol maleate; travoprost; allergy; Canada; cardiotoxicity; cataract; clinical trial; conference paper; conjunctiva disease; conjunctival hyperemia; diarrhea; electrolyte disturbance; eye irritation; fatigue; gastrointestinal toxicity; glaucoma; human; hyperpigmentation; impotence; intraocular pressure; iris disease; long term care; metabolic disorder; myopia; patient compliance; respiratory tract disease; taste disorder; visual disorder; xerostomia; alphagan; betoptic; cosopt; diamox; lumigan; timoptic xe; travatan; xalatan

Clinical implications of pharmacogenetics for glaucoma therapeutics - McLaren, N.C.; Moroi, S.E. (Pharmacogenomics Journal, 2003)
In summary, both physicians and patients are well aware that the effectiveness of a particular drug in an individual may not always correlate with published efficacy and safety results from the clinical trials derived from a very homogeneous group of study subjects. Given the current availability of five different glaucoma drug classes, the ophthalmologist must consider the patient's systemic diseases and medications, comorbid ocular conditions, economic status, health insurance, impact on quality of life, and compliance issues. The anticipated promise of genetics and genomics is to determine whether predictable treatment outcomes can be assessed in the context of the complex biological and physiological interactions among expression of drug target genes, associated pathway genes, drug metabolizing enzymes, and disease genes. Since lowering IOP is an important surrogate clinical treatment outcome to protect the optic nerve that is susceptible to glaucoma, then identifying a genetic component to drug-mediated IOP lowering response has the potential for targeting subsets of patients with glaucoma to their optimal therapy with the goal of being highly effective and minimizing progressive visual field loss.
Keywords: alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; calcium channel blocking agent; carbonate dehydratase inhibitor; cocaine; drug metabolizing enzyme; ephedrine; latanoprost; muscarinic agent; muscarinic receptor blocking agent; prostaglandin F; prostaglandin receptor stimulating agent; timolol; travoprost; article; comorbidity; disease marker; disease predisposition; drug bioavailability; drug classification; drug efficacy; drug receptor binding; drug response; drug safety; drug selectivity; economic aspect; eye protection; gene expression; gene targeting; glaucoma; health insurance; human; intraocular pressure; mydriasis; optic nerve; patient compliance; priority journal; quality of life; treatment outcome; visual impairment

Last-resort eye drops (Prescrire International, 2003)
• First-line drug treatment of chronic open-angle glaucoma or intraocular hypertonia is based on monotherapy with timolol eye drops. Patients in whom several single-agent treatments have failed can use combinations of timolol + dorzolamide (a carbonic anhydrase inhibitor) or a betablocker + pilocarpine (a parasympathomimetic agent). • An eye-drop preparation is now available in which 0.5% timolol is combined with 0.005% latanoprost, a prostaglandin F2α analogue. • A clinical trial indicated that the timolol + latanoprost combination was more effective than the timolol + dorzolamide combination on intraocular pressure, but the report of this study is too scanty to accept these results at face value. Once-a-day dosing with timolol + latanoprost has not been compared with a betablocker + pilocarpine combination. • Patients using the timolol + latanoprost combination are exposed to the adverse effects of both latanoprost (especially ocular irritation and brown iris discoloration) and the betablocker. • It is not known whether the once-a-day dosing of the timolol + latanoprost combination is a significant advantage, especially in terms of adherence to treatment. • In practice, the arrival of the timolol + latanoprost combination changes virtually nothing for patients with chronic open-angle glaucoma, except for those with no other alternative.
Keywords: antiglaucoma agent; benzalkonium chloride; beta adrenergic receptor blocking agent; carteolol; dorzolamide plus timolol; eye drops; latanoprost plus timolol; pilocarpine; latanoprost plus timolol; unclassified drug; article; blepharitis; chronic disease; clinical trial; conjunctivitis; cornea disease; dose response; drug efficacy; eye color; eye irritation; eye pain; headache; human; hyperpigmentation; intraocular hypertension; intraocular pressure; iris disease; open angle glaucoma; patient compliance; treatment failure; xalacom

Compliance barriers in glaucoma: A systematic classification - Tsai, J.C.; McClure, C.A.; Ramos, S.E.; Schlundt, D.G.; Pichert, J.W. (Journal of Glaucoma, 2003)
Purpose: To systematically identify and describe common obstacles to medication adherence (i.e., compliance) for patients with glaucoma. Methods: A prospective case series of structured interviews were conducted with 48 patients with glaucoma. The subjects' responses were recorded verbatim on interview forms as well as recorded on audiotapes. Situational obstacles to medication adherence were elicited. Using hierarchical cluster analysis, the situational descriptions were stratified, grouped, and analyzed by frequency distribution. Results: Seventy-one unique situational obstacles were reported. These were then grouped into 4 defined and separate categories: situational/environmental factors (35 of 71 situations; 49%), medication regimen (23 of 71; 32%), patient factors (11 of 71; 16%), and provider factors (2 of 71; 3%). Conclusion: Significant barriers to compliance exist for patients with glaucoma in addition to those cited by previous ophthalmic studies. A systematic classification (i.e., taxonomy) of these barriers was formulated to assist in optimizing patient education and problem-solving regarding prescribed therapeutic regimens.
Keywords: antiglaucoma agent; adult; aged; article; classification; clinical article; cluster analysis; drug dose regimen; environmental factor; female; frequency analyzer; glaucoma; health care personnel; human; male; medical record; patient attitude; patient compliance; patient education; priority journal; problem solving; process optimization; prospective study; statistical analysis; statistical significance

Intraocular Pressure, Safety, and Quality of Life in Glaucoma Patients Switching to Latanoprost from Monotherapy Treatments - Zimmerman, T.J.; Stewart, W.C. (Journal of Ocular Pharmacology and Therapeutics, 2003)
Purpose: To evaluate the efficacy, safety and quality of life in ocular hypertensive or open-angle glaucoma patients who required alteration in previous therapy and were changed to latanoprost. Methods: A prospective, multicenter, active, historical controlled trial in which qualified patients had previous therapy substituted with latanoprost 0.005% and were followed for up to 6 months. Results: 3179 patients were included in the intent-to-treat analysis. In all patients latanoprost reduced the intraocular pressure (IOP) from 20.1 ± 3.9 to 17.1 ± 3.5 mm Hg (p < 0.0001) and when compared to previous monotherapies: beta-blockers (-3.0 ± 3.5, n = 1976), alpha-agonists (-3.6 ± 3.7, n = 581), miotics (-2.8 ± 3.0, n = 21), carbonic anhydrase inhibitors (-3.2 ± 3.5, n = 198), and other prostaglandin analogs (-1.6 ± 3.7, n = 402). The most common ocular adverse event with latanoprost was conjunctival hyperemia (n = 66, 2.0% incidence) and the most common systemic adverse event was headache (n = 9, 0.2%). Over the 6-month treatment interval 89.8% of patients were maintained on latanoprost. On the solicited symptom survey patients showed a preference for latanoprost compared to previous therapy for several reasons: (depending on the product) dryness, blurred vision, tearing, stinging on instillation, crusting, itching, fatigue, dizziness, despondency and dry mouth (p < 0.005). Conclusion: Latanoprost generally provides reduced IOP, limited side-effects, improvement in many quality of life measures and is maintained in patients who required a substitution from previous monotherapy.
Keywords: alpha adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; carbonate dehydratase inhibitor; carteolol; dipivefrine; dorzolamide; latanoprost; levobunolol; metipranolol; pilocarpine; prostaglandin derivative; timolol; travoprost; unoprostone isopropyl ester; adult; allergic conjunctivitis; allergic reaction; article; backache; clinical trial; conjunctival hyperemia; drug efficacy; drug safety; dry eye; eye burn; eye irritation; eye pain; fatigue; female; headache; human; hyperemia; hyperpigmentation; intraocular foreign body; intraocular pressure; iritis; keratitis; major clinical study; male; monotherapy; multicenter study; open angle glaucoma; patient compliance; prospective study; pruritus; quality of life; retina macula cystoid edema; side effect; vertigo; visual impairment; xerostomia

Assessing the cost-effectiveness of switching from a β-blocker to latanoprost in the treatment of ocular hypertension - Costagliola, C.; Parmeggiani, F.; Sebastiani, A. (Expert Opinion on Pharmacotherapy, 2003)
Glaucoma is a pathological condition whose most important risk factor is increased intraocular pressure (IOP). The medical treatment of glaucoma essentially consists of compounds that are able to decrease the IOP. The compounds discussed in this review act in a different way, β-blockers mainly inhibit the production of aqueous humor, whereas latanoprost decreases the resistance in the outflow channels. β-Blockers are compounds with a well-known efficacy and safety profile and they are fairly inexpensive. Their systemic and local side effects are mainly cardiovascular and pulmonary adverse events, dry eye and keratopathy. Latanoprost, which has recently been introduced into the market, has been shown to be equally as effective, or better in lowering IOP in patients than timolol, although it is more expensive. Systemic reported side effects are anecdotal; local hyperaemia, keratopathy, hypertrichosis, increased pigmentation of eyelashes and iris, uveitis and cystoid macular oedema have been reported. A comparison of costs reveals that a 1-year therapy with timolol ophthalmic solution starts from €11.00 and can reach €146.00 for the most expensive preservative-free 1-day dispenser packages (∼ 13.5 times higher). For latanoprost once-daily administration, the cost for 1-years therapy is €98.55, approximately six times higher than generic or brand 0.5% timolol applied twice-daily. What are the factors influencing a change in therapy from β-blockers to latanoprost? The only good reason is represented by a further deterioration in the visual field. This may occur, despite a significant reduction in IOP, because the reached IOP is not sufficient enough to avoid further deterioration because the patient's work or social activities do not allow a correct daily dosage of the compound (bad compliance); or as a result of treatment suspension, because of the development of systemic and/or local side effects. Changes in therapy must always be related to a failing control of the disease, as any therapeutic modification leading to an increase in the number of visits and additional examinations, consequently enhances the costs.
Keywords: acetazolamide; epinephrine; befunolol; beta 1 adrenergic receptor blocking agent; beta 2 adrenergic receptor blocking agent; beta adrenergic receptor blocking agent; betaclar; betaxolol; betaxolol; carteolol; cyclic AMP; droptimol tg; eye drops; latanoprost; levobunolol; metipranolol; timolol maleate; oftimolo; pilocarpine; pindolol; prostaglandin derivative; timolol maleate; timolol; timolol maleate; timololo ciba vision; timolux; timolol maleate; turoptin; aqueous humor formation; aqueous humor outflow; cardiovascular disease; clinical trial; cost benefit analysis; cost effectiveness analysis; cost minimization analysis; cost utility analysis; deterioration; drug clearance; drug cost; drug efficacy; drug elimination; drug half life; drug inhibition; drug mechanism; drug safety; dry eye; eyelash; flu like syndrome; glaucoma; herpes simplex; human; hyperemia; hypertrichosis; intraocular hypertension; intraocular pressure; iris disease; keratopathy; lung disease; medical examination; mental disease; myalgia; neurologic disease; patient compliance; rash; retina macula cystoid edema; review; risk factor; sexual dysfunction; social behavior; treatment failure; treatment planning; uveitis; visual field defect; betaclar; betoptic s; betoptic; carteol; droptimol tg; droptimol; nyogel; oftimolo; timolabak; timololo ciba vision; timolux; timoptol xe; timoptol; turoptin; vistagan; xalatan

How to conduct glaucoma therapy when pressure stays high despite topical treatment? - Nordmann, J.-P. (Journal Francais d'Ophtalmologie, 2003)
When glaucoma worsens with elevated ocular pressure despite an initial treatment, an additional reduction of pressure is needed. It is necessary to evaluate the cause of the therapeutic failure which could be the consequence of a low compliance from the patient, a poor efficacy of the topical drug or a short or long term drift of this efficacy. Depending on the aetiology, another monotherapy or a combination of treatments should be initiated. The evaluation of the target pressure and the comparison between this pressure and the current pressure of the eye allows to evaluate the likeliness of reaching the target through medical treatment alone or through surgical approach. When medical treatment is possible, it is usual to combine two drugs, one acting on the aqueous humor inflow and the other one on the uveoscleral outflow pathway. If target pressure is lower than what can be expected to be reached with topical treatment, surgery should be proposed to the patient. Laser Argon trabeculoplasty keeps still some indications, like pigmentary or exfoliative glaucoma. Long term stability of the visual field in glaucoma depends more on the reduction of pressure and on its stability than on the choice of medical or surgical approach.
Keywords: alpha 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; aqueous humor flow; argon laser; conference paper; disease exacerbation; pseudoexfoliation; glaucoma; intraocular hypertension; laser surgery; monotherapy; patient compliance; sclera; surgical approach; trabeculoplasty; treatment failure; treatment indication; uvea; visual field

Hormone Therapy for Ophthalmoprophylaxis - Wenderlein, J.M.; Hensinger, E. (Klinische Monatsblatter fur Augenheilkunde, 2003)
Background: It has been demonstrated that HRT which was administered directly after the onset of the menopause had vascularprotective and neuroprotective effects. It has therefore hypothesised that eye function could benefit from such treatment. Material and methods: Visual acuity, intraocular pressure, patient's gynaecological and ophthalmological history, especially HRT were obtained from women visiting the gynaecological and ophthalmological ambulance. Measuring the visus and the intraocular pressure of women with HRT from the gynaecological ambulance was easily undertaken in the neighbouring ophthalmological department. Unfortunately, due to absence of compliance a control group without HRT could not be recruited. Of 514 women, 402 without having had hysterectomy and adnexectomy could be included in the study from which data were received about the menopausal age. Results: In the group of women with cataract HRT over 5 years was administered less often (two times) than in the group of women with glaucoma. Women mainly aged over 70 suffering from age-related conditions such as glaucoma and cataract almost never had HRT. Thus in the following only women aged up to 60 have been of interest. 7 of 10 women being in the menopause for over 10 years with a visus higher than 0.7 received HRT. Only 1 of 10 women had a visual acuity less than 0.4. There was also a correlation between receiving HRT and intraocular pressure. In the group aged up to 60 without taking HRT 19% had an intraocular pressure above 19. In women with HRT over 5 years this occurred in only 7%. Conclusions: Initiating HRT in healthy women shortly after the onset of the menopause may have vascularprotective and neuroprotective effects for the eye. This is supported by the fact that HRT administered for more than 5 years to healthy women aged up to 60 years was associated with better visual acuity and normal inUniversitätsfrauenklink Ulm traocular pressure. This is further highlighted by ultrasound scan studies in the literature. Thus an ophthalmoprophylaxis could be expected, which has to be confirmed in prospective studies using suitable control groups.
Keywords: sex hormone; salpingooophorectomy; adult; aged; ambulance; anamnesis; article; cataract; controlled study; correlation analysis; echography; eye protection; female; glaucoma; gynecologic surgery; hormonal therapy; human; hysterectomy; intraocular pressure; literature; major clinical study; measurement; menopausal syndrome; menopause; patient compliance; postmenopause; prophylaxis; risk factor; visual acuity

Medical therapy cost considerations for glaucoma - Fiscella, R.G.; Green, A.; Patuszynski, D.H.; Wilensky, J.; Appel, A.; Brown, G.C. (Evidence-Based Eye Care, 2003)
Keywords: alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; brinzolamide; carbonate dehydratase inhibitor; prostaglandin; timolol maleate; burning sensation; calculation; cost minimization analysis; cost utility analysis; drug cost; drug dose regimen; drug efficacy; experience; experimentation; glaucoma; health care cost; human; medical care; pain; patient compliance; priority journal; prospective study; pruritus; quality of life; short survey; treatment failure; United States; validation process; visual impairment

Canadian study of travatan as replacement therapy (CSTART): Switching to Travatan can improve long-term care - Klein, T. (Clinical and Surgical Ophthalmology, 2003)
Keywords: acetazolamide; epinephrine; betaxolol; betaxolol; bimatoprost; brimonidine; dorzolamide; dorzolamide plus timolol; latanoprost; pilocarpine; prostaglandin derivative; timolol maleate; travoprost; cataract; clinical trial; conference paper; conjunctiva disease; diarrhea; drug choice; drug hypersensitivity; electrolyte disturbance; erythema; eye color; eye disease; eye irritation; eye pain; fatigue; follow up; gastrointestinal symptom; glaucoma; hair growth; heart disease; human; hyperemia; hyperpigmentation; impotence; incidence; intraocular hypertension; intraocular pressure; long term care; metabolic disorder; monotherapy; myopia; night vision; open angle glaucoma; patient compliance; pigment disorder; respiratory tract disease; side effect; taste disorder; treatment outcome; visual disorder; xerostomia; alphagan; betoptic s; cosopt; diamox; lumigan; timoptic xe; travatan; xalatan

Inhaled corticosteroids: Past lessons and future issues - Allen, D.B.; Bielory, L.; Derendorf, H.; Dluhy, R.; Colice, G.L.; Szefler, S.J. (Journal of Allergy and Clinical Immunology, 2003)
Inhaled corticosteroids play a pivotal role in the treatment of asthma. Inhalation permits effective delivery of the corticosteroid in high concentration to target sites within the lung while minimizing systemic exposure. Consequently, the safety profile of inhaled corticosteroids is markedly better than that of oral corticosteroid therapy. However, although it was first thought that direct delivery might eliminate systemic adverse effects, this has not been confirmed by clinical trials and experience. Inhaled corticosteroids are absorbed from the lungs into the systemic circulation, in which they can acutely decrease growth velocity in children, an effect that fortunately appears to be temporary and might have no effect on final adult height. In sufficient dosages, they also produce bone mineral loss leading to osteoporosis and might increase the risk of cataracts, glaucoma, skin atrophy, and vascular changes that increase the risk of ecchymoses. Effective evaluation of the severity and significance of these complications is challenging because highly sensitive tests do not reliably predict clinically significant events, and short-term observations do not predict long-term consequences. Also, compliance wanes with long-term treatment, and susceptibility to a particular adverse event can vary over time, even in the same individual, because of developmental or hormonal changes. This journal supplement will review what has been learned about the safety of inhaled corticosteroids during the past decade, discussing some of the questions that remain and considering the characteristics of an "ideal" inhaled corticosteroid: one with high local activity in the lung and minimal or no adverse systemic effects.
Keywords: beclomethasone dipropionate; budesonide; ciclesonide; corticosteroid; flunisolide; fluticasone propionate; mometasone furoate; prednisone; prodrug; triamcinolone acetonide; aging; asthma; atrophy; bioavailability; bone mineral; cataract; Cushing syndrome; disease severity; dose response; dose time effect relation; drug activity; drug clearance; drug conjugation; drug distribution; drug effect; drug half life; drug mechanism; drug receptor binding; drug safety; ecchymosis; glaucoma; growth rate; hirsutism; human; intraocular hypertension; keratoconjunctivitis; long term care; obesity; osteolysis; osteoporosis; patient compliance; perioral dermatitis; priority journal; protein binding; review; risk; risk factor; sensitivity and specificity; side effect; Stevens Johnson syndrome; stria; systemic circulation; tinea; treatment outcome

Diabetes: Don't forget the eyes - Constable, I.J. (Medicine Today, 2003)
• Almost all people with diabetes eventually develop some evidence of diabetec retinopathy. • Regular screening is essential because diabetic retinophathy, is common and has an effective treatment with laser photocoagulation. • Make sure each of your diabetic patients has two normal eyes, by formal screening at the time of diagnosis and every one to two years thereafter. • Tight control of blood glucose and glycosylated haemoglobin levels over many years can greatly decrease the risk of eye problems or their progression to visual loss.
Keywords: antidiabetic agent; glucose; glycosylated hemoglobin; article; blood glucose monitoring; cataract; cataract extraction; diabetic retinopathy; diet therapy; disease course; disease severity; early diagnosis; exercise; fluorescence angiography; follow up; glaucoma; health care access; high risk patient; human; insulin dependent diabetes mellitus; ischemic optic neuropathy; laser coagulation; laser surgery; mass screening; mydriasis; native species; non insulin dependent diabetes mellitus; ophthalmoscopy; patient education; risk assessment; rural area; smoking cessation; visual impairment; visual system examination; vitrectomy; body weight loss

Efficacy and safety of substituting a twice-daily regimen of timolol with a single daily instillation of nonpreserved beta-blocker in patients with chronic glaucoma or ocular hypertension - Bron, A.; Chiambaretta, F.; Pouliquen, P.; Rigal, D.; Rouland, J.-F. (Journal Francais d'Ophtalmologie, 2003)
Aim: To evaluate the efficacy and safety of a single daily instillation of nonpreserved timolol in patients with chronic glaucoma or ocular hypertension previously treated with a twice-daily regimen of timolol 0.25% or 0.50%. Patients and methods: A prospective open clinical trial was undertaken by 220 ophthalmologists in 435 patients with chronic glaucoma or ocular hypertension controlled with twicedaily instillations of timolol 0.25% or 0.50%. In this population, the previous regimen was substituted with a single daily instillation of preservative-free timolol 0.25% or 0.50% for 3 months. The changes in intraocular pressure (IOP) were recorded as well as local and systemic tolerance and patient compliance. Results: It was found that 398 patients (93.6%) maintained stable IOP: in 92%, IOP increased no more than 2 mmHg. The mean IOP was 17.0 ± 2.2mmHg at DO, 16.5 ± 2.4mmHg at D28/ 42 and 16.6 ± 2.4mmHg at D84. The proportion of patients with at least one ocular symptom upon instillation or at another time decreased (p<0.0001 and p=0.03, respectively). The proportion of conjunctival hyperemia reduced from 24.4% to 14.6% (P=0.0002). The rate of folliculopapillar reactions and superficial punctate keratitis was halved (p=0.005 and p=0.02, respectively). Conclusion: During this study in daily practice, the switch from a twice-daily regimen of timolol to a once-daily application maintained stable intraocular pressure with a notable improvement in tolerance.
Keywords: timolol; adult; aged; article; clinical trial; conjunctival hyperemia; controlled clinical trial; controlled study; dose response; dose time effect relation; drug efficacy; drug instillation; drug safety; drug tolerability; drug tolerance; eye irritation; female; glaucoma; human; intraocular hypertension; intraocular pressure; major clinical study; male; multicenter study; patient compliance; phase 4 clinical trial; punctate keratitis; treatment outcome

Benefits of different drug formulations in psychopharmacology - Frijlink, H.W. (European Neuropsychopharmacology, 2003)
Adequate dosage forms are essential for achieving successful pharmacotherapy. Innovative dosage forms or delivery systems may direct a drug to its specific site of action, optimize the timing of the drug release, or increase comfort or convenience for the patient. Thus, such innovations may improve efficacy and tolerability and lead to improvements in health-related quality of life. Specialized dosage forms (e.g., depot injections, extended-release formulations) of several psychiatric agents have been extensively used. The latest addition is an orally disintegrating formulation of the antidepressant mirtazapine. This dosage form dissolves rapidly in the mouth and is convenient for the large proportion of patients who have difficulty in swallowing tablets. © 2003 Elsevier B.V./ECNP. All rights reserved.
Keywords: amfebutamone; antibiotic agent; antidepressant agent; calcium channel blocking agent; colistin; ethinylestradiol plus etonogestrel; etonogestrel; flupentixol; fluphenazine; gestagen; haloperidol; immunosuppressive agent; insulin; levonorgestrel; mirtazapine; mirtrazapine soltab; omeprazole; proton pump inhibitor; serotonin uptake inhibitor; tobramycin; venlafaxine; verapamil; allergy; asthma; bioequivalence; malignant neoplasm; chronic obstructive lung disease; chronotherapy; circadian rhythm; circadian rhythm sleep disorder; conference paper; congestive heart failure; cystic fibrosis; diabetes mellitus; drug absorption; drug delivery system; drug dosage form; drug formulation; drug release; epilepsy; glaucoma; human; Human immunodeficiency virus infection; hyperlipidemia; hypertension; immunosuppressive treatment; infection prevention; inhaler; kidney transplantation; medical nebulizer; mental disease; nebulization; patient compliance; peptic ulcer; postmenopause; priority journal; psychopharmacology; quality of life; rheumatoid arthritis; tuberculosis; implanon; mirena; mirtrazapine soltab; nuvaring; remeron soltab

African American Health Disparities: Glaucoma as a Case Study - Kosoko-Lasaki, O.; Olivier, M.M.G. (International Ophthalmology Clinics, 2003)
Keywords: alpha adrenergic receptor blocking agent; antimetabolite; beta adrenergic receptor blocking agent; carvedilol; dipeptidyl carboxypeptidase inhibitor; enalapril; latanoprost; prostaglandin derivative; timolol; travoprost; argon laser; blindness; budget; clinical trial; cornea thickness; drug response; epidemiological data; ethnic difference; glaucoma; health care delivery; health care quality; health service; human; laser surgery; medicare; open angle glaucoma; optic nerve; patient compliance; patient education; population genetics; prevalence; priority journal; race difference; review; tonometer; trabeculectomy; treatment failure

Asian Americans: Glaucoma - Law, S.K. (International Ophthalmology Clinics, 2003)
Certain ethnic subgroups of Asian-Americans appear to have a higher rate of occludable angle and PACG than do whites and blacks. It is important to recognize the different contribution of nonpupillary block mechanism of angle closure, such as anteriorly positioned ciliary processes (as in plateau iris configuration) and lens-induced decrease of anterior chamber angle width. The difference in the combination of mechanisms of angle closure in the Asian-American population would be better understood with wider application of ultrasonic biomicroscopy in evaluating the angular configuration. Because the majority of angle-closure glaucoma in Asian-Americans may be asymptomatic and laser peripheral iridotomy is proven to be an effective prophylactic treatment, examination of the peripheral angle with gonioscopy is crucial for early diagnosis and appropriate treatment. Application of public resources to the at-risk population is considered to be cost-effective in glaucoma care. For angle-closure glaucoma in Asian Americans, the at-risk population is patients older than 40 years, women, hypermetropia, family history of angle closure, and patients of certain ethnic subgroups, such as Chinese, patients from Indochina, and Asian Indians. As eye care professionals, we need to be aware that certain ethnic groups of Asian-Americans may have a lower average IOP than that of whites and blacks. Applying the average IOP for whites or blacks to Asian-Americans in diagnosing glaucoma will miss a significant proportion of Asian-American patients with glaucoma. Glaucoma is defined by the presence of glaucomatous optic neuropathy. Careful evaluation of the optic disc with dilated fundus examination and stereoscopic optic disc photography is a sensitive method of evaluation. Our understanding of primary glaucoma in Asia-Americans is limited. The prevalence and presentation of diseases in U.S. Asians may be different from that in Asians in the East because of the difference in health care structure in terms of accessibility, ophthalmic practice in terms of wider use of laser therapy, and cataract extraction in the United States; possibly such environmental factors as life-style, nutrition, and geographical location; and genetic variation from interracial marriage. Although the multicultural social environment of the United States is certainly different from that in Asia, it may provide a unique opportunity for studying glaucoma among different ethnic groups in a single setting.
Keywords: Asian American; biomicroscopy; cataract extraction; clinical practice; closed angle glaucoma; cost effectiveness analysis; early diagnosis; environmental factor; ethnic difference; follow up; genetic variability; gonioscopy; health care access; health care system; high risk population; human; intraocular pressure; iridotomy; laser surgery; lifestyle; medicare; open angle glaucoma; ophthalmoscopy; optic disk; pathophysiology; phacoemulsification; population research; postoperative complication; prevalence; priority journal; prophylaxis; race difference; review; trabeculectomy

Ambulatorial follow-up of ocular open trauma - Machado Fontes, B.; Hasler Príncipe, A.; Mitne, S.; Tijoe Pwa, H.W.; Bueno Moraes, N.S. (Revista Brasileira de Oftalmologia, 2003)
Purpose: To study the causes, characteristics and associated factors of ocular open trauma and the evolution of visual function in patients with ambulatory follow-up. Methods: We reviewed the charts of 100 patients who received ophthalmologic care at the emergency room of São Paulo Hospital and were followed since then in the trauma sector of the department of ophthalmology of the Federal University of São Paulo. Results: All patients were assisted between January 2002 and February 2003. We found a higher number of occurrences (80%) in males, with age varying from 2 to 85 years old. Most patients (61%) had prior medical assistance, and only 40% arrived at the emergency room within the first 12 hours after the incident. Corneal suture was the most common surgical procedure, and lesions responsible to visual loss were seen in 80% of the patients in the period of study. Conclusion: Despite the best medical training and free access to last generation equipments and technologies, open ocular trauma continues to be a leading cause of severe visual loss, and all the efforts should be made for its prevention. Descriptors: Eye injuries, Eye injuries penetrating, Blindness.
Keywords: adolescent; adult; aged; ambulatory monitoring; article; Brazil; child; choroid disease; controlled study; cornea disease; cornea surgery; emergency ward; eye injury; female; follow up; glaucoma; human; major clinical study; male; medical care; medical record; postoperative period; ptosis (eyelid); retina disease; retina gyrate atrophy; surgical technique; suture technique; vision; visual impairment; vitreous disease

Herpes Zoster in the Immunocompetent Patient: Management of Post-herpetic Neuralgia - Johnson, R.W. (Herpes, 2003)
Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ, shingles), particularly in the elderly and those with severe acute phase symptoms. Unless or until varicella vaccination reduces the incidence of HZ and attenuates the risk and/or severity of complications, PHN will continue to result in patient suffering and remain a significant cause of healthcare and social support resource consumption. There have been useful advances in PHN management (e.g. use of the anticonvulsant gabapentin and topical local anaesthetic patches), but some cases remain intractable. Prevention is an important strategy, and antiviral drugs, while not totally effective, provide the most accepted method. Other acute interventions require further evaluation (nerve blocks, acute phase use of tricyclic antidepressants or anticonvulsants). As prevention of PHN requires early recognition and prompt management of at-risk patients presenting with acute HZ, public education and provision of information to relevant healthcare personnel are important. This article discusses issues relevant to PHN management and prevention, and provides a review of the pertinent literature.
Keywords: aciclovir; amitriptyline; anticonvulsive agent; antivirus agent; carbamazepine; chickenpox vaccine; codeine; desipramine; dihydrocodeine; famciclovir; gabapentin; lamotrigine; lidocaine; live vaccine; local anesthetic agent; maprotiline; methadone; methylprednisolone; morphine; nortriptyline; opiate; phenytoin; pregabalin; prodrug; steroid; tramadol; tricyclic antidepressant agent; unindexed drug; valaciclovir; valproic acid; aggression; anticholinergic effect; arachnoiditis; ataxia; clinical feature; clinical protocol; clinical trial; constipation; delirium; disease severity; drowsiness; drug dose regimen; drug effect; drug efficacy; drug safety; drug tolerability; drug utilization; early diagnosis; glaucoma; health care cost; health care personnel; health education; herpes zoster; high risk patient; human; immunocompetence; increased appetite; medical information; mood disorder; nerve block; outcomes research; pain; pain assessment; patient care; patient compliance; patient education; peripheral edema; postherpetic neuralgia; practice guideline; priority journal; rash; review; risk assessment; scoring system; sedation; side effect; social support; somnolence; sympathectomy; symptom; urine retention; vaccination; vertigo; virus reactivation; visual impairment; xerostomia; lidoderm

Experience with cosopt, the fixed combination of timolol and dorzolamide, after switch from free combination of timolol and dorzolamide, in Swiss ophthalmologists' offices - Gugleta, K.; Orgül, S.; Flammer, J. (Current Medical Research and Opinion, 2003)
Purpose: To analyse a response to the therapy switch from the concomitant application of βblocker and topical carbonic anhydrase inhibitor to the fixed combination of timolol and dorzolamide (Cosopt*) in glaucoma/ocular hypertensive patients under everyday, office-practice conditions. Patients and methods: The data source was a survey among practising ophthalmologists in Switzerland assessing their experience with glaucoma patients/ocular hypertensives put for the first time on the fixed combination of timolol and dorzolamide. A total of 98 patients underwent the therapy switch in at least one eye. The intraocular pressure (IOP) change between the baseline visit before switch to the timolol-dorzolamide fixed combination occurred, and the first follow-up control after the switch, served as an indicator of compliance. Results: The IOP decreased on average from 19.43 ± 5.64 mmHg to 17.97 ± 3.58 mmHg (p < 0.01). The time to the follow-up visit ranged from 4 to 354 days, and the magnitude of IOP change demonstrated a significant dependence on the time to the follow-up visit, also when corrected for baseline IOP level. A total of 87 (85.3%) continued on the timolol-dorzolamide fixed combination therapy after the first control visit. In 68 of these 98 patients the contralateral eyes underwent the same therapy switch, and their IOP followed an identical pattern of behaviour. Conclusion: The average IOP decrease of 1.5 mmHg upon therapy switch to the timolol-dorzolamide fixed combination suggests a better efficacy due to improved compliance. Short-term compliance benefit seems to be more pronounced. The high timolol-dorzolamide fixed combination therapy continuation rate reflects an improvement in compliance and subjectively-perceived convenience.
Keywords: dorzolamide; dorzolamide plus timolol; timolol; adult; aged; article; drug efficacy; female; follow up; glaucoma; human; intraocular pressure; major clinical study; male; patient compliance; Switzerland; treatment outcome; cosopt

Gender and blindness: Eye disease and the use of eye care services - Courtright, P.; Bassett, K. (Journal of Community Eye Health, 2003)
Keywords: article; blindness; cataract; eye disease; female; gender; glaucoma; health care utilization; health service; human; hygiene; lagophthalmos; leprosy; male; policy; quality of life; socioeconomics; trachoma

Patient persistency with pharmacotherapy in the management of glaucoma. - Reardon, G.; Schwartz, G.F.; Mozaffari, E. (European journal of ophthalmology, 2003)
PURPOSE: To evaluate persistency with monotherapy in the treatment of glaucoma in patients new to pharmacological management. METHODS: This population-based, retrospective cohort study, using managed care administrative claims data, included patients who were 20 years of age and older and who initiated monotherapy with betaxolol, brimonidine, dorzolamide, latanoprost, or timolol between May 1999 and January 2001. Follow-up continued through January 31, 2001, and prescription refill records for all ocular hypotensive medications were extracted for the full 21-month study period. The primary outcome measures were discontinuation and change (switching/adding on) of the index ocular hypotensive medication. Rates of discontinuation and discontinuation/change were compared using Cox regression methods; survival curves were generated. RESULTS: In all, 14,539 patients were prescribed any ocular hypotensive drug during the study period, and 2850 patients met all inclusion criteria. Patients treated with betaxolol, brimonidine, dorzolamide, or timolol were significantly (p < 0.05) more likely to discontinue and to discontinue/change the index therapy than were those treated with latanoprost. Results were confirmed in analyses adjusted for age and sex. CONCLUSIONS: Patients initially treated with latanoprost monotherapy are more persistent than those who begin treatment with beta-blockers, brimonidine, or the carbonic anhydrase inhibitor dorzolamide. Greater persistency with an initial ocular hypotensive therapy may improve health outcomes and reduce long-term costs to patients and health plans by limiting the increased resource use associated with discontinuations or changes in therapy.
Keywords: antihypertensive agent; beta adrenergic receptor blocking agent; brimonidine; dorzolamide; latanoprost; prostaglandin F; quinoxaline derivative; sulfonamide; thiophene derivative; adult; aged; article; cohort analysis; comparative study; drug effect; drug utilization; economics; glaucoma; human; intraocular hypertension; intraocular pressure; middle aged; patient compliance; retrospective study; statistics

Contact lens - Associated corneal infiltrates - Robboy, M.W.; Comstock, T.L.; Kalsow, C.M. (Eye and Contact Lens, 2003)
Purpose. This review article examines recent studies pertaining to contact lens - associated corneal infiltrates (CLACI) that occur in the absence of culture-proven microbial infection. Methods. The literature was reviewed in regard to the clinical appearance, incidence and risk, etiology, pathophysiology, differential diagnosis, and management of CLACI. Recent insights are presented in the context of future directions for prevention of CLACI. Results. Contact lens - associated comeal infiltrates may manifest in various forms that require careful observational skills to ensure proper diagnosis. Although the reported incidence of CLACI varies widely, even a low percentage of contact lens wearers would constitute a substantial number of affected individuals. Any one or a combination of multiple mechanical, hypoxic, or toxic stimuli associated with contact lens use can induce proinflammatory responses that lead to infiltration of inflammatory cells into the cornea. A number of candidate cytokines, chemokines, adhesion molecules, and so forth have been identified. In addition to differentiation from microbial keratitis, CLACI also should be differentiated from ocular disorders not associated with contact lenses but involving corneal infiltrates and from contact lens - associated disorders that may resemble infiltrates. Management of CLACI can range from simple monitoring of the patient to the use of pharmacologic intervention. Conclusions. The small percentage of affected lens wearers translates into a notable number of individuals who, although not experiencing a vision-threatening event, are inconvenienced by the development of infiltrates. Design of preventive measures for CLACI should focus on the elimination of various mechanical, hypoxic, and toxic stimuli that can induce infiltrates and on the approaches for molecular intervention of the inflammatory cascade initiated by the stimuli. © 2003 Contact Lens Association of Ophthalmologists, Inc.
Keywords: antibiotic agent; bacterium lipopolysaccharide; cell adhesion molecule; chemokine; contact lens solution; cytokine; interleukin 1; interleukin 1 receptor blocking agent; interleukin 1alpha; interleukin 1beta; interleukin 6; interleukin 8; leukotriene B4; silicone; thrombocyte activating factor; tumor necrosis factor; vascular cell adhesion molecule 1; Acinetobacter; antibiotic therapy; antibody production; antibody response; antigen antibody reaction; bacterial infection; cell infiltration; clinical feature; complement system; contact lens; contact lens associated cornea infiltrate; diagnostic accuracy; differential diagnosis; disease association; disease classification; disease severity; experimental model; experimental mouse; extended wear contact lens; eye care; eye toxicity; follow up; Gram negative bacterium; Haemophilus influenzae; high risk population; human; hydrogel; hypoxia; immune response; immunopathology; incidence; inflammatory cell; inflammatory infiltrate; keratitis; mechanical stimulation; nonhuman; pathophysiology; patient compliance; patient monitoring; preventive medicine; priority journal; Leporidae; review; risk assessment; Staphylococcus aureus; Streptococcus pneumoniae

Effect of hospitalization on intraocular pressure in patients with normal-tension glaucoma - Kashiwagi, K.; Kohno, K.; Tsukahara, S. (Ophthalmologica, 2003)
Objective: To investigate the effect of hospitalization on intraocular pressure (IOP) in patients with normal-tension glaucoma (NTG). Methods: The study was conducted in 52 patients with a definite diagnosis of NTG. The correlation between IOP measured from 9.00 a.m. to 12.00 p.m. on an outpatient basis within 3 months each prior to and after hospitalization (ambulatory IOP) and IOP measured during the same time period after admission (inpatient IOP) was investigated in NTG patients. Results: Inpatient IOP (13.9 ± 2.4 mm Hg) was significantly lower than ambulatory IOP (15.2 ± 2.1 mm Hg), with a difference of 1.3 ± 2.0 mm Hg (p < 0.01). The difference between inpatient IOP and ambulatory IOP was negatively correlated with inpatient IOP (r = 0.58, p < 0.01). Conclusions: These results revealed that hospitalization decreased IOP in NTG patients, with the decrease being particularly pronounced in cases of low ambulatory IOP. Interpretation of inpatient IOP should be carefully included in glaucoma treatment. Copyright © 2003 S. Karger AG, Basel.
Keywords: adult; aged; ambulatory monitoring; article; controlled study; correlation analysis; female; glaucoma; hospital patient; hospitalization; human; intraocular pressure; major clinical study; male; measurement; outpatient

Fluorometholone in children [3] (multiple letters) - Novack, G.D.; Fan, D.S.P.; Chan, K.M.C.; Yu, C.B.O.; Ng, J.S.K.; Lam, D.S.C. (Ophthalmology, 2003)
Keywords: corticosteroid; dexamethasone; fluorometholone; child; dose response; drug absorption; drug dose regimen; drug effect; drug potency; human; intraocular hypertension; letter; patient compliance; priority journal

Special considerations in the evaluation and management of uveitis in children - Holland, G.N.; Stiehm, E.R. (American Journal of Ophthalmology, 2003)
PURPOSE: To review issues related to the diagnosis, examination, and treatment of children with uveitis that are important for ophthalmologists. DESIGN: Literature review. METHODS: A review was made of pertinent reports from the medical literature, with commentary based on the authors' experiences and on discussions at an international workshop. RESULTS: There are differences between children and adults in the differential diagnosis and manifestations of uveitis that should be considered during evaluation. There may be a higher risk of some ocular complications such as uveitic glaucoma, and the presence of other unique complications, such as amblyopia, in young patients during follow-up. With regard to treatment, children with uveitis may have unique dosing requirements and drug-associated risks such as growth retardation with systemic corticosteroids that must be considered. Examination and treatment may also be more difficult with children because of problems with patient cooperation. CONCLUSIONS: There are unique patient care issues associated with uveitis in children that must be considered by care providers. Attention to these issues will improve the well-being of this patient population. © 2003 by Elsevier Inc. All rights reserved.
Keywords: acetazolamide; calcium phosphate; chlorambucil; cyclophosphamide; cyclosporine; etanercept; infliximab; methotrexate; nonsteroid antiinflammatory agent; prednisone; vitamin D; abdominal pain; acne; adult; age distribution; amblyopia; anorexia; Behcet disease; bone fragility; cataract extraction; cataractogenesis; child; chorioretinopathy; clinical feature; hereditary corneal dystrophy; differential diagnosis; drug cytotoxicity; eye synechia; follow up; growth retardation; human; iridocyclitis; juvenile xanthogranuloma; keratopathy; medical literature; mental instability; mucocutaneous lymph node syndrome; nausea; nephrotoxicity; opportunistic infection; patient care; patient compliance; patient monitoring; priority journal; retina edema; review; risk assessment; risk factor; sarcoidosis; secondary glaucoma; somnolence; strabismus; uveoretinitis; Vogt Koyanagi syndrome; body weight gain; wellbeing

What's Next When Glaucoma Drops are Not Providing Effective Treatment? - Lahr, J.W. (Clinical and Refractive Optometry, 2003)
Glaucoma is a neuropathy that can and should be managed by optometrists who can provide convenient and accessible eye services. Approval of new treatments over the past 2 years has expanded the options for managing this group of patients. New topical medications allow greater intraocular pressure reduction, however increased cost and adverse effects may limit compliance with these new options. While primary eye providers have referred patients for secondary and tertiary procedures as the glaucoma progresses or is not controlled with topical therapy, the return of the patient for postoperative and ongoing care following these procedures has not been consistent. New laser and surgical procedures now allow the optometrist to remain in control of the patient's care. Selective laser trabeculoplasty is a non-thermal laser that increases outflow and lowers IOP for several years, and can be repeated. While this option does not eliminate the need for drops, it may reduce the number of medications being taken. Non-penetrating deep sclerectomy with a collagen implant is a new surgical option that can significantly reduce or eliminate the need for topical medications, with minimal complications when compared to trabeculectomy. This provides a new treatment modality for non-compliant patients, those who are uncontrolled on maximum medical therapy and others who do not wish to manage their glaucoma every day. The quiet postoperative course makes co-management an option with consistent return of the patient to the optometrist's care long-term.
Keywords: beta adrenergic receptor blocking agent; eye drops; conference paper; disease control; drug cost; drug induced disease; glaucoma; human; intermethod comparison; intraocular pressure; laser surgery; long term care; neuropathy; patient care; patient compliance; postoperative period; sclerectomy; surgical technique; trabeculectomy; treatment planning

Overview - Mackey, D.A. (British Journal of Ophthalmology, 2003)
Keywords: DNA; retinol; anesthesia; clinical practice; cost effectiveness analysis; diagnostic accuracy; diagnostic value; DNA determination; DNA screening; drug megadose; early diagnosis; electrophysiology; electroretinography; gene mutation; genetic polymorphism; genetic screening; genotype phenotype correlation; glaucoma; health care access; health care availability; human; laboratory diagnosis; laboratory test; light; medical ethics; medical information system; medical research; night blindness; ophthalmology; patient care; patient counseling; practice guideline; prediction; priority journal; prophylaxis; retinitis pigmentosa; retinoblastoma; review; time

Measuring outcomes in chronic diseases: Ready for prime time? - Lee, P.P. (Archives of Ophthalmology, 2003)
Keywords: Ginkgo biloba extract; alternative medicine; cataract extraction; chronic disease; competence; drug cost; editorial; glaucoma; health care cost; health care delivery; health care policy; health care quality; health economics; health insurance; heart surgery; human; immunization; medicare; occupation; outcomes research; patient care; patient compliance; patient information; prescription; priority journal; risk factor; scoring system; slit lamp; social class; survival rate; visual acuity; visual field

Remind patients with glaucoma of importance of using eye-drops (Pharmaceutical Journal, 2003)
Keywords: eye drops; drug formulation; human; Internet; medical literature; note; open angle glaucoma; patient compliance; practice guideline; prescription; side effect; symptomatology

Inhaled corticosteriod in the treatment of asthma: On-site activation of ciclesonide - Schlenger, R. (Deutsche Apotheker Zeitung, 2003)
Keywords: ciclesonide; corticosteroid; glucocorticoid receptor; prodrug; asthma; cataract; drug activation; drug effect; drug structure; forced expiratory volume; glaucoma; human; osteoporosis; patient compliance; short survey

Patient preferences for eye drop characteristics: A willingness-to-pay analysis - Jampel, H.D.; Schwartz, G.F.; Robin, A.L.; Abrams, D.A.; Johnson, E.; Miller, R.B. (Archives of Ophthalmology, 2003)
Objective: To determine the importance that patients place on the characteristics of topical therapy for lowering intraocular pressure. Methods: We administered a willingness-to-pay instrument to 230 patients from 4 glaucoma subspecialty practices, asking them how much they would be willing to pay to obtain particular characteristics in an eye drop. Data about the subjects' demographics, economic status, attitudes toward eye drops and systemic medications, and symptoms from eye drops were correlated with their willingness to pay using 2-part models. Results: Of our subjects, 169 (77%) were using eye drops to lower their intraocular pressure. Fatigue, blurred vision, and tearing were the most commonly reported symptoms. Eye drop medications most valued by the subjects did not produce blurring, drowsiness, or inhibition of sexual performance; 85% were willing to pay more for an eye drop that did not cause blurring, and on average they were willing to pay 40% more. Higher educational levels and income were generally associated with a willingness to pay more for eye drops with desirable attributes. Main Outcome Measure: Willingness to pay more (in dollars). Conclusions: Patient preferences for eye drop characteristics can be assessed using a willingness-to-pay instrument. Patients place differing value on various eye drop characteristics. A better understanding of patient preference could lead to better compliance.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; eye drops; miotic agent; prostaglandin; adult; aged; article; drowsiness; fatigue; female; human; intraocular pressure abnormality; major clinical study; male; patient attitude; patient compliance; patient education; priority journal; prospective payment; retina tear; sexual dysfunction; side effect; symptomatology; taste disorder; visual impairment

Alternative medicine for glaucoma [6] (multiple letters) - Taylor, J.R.W.; Rhee, D.J.; Spaeth, G.L.; Myers, J.S.; Katz, L.J. (Ophthalmology, 2003)
Keywords: alternative medicine; doctor patient relationship; glaucoma; human; letter; mathematical analysis; medical decision making; neuroophthalmology; patient compliance; patient information; priority journal; treatment planning

Blindness in patients with treated open-angle glaucoma - Chen, P.P. (Ophthalmology, 2003)
Purpose: To investigate blindness in patients with treated open-angle glaucoma (OAG) and risk factors for blindness. Design: Retrospective observational case series. Participants: One hundred eighty-six patients seen between April and November 2000 at the University of Washington Medical Center Eye Clinic, diagnosed in 1975 or later, and treated for at least 2 years for OAG. Methods: Chart review with evaluation of visual acuity and visual field. Kaplan-Meier survival analysis was used to estimate the risk of blindness in one and both eyes. Variables considered to be possible risk factors for blindness were evaluated using chi-square test, t test, and Cox proportional hazards regression analysis. Main Outcome Measures: Blindness, defined as visual acuity of 20/200 or worse, and/or continuous constriction of the visual field to 20° or less in all four quadrants with a size III4e Goldmann stimulus or the equivalent on automated perimetry, allowing a higher threshold level on one point in one quadrant on automated perimetry. Results: The mean duration of disease was 10.2 ± 4.9 years. Twelve patients were blind in at least one eye from OAG at diagnosis. Nineteen other patients became blind in at least one eye from OAG, and three patients became bilaterally blind from OAG. The Kaplan-Meier estimate for blindness at 15 years in one eye was 14.6%, and in both eyes was 6.4%. Noncompliance with the treatment regimen (P = 0.016) and worse initial visual field loss (P < 0.0001) were significantly associated with development of blindness. Nonwhite race was associated with blindness (P = 0.014) when all blindness, including that found at diagnosis, was considered in the analysis. Conclusions: Bilateral blindness from chronic OAG was uncommon in this population of treated patients diagnosed in 1975 or later. Of patients with a blind eye, 39% were blind at diagnosis, and worse visual field loss at diagnosis and noncompliance were associated with development of blindness. © 2003 by the American Academy of Ophthalmology.
Keywords: adult; aged; article; blindness; chi square distribution; controlled study; diode laser; disease course; disease severity; glaucoma surgery; human; major clinical study; open angle glaucoma; patient compliance; perimetry; postoperative complication; priority journal; prognosis; regression analysis; retrospective study; risk assessment; risk factor; survival rate; visual acuity; visual field

Liver transplantation - Neuberger, J.M. (Bailliere's Best Practice and Research in Clinical Gastroenterology, 2003)
With the increasing success of liver transplantation in children, a growing number of children are reaching an age when it is no longer appropriate for them to be followed by paediatricians. Clinicians looking after these liver allograft recipients need to be aware of the additional problems and needs in this group of young patients.While life after transplantation is usually near normal, a proportion of adolescents suffer from physical and psychological stresses that may result in social and behavioural problems. Non-compliance can have a major adverse impact on graft function. Immunosuppression needs to be adjusted to maintain good graft function, but also to keep to a minimum the adverse effects including renal failure and malignancy. The adverse cosmetic effects of some immunosuppressive drugs can be particularly troublesome at this stage in life.Overall, adolescent liver allograft recipients can have an excellent quality of life. Health care professionals need to be aware of the additional problems that this group of patients may have and they will need to adapt the follow-up in response to these issues.
Keywords: midomafetamine; aciclovir; allopurinol; antacid agent; antineoplastic agent; antivirus agent; azathioprine; bromocriptine; calcineurin inhibitor; cimetidine; cisapride; colestyramine; cyclosporine; cytochrome P450 inhibitor; dipeptidyl carboxypeptidase inhibitor; Haemophilus influenzae vaccine; hepatitis A vaccine; hepatitis B vaccine; immunosuppressive agent; influenza vaccine; mycophenolate mofetil; nonsteroid antiinflammatory agent; Pneumococcus vaccine; prednisolone; probenecid; rapamycin; rituximab; tacrolimus; unindexed drug; ursodeoxycholic acid; adolescence; age distribution; allograft; article; autoimmune hepatitis; awareness; behavior disorder; brain pseudotumor; cataract; child; colon cancer; convulsion; Cushingoid syndrome; depression; diabetes mellitus; diarrhea; digestive system perforation; drug absorption; drug mechanism; drug potentiation; euphoria; femur head necrosis; fluid retention; follow up; gastrointestinal hemorrhage; gingiva hypertrophy; glaucoma; gout; graft rejection; growth retardation; headache; health care personnel; heart ventricle hypertrophy; hepatitis A; hepatitis B; hirsutism; human; hypercholesterolemia; hyperkalemia; hyperlipidemia; hypertension; hyperuricemia; immunosuppressive treatment; influenza; intraocular hypertension; kidney cancer; kidney disease; kidney failure; leukopenia; liver toxicity; liver transplantation; liver venoocclusive disease; male infertility; mental stress; mood disorder; muscle atrophy; muscle weakness; myopathy; nausea and vomiting; nephrotoxicity; osteoporosis; pancreatitis; patient compliance; peptic ulcer; physical stress; potassium depletion; quality of life; recipient; recurrent infection; side effect

56,000 ways to treat glaucoma - Realini, A.T.; Rechtner, R.D.; Ganley, J. (Evidence-Based Eye Care, 2003)
Keywords: antiglaucoma agent; algorithm; clinical practice; cost benefit analysis; drug approval; Food and Drug Administration; glaucoma; human; intraocular pressure; lifestyle; maximum tolerated dose; medical decision making; mental stress; methodology; patient compliance; practice guideline; priority journal; psychometry; quality of life; short survey; social aspect; United States; visual impairment

Management of hay fever in the pharmacy - Mason, P. (Pharmaceutical Journal, 2003)
Keywords: acrivastine; adrenergic receptor stimulating agent; alcohol; antihistaminic agent; anxiolytic agent; ascorbic acid; azelastine; beclometasone; cetirizine; chlorpheniramine; corticosteroid; cromoglycate disodium; decongestive agent; eye drops; flavonoid; fluticasone; histamine H1 receptor; hypnotic sedative agent; leukotriene; levocabastine; loratadine; orphenadrine; phenothiazine derivative; promethazine; prostanoid; quercetin; tricyclic antidepressant agent; trihexyphenidyl; unindexed drug; xylometazoline; acupuncture; allergic conjunctivitis; allergic rhinitis; alternative medicine; antiinflammatory activity; constipation; disease severity; drowsiness; drug classification; drug contraindication; endocrine disease; epistaxis; glaucoma; pollen allergy; heart palpitation; human; hypertension; insomnia; intraocular pressure abnormality; irritability; nose irritation; nose septum perforation; note; patient compliance; patient education; pollen allergy; restlessness; seasonal variation; sedation; side effect; smelling disorder; taste disorder; throat disease; tremor; urine retention; visual impairment; xerostomia

The safety and efficacy of fixed-combination timolol and latanoprost in the treatment of glaucoma: Review of two clinical trials - Higginbotham, E.J. (Today's Therapeutic Trends, 2003)
The principal clinical objective in treating glaucoma is to achieve a significant reduction in intraocular pressure (IOP). Two therapeutic agents that have proven highly effective in reducing IOP, latanoprost 0.005% and timolol 0.5%, have now been combined in a single fixed-dose preparation for the treatment of glaucoma. The results of two pivotal clinical trials, in Germany and the United States, have documented the safety and efficacy of this fixed- combination (FC) product administered once daily. In both studies, patients receiving the FC preparation showed substantially greater reductions in IOP than with the use of either of the component agents alone, and with no increase in the number of reported adverse events. Iris color changes and hypertrichosis (eyelash changes) occurred in larger proportions of those randomized to latanoprost alone than in the FC group. However, differences in pigmentation changes and response to timolol have been noted between caucasian patients and those of African-American descent. The ease and convenience of once-daily administration of the fixed combination of timolol and latanoprost should enhance patient compliance, an important factor in effectively treating glaucoma.
Keywords: epinephrine; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; latanoprost plus timolol; timolol; unclassified drug; Caucasian; clinical trial; demography; drug efficacy; drug mixture; drug safety; eye color; Germany; human; hypertrichosis; intraocular hypertension; intraocular pressure; meta analysis; Black person; open angle glaucoma; patient compliance; review; side effect; treatment outcome; United States; cosopt; xalacom

Penetrating keratoplasty in Down's syndrome - Bodenmueller, M.; Goldblum, D.; Frueh, B.E. (Klinische Monatsblatter fur Augenheilkunde, 2003)
Background: Purpose of this retrospective study was to analyze outcome and complications after penetrating keratoplasty (PK) in patients with Down's syndrome. Patients and methods: The medical records of all patients with Down's syndrome and PK from 1985 were reviewed retrospectively. Age, sex, systemic diseases, communication, indication for surgery and surgical technique, age at first PK, complications, visual acuity and best corrected visual acuity and findings at last follow-up were noted. Age matched mentally non-retarded patients with keratoconus and PK served as a control group. Results: All eyes of 9 patients had keratoconus, 16 were operated. Indication for surgery was spontaneous perforation in 3 and refractive in the remaining 13 eyes. Five grafts were clear at last follow-up. In 7 eyes, at least 1 re-PK had to be performed. Seven eyes developed graft rejection and 4 eyes needed conjunctival grafting because of non-healing epithelial defects. Ten eyes developed cataracts, 3 secondary glaucoma. In the control group 22 out of 25 operated corneas were clear at last follow-up. Conclusions: Prognosis of PK in patients with Down's syndrome is worse than in other patients with keratoconus. Poor results are not only explained due to the lack of cooperation of patients, but also because of: 1) high rate of emergency procedures (3/16), 2) presence of lid anomalies and 3) very advanced keratoconus, necessitating bigger sized grafts, leading to frequent immunological reactions, suture loosening and secondary glaucoma. Indication for PK in Down's syndrome patients with keratoconus and floppy eyelids should be very restrictive. Postoperative complications and the high rejection rate might be decreased by performing deep lamellar keratoplasty as this would not be an intraocular procedure.
Keywords: adolescent; cataract; child; clinical article; conference paper; controlled study; disease course; disease severity; doctor patient relationship; Down syndrome; emergency treatment; eyelid disease; female; follow up; graft rejection; human; keratoconus; male; medical record; patient compliance; penetrating keratoplasty; postoperative complication; prognosis; refraction error; reoperation; retrospective study; secondary glaucoma; surgical technique; treatment indication; treatment outcome; visual acuity

Glaucomatous knowledge level about their disease - Amorim Barretto, C.; De Melo Ventura, A.G.G.; Dantas, H. (Revista Brasileira de Oftalmologia, 2003)
Purpose: To analyze the knowledge level shown by glaucomatous patients about their disease. Methods: Seventy glaucomatous patients, cared for at the Glaucoma Department - Altino Ventura Foundation, Recife-PE-Brasil, were interviewed from August to October, 2001. Results: Thirty-one patients (44.3%) did not know they had glaucoma, whereas 52 (74.3%) did not know what glaucoma meant and 26 (52.0%) did not know the purpose of the medication. Comments: The results suggest that the patients were not well informed about their disease and this may affect the treatment compliance.
Keywords: adult; aged; article; Brazil; female; glaucoma; human; major clinical study; male; patient attitude; patient compliance; patient education

Vernal keratoconjunctivitis in Thailand - Kosrirukvongs, P.; Vichyanond, P.; Wongsawad, W. (Asian Pacific Journal of Allergy and Immunology, 2003)
A prospective, cross-sectional and randomized cross-over study was conducted to study the clinical features and treatment outcome among Thai patients with vernal keratoconjunctivitis (VKC). History-taking and eye examinations were performed. Mild cases of VKC were given topical antihistamine four times daily. Moderate and severe cases of VKC were treated with topical lodoxamide four times a day. Severe cases of VKC were given topical corticosteroids. Moderate and severe cases of VKC, which were refractory to treatment with either corticosteroids or a mast cell stabilizer had topical cyclosporine 0.5 % instilled four times daily. Five patients were exposed to two different treatment regimens in sequence. As main outcome measures, itching, foreign body sensation, photophobia, conjunctival injection, papillae and chemosis were evaluated weekly. The patients with the palpebral type of VKC had daily symptoms, which were more severe and triggered by house-dust with a significant difference among the groups. Limbal VKC was associated with allergic rhinitis more commonly than palpebral VKC. Positive results of skin prick testing to acacia, careless weed, mold, Johnson grass and cow's milk were significantly more common in patients with palpebral VKC. The most common symptoms and signs were found in the mixed type of VKC. Purulent discharge, pannus and lid erythema were found in the palpebral type. Levocabastine hydrochloride was sufficient for mild cases of limbal VKC; lodoxamide for the limbal and mixed types. Prednisolone acetate was the drug of choice in severe cases of any type but only for a short period of time. The success rate of topical cyclosporine in the palpebral type was lower than in the limbal type due to an intolerable burning sensation. Topical cyclosporine used in 4 patients with limbal and palpebral type had a success rate of 100% which was greater than in the lodoxamide group. (66.7%, 0%). Compared with topical corticosteroid-treated eyes in one patient, the success rate in topical cyclosporine-treated eyes was not success. Grading the severity of each type of VKC is crucial to obtain good response of any medication and compliance. Topical cyclosporine 0.5% can be an alternative drug to relieve symptoms and signs of VKC in order to avoid steroid-induced glaucoma.
Keywords: antibiotic agent; antihistaminic agent; corticosteroid; cyclosporine; histamine H1 receptor antagonist; levocabastine; lodoxamide; histamine release inhibitor; prednisolone acetate; stabilizing agent; steroid; unclassified drug; Acacia; adolescent; adult; allergic rhinitis; anamnesis; article; burning sensation; chemosis; child; clinical article; clinical examination; clinical feature; clinical trial; controlled clinical trial; controlled study; crossover procedure; disease association; disease severity; drug choice; drug efficacy; drug exposure; drug hypersensitivity; drug induced disease; erythema; female; glaucoma; grass; house dust; human; infant; intraocular foreign body; male; mast cell; milk; mold; optic nerve lesion; outcomes research; palpebral fissure; pannus; papillary conjunctivitis; patient compliance; photophobia; prevalence; prick test; prospective study; pruritus; pus; randomized controlled trial; symptomatology; Thailand; treatment outcome; vernal conjunctivitis; weed

Defining the effects of an inhaled corticosteroid and long-acting β-agonist on therapeutic targets - Settipane, R.A. (Allergy and Asthma Proceedings, 2003)
The effects of inhaled corticosteroids (ICSs) and long-acting β2-agonists (LABAs) on therapeutic targets have significant clinical relevance regarding optimal management of asthma. Asthma pathophysiology involves two main components: smooth muscle dysfunction and airway inflammation. LABAs and ICSs provide complementary modes of action in that these agents modulate smooth muscle dysfunction/bronchoconstriction and airway inflammation, respectively. Despite the documented benefits of ICSs, they remain underutilized because of a variety of physician- and patient-associated reasons including safety concerns. Underlying these concerns are published reports that suggest systemic effects of high doses of ICSs: skin bruising, reduction of bone mineral density, cataracts, glaucoma, and impaired short-term growth in children. Simple strategies to reduce the potential adverse effects of inhaled steroids include using the lowest effective maintenance dose and optimizing steroid-sparing strategies, specifically combination therapy with a LABA, leukotriene modifier, or theophyl-line. LABA therapy, when added to ICS therapy, provides clinically significant steroid-sparing effects while at the same time reducing the rate at which asthma exacerbations occur. Available clinical evidence suggests that the combination of ICS plus LABA is the best available option for the management of moderate persistent asthma. Consequently, this combination is the preferred choice for treating moderate persistent asthma based on current National Asthma Education and Prevention Program guidelines for the diagnosis and treatment of asthma.
Keywords: antiinflammatory agent; beta 2 adrenergic receptor; beta 2 adrenergic receptor stimulating agent; bronchodilating agent; corticosteroid; fluticasone propionate plus salmeterol; glucocorticoid receptor; leukotriene receptor blocking agent; salmeterol; theophylline; allergic rhinitis; asthma; bronchospasm; cataract; clinical feature; conference paper; corticosteroid induced osteoporosis; disease exacerbation; drug megadose; drug safety; forced expiratory volume; glaucoma; growth retardation; human; lung biopsy; maintenance drug dose; muscle function; pathophysiology; patient; patient compliance; physician; recurrent disease; respiratory tract inflammation; side effect; skin contusion; smooth muscle; statistical significance; treatment outcome

Comparison of efficacy and tolerability between two gel-forming timolol maleate ophthalmic solutions in patients with glaucoma or ocular hypertension - Shibuya, T.; Kashiwagi, K.; Tsukahara, S. (Ophthalmologica, 2003)
Purpose: To compare two gel-forming timolol maleate ophthalmic solutions, Timoptol XE® and Lizmon TG®, in regard to efficacy and tolerability in patients with glaucoma or ocular hypertension by means of a patient-masked prospective randomized crossover study. Subjects and Methods: A total of 37 patients with glaucoma or ocular hypertension under treatment with antiglaucoma ophthalmic solutions including 0.5% twice-daily timolol maleate participated in this study. Only timolol maleate was withdrawn and either Timoptol XE or Lizmon TG was randomly allocated. After instillation for 1 month, the other ophthalmic solution was subsequently instilled for another month. Routine ophthalmic examination including slit-lamp examination and intraocular pressure (IOP) monitoring was conducted before instillation of gel-forming ophthalmic solutions and just after completing the instillation of each ophthalmic solution. Patient questionnaire surveys were also performed just after completing the instillation of each ophthalmic solution. Results: Mean IOP, just before the withdrawal of timolol ophthalmic solution, was 16.4 ± 2.9 mm Hg. At the end of Timoptol XE or Lizmon TG instillation, mean IOPs were 16.3 ± 2.5 or 16.3 ± 3.0 mm Hg, respectively. The results of the questionnaire survey showed no significant difference between Timoptol XE and Lizmon TG in regard to all survey items. Twenty-nine patients (78.4%) preferred to use gel-forming timolol solutions rather than twice-daily timolol ophthalmic solution. The presence of concurrently used ophthalmic solutions did not effect the incidences of subjective symptoms. The incidences of objective adverse effects were not significantly different between two gel-forming timolol ophthalmic solutions. Conclusion: Both gel-forming timolol ophthalmic solutions could be good choices for glaucoma treatment. Copyright © 2003 S. Karger AG, Basel.
Keywords: antiglaucoma agent; dipivefrine; dorzolamide; latanoprost; lizmon tg; pilocarpine; timolol maleate; timolol maleate; unoprostone isopropyl ester; adult; aged; article; clinical article; clinical trial; conjunctiva disease; conjunctival congestion; controlled clinical trial; controlled study; drug efficacy; drug instillation; drug tolerability; drug withdrawal; eye irritation; female; health survey; human; intraocular foreign body; intraocular hypertension; intraocular pressure; male; ocular pruritus; open angle glaucoma; patient compliance; questionnaire; randomization; randomized controlled trial; secondary glaucoma; slit lamp; symptom; visual impairment; lizmon tg; timoptol xe

Survey on the usage of eyedrops by patients of open angle glaucoma - Yoshikawa, K. (Japanese Journal of Clinical Ophthalmology, 2003)
A total of 145 patients of open angle glaucoma were interviewed regarding the actual use of eyedrops. They had been using eyedrops for 3 months or longer. They had received due instructions regarding the name of eyedrops, time and frequency of instillation before start of treatment. The ages of patients ranged from 29 to 82 years, average 59.9±12.9 years. The name of eyedrops was correctly remembered by 62 patients (42.8%). The frequency of instillation was in accordance to the instructions by 135 patients (93.1%). Instillation of eyedrops was performed at the designated time of the day by 114 patients (78.7%). The name of eyedrops was better remembered by males than females (p<(0.01), by younger than aged patients (p<0.001), and by those under longer period of medication (p<0.01). Instruction as to frequency and timing were better adhered to when the patients visited the clinic more frequently (p<0.05), when they received plural medications (p<0.05), and when they were using eyedrops for shorter periods (p<0.001).
Keywords: eye drops; adult; age distribution; aged; article; drug delivery system; female; health survey; human; interview; major clinical study; male; open angle glaucoma; patient compliance; sex difference

Readability of ocular medication inserts - Khurana, R.N.; Lee, P.P.; Challa, P. (Journal of Glaucoma, 2003)
Objective: To determine the readability of ocular medication inserts and whether they are an appropriate source of medication information for patients. Materials and Methods: The Flesch-Kincaid and SMOG readability formulas were used to calculate the readability of 10 common glaucoma medication inserts (Alphagan, Azopt, Betoptic, Betimolol, Cosopt, Optipranolol, Rescula, Trusopt, Timoptic, and Xalatan) and 6 widely used nonglaucoma medication inserts (Alrex, Lotemax, Ocuflox, Patanol, Pred Forte, and Zaditor). Results: The 10 glaucoma medication inserts surveyed required an average overall grade level of 12.9 ± 0.6 by the Flesch-Kincaid Index and of 13.5 ± 0.6 by the SMOG formula. The 6 nonglaucoma medication inserts had an overall grade level of 11.1 ± 0.6 by the Flesch-Kincaid Index and of 11.7 ± 0.9 by the SMOG formula. All medications reviewed were above the eighth-grade level recommended by the Flesch-Kincaid Index for public materials. Conclusions: Ocular medication inserts are too complex to be an adequate source of medication information for the average American adult. This study highlights the need for improving communication and education regarding patients' medications.
Keywords: betaxolol; betimolol; brimonidine; brinzolamide; dorzolamide; dorzolamide plus timolol; ketotifen fumarate; latanoprost; loteprednol etabonate; metipranolol; ofloxacin; olopatadine; prednisolone acetate; timolol; timolol maleate; unoprostone isopropyl ester; article; doctor patient relationship; drug information; drug manufacture; drug marketing; drug packaging; Food and Drug Administration; glaucoma; health care delivery; human; patient compliance; patient education; prescription; priority journal; alphagan; alrex; azopt; betimolol; betoptic; cosopt; lotemax; ocuflox; optipranolol; patanol; pred forte; rescula; timoptic; trusopt; xalatan; zaditor

Conjunctival hyperemia and the use of topical prostaglandins in glaucoma and ocular hypertension - Feldman, R.M. (Journal of Ocular Pharmacology and Therapeutics, 2003)
The prostaglandin derivatives are thought to lower intraocular pressure (IOP) primarily by increasing uveoscleral outflow. The ocular side effect, hyperemia, appears to occur via a secondary, unrelated mechanism. Variations in the IOP-lowering effect and incidence of hyperemia associated with these drugs are a function of their different chemical structures. Among the currently approved prostaglandin derivatives, hyperemia occurs in as many as 50% of patients treated with travoprost and as few as 5% of patients treated with latanoprost. The side effect of hyperemia may be of concern to the ophthalmologist for at least 2 reasons: hyperemia may compromise the outcome of filtration surgery, and it may represent a cosmetic problem to the patient thereby leading to noncompliance. The extent to which hyperemia may contribute to patient noncompliance and the effect of administration of the prostaglandin derivatives on outcome of filtration surgery remain to be determined. Until more definitive data are available, when selecting a prostaglandin analogue for ocular hypotensive therapy, it seems prudent to choose an agent with a low incidence of hyperemia.
Keywords: bimatoprost; brimonidine; dorzolamide; latanoprost; prostaglandin derivative; timolol; travoprost; unoprostone isopropyl ester; clinical trial; conjunctival hyperemia; drug receptor binding; drug use; glaucoma; human; intraocular hypertension; intraocular hypotension; intraocular pressure; patient compliance; review

Topical mitomycin C for conjunctival-corneal squamous cell carcinoma [1] (multiple letters) - Panda, A.; Bajaj, M.S.; Balasubramanya, R.; Prakash, G.; Shields, C.L.; Naseripour, M.; Shields, J.A. (American Journal of Ophthalmology, 2003)
Keywords: mitomycin; calcification; cancer recurrence; cancer surgery; cataract; conjunctiva disease; cornea disease; cornea neovascularization; cytology; differential diagnosis; drug efficacy; drug safety; dry eye; follow up; glaucoma; histopathology; human; iridocyclitis; letter; operation duration; patient compliance; patient monitoring; priority journal; retina pigment epitheliopathy; sclera; sclera disease; scleritis; squamous cell carcinoma; surgical injury; topical treatment; ulcer

Comparison of Yatabe-Guilford personality test results in retinitis pigmentosa and glaucoma patients - Igarashi, Y.; Sato, E.; Ito, A.; Miyauchi, O.; Ikejiri, M.; Hanawa, T.; Tsuyama, Y.; Mizota, A.; Fujimoto, N.; Adachi-Usami, E. (Japanese Journal of Ophthalmology, 2003)
Purpose: To determine the psychological state and personality traits of patients with retinitis pigmentosa (RP) or glaucoma so that a closer and better relationship can be developed with the patients. Methods: The Yatabe-Guilford personality test was administered to 75 RP patients and 42 glaucoma patients. The latter group included 29 cases of primary open-angle glaucoma, 6 of primary angle-closure glaucoma, and 7 of normal-tension glaucoma. The patients were being treated at the Department of Ophthalmology, Chiba University Hospital. As controls, 47 age-matched volunteers were tested. Results: A comparison of these three groups showed that the proportions of patients with cyclic tendency, rhathymia, and lack of cooperativeness traits were significantly higher in the RP group than in the glaucoma group. The lack of cooperativeness value was especially higher in the RP than in the glaucoma group and the control group (Fisher exact test, P <.05). On the other hand, the nervousness value was significantly higher in the glaucoma group than in the RP group and than in controls (Fisher exact test, P <.05). Factors of sex, age, type of disease, corrected visual acuity, and central visual fields did not influence the profiles of the RP and glaucoma groups. Conclusion: RP patients had relatively well-stabilized personalities and were optimistic, while glaucoma patients tended toward nervousness in comparison with RP patients and controls. © 2003 Japanese Ophthalmological Society.
Keywords: adult; aged; article; closed angle glaucoma; controlled study; female; Fisher exact test; glaucoma; human; human experiment; major clinical study; male; nervousness; low tension glaucoma; open angle glaucoma; patient compliance; personality; personality test; priority journal; psychological aspect; retinitis pigmentosa; sex; visual acuity; visual field

Patient compliance in glaucoma therapy - Vogel, A.; Pfeiffer, N.; Schwenn, O. (Ophthalmologe, 2002)
Keywords: antiglaucoma agent; glaucoma; human; patient care; patient compliance; review; treatment outcome

Health economics, economic evaluation, and glaucoma - Kobelt, G. (Journal of Glaucoma, 2002)
Glaucoma has not received a great deal of attention from health economists in the past, partly due to the fact that no new treatments have been introduced for some time. Economic evaluation is generally performed for new technologies, to assess their cost-effectiveness compared with current treatments, to estimate the potential changes in the use of health care resources that their introduction may produce, and to make decisions about their reimbursement status and formulary inclusion. Economic studies in glaucoma have been largely limited to studies about cost, because a useful outcome measure has been lacking. Therapy aims at reducing intraocular pressure, but the data to estimate the absolute risk of vision loss due to high pressure have been lacking. Hence, it has been impossible to assess the benefit of treatments in terms of their ability to reduce blindness. However, as new out knowledge about these issues increases and more data become available, such studies become possible. This review illustrates the issues encountered when performing economic evaluation in glaucoma and reviews the current economic literature in the field.
Keywords: beta adrenergic receptor blocking agent; dorzolamide; latanoprost; blindness; cost effectiveness analysis; decision making; economic evaluation; glaucoma; health care cost; health care utilization; health economics; human; intraocular hypertension; intraocular pressure; laser surgery; medical literature; money; outcomes research; priority journal; quality adjusted life year; reimbursement; review; trabeculectomy; visual impairment

Outcome after treatment of congenital unilateral cataract - Lundvall, A.; Kugelberg, U. (Acta Ophthalmologica Scandinavica, 2002)
Purpose: To evaluate long-term functional outcome after treatment of congenital unilateral cataract. Methods: The records of 30 consecutive children operated on before the age of 12 months at St. Erik's Eye Hospital over a 5-year period (1991-96) were reviewed retrospectively. The patients were followed until 4-9.5 years of age. Linear Snellen visual acuity (VA), occlusion therapy compliance, and the presence of nystagmus, strabismus and other complications are reported. Results: Six children achieved VA of 0.1 or better. They were all operated on before 3 months of age. Of the 12 infants operated on before 6 weeks of age, four have VA between 0.3 and 0.4 and eight have VA of finger counting or less. Four developed severe secondary glaucoma within 6 months of cataract extraction. Two of these had persistent fetal vasculature. Three eyes developing glaucoma became amaurotic. Occlusion therapy was abandoned before the age of 2.5 years in 21 children. Conclusion: Good levels of VA were achieved only in children who underwent cataract surgery before 3 months of age and who adhered to the occlusion therapy schedule. Severe secondary glaucoma developed in four out of 12 children operated on within 6 weeks. Full compliance with the occlusion therapy programme was uncommon.
Keywords: aphakia; article; blindness; child; clinical article; congenital cataract; controlled study; disease severity; female; follow up; functional assessment; glaucoma; human; male; nystagmus; patient compliance; priority journal; retrospective study; strabismus; trabeculectomy; treatment outcome; vision test; visual acuity; vitrectomy

Optimisation of treatment by applying programmable rate-controlled drug delivery technology - Chien, Y.W.; Lin, S. (Clinical Pharmacokinetics, 2002)
A number of programmable rate-controlled drug delivery technologies have been developed during the last two decades with the aim of regulating the rate of drug delivery, sustaining the duration of therapeutic action and/or targeting the delivery of drug to a specific tissue. As a result, several therapeutically beneficial outcomes can be achieved, such as: (i) controlled delivery of a therapeutic dose at a desirable rate of delivery; (ii) maintenance of drug concentrations within an optimal therapeutic range for prolonged duration of treatment; (iii) maximisation of efficacy-dose relationship; (iv) reduction of adverse effects; (v) minimisation of the need for frequent dose intake; and (vi) enhancement of patient compliance. The treatment of illness can thus be optimised. To gain a better understanding of how to optimise the treatment of illnesses by applying programmable rate-controlled drug delivery technologies, this article reviews the scientific concepts and technical principles behind the development of various programmable rate-controlled drug delivery systems that have been marketed or are under active development. Finally, the roles of these technologies in optimising therapeutic outcomes in nine therapeutic areas are discussed.
Keywords: clonidine; diazepam; estradiol; estradiol plus norethisterone acetate; fentanyl; glyceryl trinitrate; goserelin; leuprorelin; levonorgestrel; medroxyprogesterone acetate; microsphere; nicotine; nifedipine; phenylpropanolamine; pilocarpine; polymer; progesterone; scopolamine; testosterone; chlorpheniramine polistirex plus hydrocodone polistirex; androgen therapy; angina pectoris; anxiety disorder; contraception; controlled drug release; dose response; drug delivery system; drug diffusion; drug efficacy; drug implant; drug targeting; encapsulation; estrogen therapy; feedback system; human; hydration; hydrodynamics; hydrolysis; hypertension; iontophoresis; magnetism; membrane permeability; motion sickness; open angle glaucoma; osmotic pressure; osmotic pump; pain; partition coefficient; patient compliance; pH; priority journal; prostate cancer; review; smoking cessation; ultrasound; vapor pressure; acutrim; alora; androderm; catapres tts; climara; combipatch; compudose; depo provera; deponit; duragesic; estraderm; habitrol; lupron depot; minitran; nicotrol; nitro dur; nitrodisc; norplant; ocusert; procardia xl; progestasert; prostep; testoderm; transderm nitro; transderm scop; tussionex; vivelle dot; vivelle; zoladex; Alzet; Syrijet; Vitajet

Characteristics of eye care practices with managed care contracts - Solomon, M.D.; Lee, P.P.; Mangione, C.M.; Kapur, K.; Adams, J.L.; Wickstrom, S.L.; Escarce, J.J. (American Journal of Managed Care, 2002)
Objectives: To describe the variation in practice structure, financial arrangements, and utilization and quality management systems for eye care practices with managed care contracts. Study design: Cross-sectional survey of 88 group and 56 solo eye care practices that contract with 6 health plans affiliated with a national managed care organization. The survey contained modules on practice structure, financial arrangements, utilization management, and quality management. The survey response rate was 85%. Results: Group practices with both ophthalmologists and optometrists were triple the size of ophthalmology-only groups, and 5 times the size of optometry-only groups. Fee-for-service payments were the primary source of group practice revenues, although 60% of group derived some revenues from capitation payments. Group practices paid their physicians almost exclusively with fee-for-service payments or salary arrangements, with minimal capitation at the individual level. Almost no practices used both capitation and bonuses to compensate providers. Most practices received practice profiles and three fourths were subject to utilization review, which mainly consisted of preauthorization for procedures, tests, or referrals. Nearly all practices used clinical guidelines, protocols, or pathways in managing patients with diabetic retinopathy or glaucoma. Further, nearly all group practices used computerized information systems to assist in delivering care, and most had provider education programs. Conclusions: Managed care has affected the way eye care providers organize, finance, and deliver healthcare. In general, our findings paint an optimistic picture of eye care practices that contract with managed care organizations. Few practices bear substantial financial risk, and nearly all practices use quality management tools that could help to improve the quality of care.
Keywords: article; clinical pathway; clinical practice; clinical protocol; software; cost benefit analysis; diabetic retinopathy; group practice; health care delivery; health care financing; health care management; health care organization; health care quality; health care utilization; health insurance; health survey; human; information system; managed care; managed care organization; medical education; medical fee; medical specialist; open angle glaucoma; ophthalmology; optometry; patient care; patient referral; physician; practice guideline; prevalence; primary medical care; priority journal; risk; salary

Psychopharmacotherapy in elderly - Kozarić Kovačić, D.; Kocijan Hercigonja, D.; Bajs, M. (Medicus, 2002)
Application of drugs in older age requires specific attention due to a series of physiological changes connected with ageing, frequent comorbidity and increased susceptibility to adverse reactions to drugs. The most important goals of pharmacotherapy in elderly people with mental disorders are the improvement of their quality of life and postponing the inability for independent life. The basic principles include individual dosage, careful drug titration at the beginning and ceasing of therapy, as well as the continuous follow-up of drug efficacy and potential adverse events. Elderly people often take several medications for various disorders, what increases the risk of drug interaction. A substantial part of rational pharmacotherapy is also the estimation of compliance. Clinical studies specifically dealing with treatment of elderly persons with mental disorders, have not been frequent up to now, mostly due to ethical reasons. Thus, the data on the drug efficacy, characteristics of action and side effects are sometimes limited. Having in mind the increase of elderly people in general population, there is a growing interest as well as need for evidence-based knowledge how to treat elderly patients with mental disorders.
Keywords: alpha adrenergic receptor stimulating agent; alprazolam; amitriptyline; anticonvulsive agent; antidepressant agent; benzodiazepine derivative; beta adrenergic receptor blocking agent; carbamazepine; clomipramine; clonazepam; diuretic agent; fluoxetine; flurazepam; lamotrigine; lorazepam; maprotiline; midazolam; monoamine oxidase inhibitor; neuroleptic agent; nitrazepam; oxazepam; paroxetine; phenobarbital; sertraline; temazepam; trazodone; tricyclic antidepressant agent; unindexed drug; valproic acid; zolpidem; aged; aging; agranulocytosis; akathisia; amnesia; article; bradykinesia; breathing disorder; cognitive defect; comorbidity; confusion; constipation; delirium; depression; disease exacerbation; drug dose regimen; drug efficacy; drug mechanism; dystonia; ECG abnormality; epilepsy; ethics; evidence based medicine; extrapyramidal symptom; follow up; glaucoma; human; hyponatremia; hypotension; mental disease; neuroleptic malignant syndrome; nose obstruction; patient compliance; photosensitivity; population; psychopharmacotherapy; quality of life; sedation; sexual dysfunction; side effect; tachycardia; titrimetry; tremor; urine retention

Causes of Non-Compliance with Drug Regimens in Glaucoma Patients: A Qualitative Study - Taylor, S.A.; Galbraith, S.M.; Mills, R.P. (Journal of Ocular Pharmacology and Therapeutics, 2002)
The purpose of this study was to gain insights into why patients are not compliant with their glaucoma medications. Patients were recruited from lists provided by two ophthalmologists. Each patient had seen a minimum of two ophthalmologists for their glaucoma, and was taking at least two topical medications for glaucoma. Qualitative methodology was utilized, including two focus groups and eleven in-depth interviews in patients' homes. The results showed that forgetfulness was the number one reported reason for non-compliance. Patients did not claim to be non-compliant specifically because of side effects, but they did complain about them. Communication between physicians and patients is a key factor in compliance for glaucoma patients. Specifically, patients would like their physicians to teach them how to instill their eye drops, tell them about new/alternate medications and procedures as they become available, and offer new ways to make their regimen easier. Patients often do not tell their physician if they experience a side effect unless it is intolerable to them, yet they do realize the seriousness of glaucoma, and the consequences of not following their doctor's orders. Finally, while cost was not a reported deterrence to compliance, some patients would prefer less expensive alternatives.
Keywords: dorzolamide; latanoprost; pilocarpine; timolol; timolol maleate; article; clinical article; controlled study; doctor patient relationship; drug cost; drug tolerability; eye color; eye pain; eyelash; female; glaucoma; human; interview; male; patient attitude; patient compliance; patient education; qualitative analysis; side effect; stinging sensation; visual disorder; timoptic; trusopt; xalatan

Intraocular pressure sensory system for continuous recording of intraocular pressure - Kreiner, C.F.; Streufert, D. (Biomedizinische Technik. Biomedical engineering, 2002)
Keywords: ambulatory monitoring; article; equipment design; glaucoma; human; information processing; devices; intraocular pressure; lens implant; microcomputer; pathophysiology; physiology; spectacles

Primary open-angle glaucoma - Goldberg, I.; Graham, S.L.; Healey, P.R. (Medical Journal of Australia, 2002)
Keywords: epinephrine; agents acting on the eye; alpha 2 adrenergic receptor stimulating agent; antifibrotic agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; dorzolamide; fluorouracil; latanoprost; levobunolol; memantine; mitomycin; n methyl dextro aspartic acid receptor blocking agent; pilocarpine; prostaglandin F2 alpha agonist; timolol; travoprost; unclassified drug; blindness; clinical trial; editorial; glaucoma drainage implant; human; intraocular pressure; laser surgery; linkage analysis; long term care; monitoring; open angle glaucoma; patient compliance; perimetry; prevalence; risk factor; trabeculoplasty; treatment failure; visual acuity; visual field defect

Anti-acanthamoeba efficacy in contact lens disinfecting systems [11] - Beattie, T.K.; Tomlinson, A.; Seal, D.V. (British Journal of Ophthalmology, 2002)
Keywords: catalase; hydrogen peroxide; poly(hexamethylenebiguanide); Acanthamoeba; Acanthamoeba keratitis; contact lens; disinfection; keratitis; letter; microbial sensitivity test; minimum inhibitory concentration; patient compliance; priority journal

Glaucoma: prevalence, utilization, and economic implications. - Dalzell, M.D. (Managed care (Langhorne, Pa.), 2002)
Keywords: adult; aged; ambulatory care; article; comparative study; economics; ethnology; female; glaucoma; health service; human; male; middle aged; prevalence; United States; utilization review

Improving adherence to drug-treatment regimens for glaucoma. - Mansukani, S.S. (Managed care (Langhorne, Pa.), 2002)
Compliance with glaucoma therapy is relatively poor. Because glaucoma progresses slowly, long-term adherence is crucial to improving clinical and financial outcomes of treatment. Physicians must consider several factors before steps can be taken to promote correct use of medications.
Keywords: article; clinical practice; doctor patient relationship; glaucoma; human; patient compliance; patient education; prescription; United States

How patients react when glaucoma is diagnosed? - Hamelin, N.; Blatrix, C.; Brion, F.; Mathieu, C.; Goemaere, I.; Nordmann, J.-P. (Journal Francais d'Ophtalmologie, 2002)
Purpose: Evaluate the psychological consequences of announcing the diagnosis of glaucoma. Materials and methods: Two hundred patients completed a 20-item questionnaire designed to analyze the context in which glaucoma was discovered and the patients' reaction to this diagnosis. Behavioral modification in patients and their families are specified as well as their perception of the information received. Comments: Most patients had open-angle glaucoma and showed either an anxious or a passive reaction to the announcement of the diagnosis. Severe anxiety led to prescription of minor tranquilizers or antidepressants in 11% of cases. Nearly half of the patients declared that they had modified their behavior after receiving the diagnosis, indicating a need to play an active role in disease management. A large majority of the patients were conscious of the risk of blindness related to glaucoma; however, they did not feel « ill » but rather « handicapped ». Most were dissatisfied with the information provided by their doctor and sought other sources of information. Conclusion: Announcing a diagnosis of glaucoma is a decisive step in the physician-patient relationship, known to be important in future treatment compliance. Better adapted information with regular reevaluation of the need for additional information is necessary. The psychological impact should be evaluated regularly in order to promote an active role on the part of the patient and avoid a decline in quality of life.
Keywords: antidepressant agent; tranquilizer; anxiety disorder; article; behavior modification; blindness; depression; doctor patient relationship; fear; human; major clinical study; open angle glaucoma; patient attitude; patient compliance; patient satisfaction; perception; psychological aspect; quality of life; questionnaire; risk factor

Patient education in renal transplantation - Akyolcu, N. (EDTNA-ERCA Journal, 2002)
Renal transplantation is the surgical implantation of a human kidney from a compatible donor into a recipient. Renal transplantation is a means of restoring renal function to normal in most patients, thus allowing a return to a healthy lifestyle. Patients and their families often ask nurses for health information. Professional nurses must ensure that patients and families understand the transplantation and therapeutic regimen and provide health education. It should be remembered that certain physiological, psychosocial and pathological conditions might inhibit the education process. Before renal transplantation the patient's understanding of the procedure and follow-up regimen and also the patient's ability to cope with a complex medication regimen are assessed. The nurse and the patient and family should work together to set realistic, achievable goals, the aims of which are mutually agreed. The agreed goals of health education should be documented in a care plan, which will also provide reinforcement for both the nurse and patient.
Keywords: immunosuppressive agent; article; cooperation; coping behavior; Cushing disease; diabetes mellitus; family counseling; follow up; gastrointestinal hemorrhage; glaucoma; health education; hemorrhagic shock; home care; human; kidney artery stenosis; kidney function; kidney transplantation; learning; lifestyle; lung disease; nurse patient relationship; nursing; paralytic ileus; patient compliance; patient education; quality of life; side effect; social psychology; treatment planning; urethra fistula; urinary tract infection; wound infection

New treatment paradigm for glaucoma: Prostaglandin analogue update - Penna, P. (Drug Benefit Trends, 2002)
Although more prevalent in elderly persons, glaucoma is a chronic health problem that affects all populations, especially African Americans. This disease is often over-looked because no pain is associated with it and most persons are unaware of minor, progressive reductions in their visual acuity and do not seek treatment until their visual field is irrevocably impaired. Preserving the optic nerve is vital in glaucoma management, but decreasing intraocular pressure remains the cornerstone of effective therapy. Treatment compliance is key in preventing blindness from glaucoma, and the emergence of prostaglandin analogues and their effectiveness have helped simplify drug regimens, increasing patient compliance and improving outcomes.
Keywords: acetazolamide; alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; beta adrenergic receptor stimulating agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; dipivefrine; dorzolamide; latanoprost; methazolamide; miotic agent; pilocarpine; prostaglandin derivative; timolol; travoprost; unoprostone isopropyl ester; blindness; central nervous system disease; chronicity; clinical trial; disease classification; drug approval; drug cost; drug efficacy; elderly care; ethnic group; eye disease; gastrointestinal symptom; glaucoma; health care cost; human; hyperemia; intraocular hypertension; intraocular pressure; kidney disease; open angle glaucoma; optic nerve; patient compliance; population research; prevalence; review; risk factor; side effect; tachyphylaxis; trabeculoplasty; treatment outcome; United States; visual acuity; visual field defect; visual impairment; lumigan; rescula; travatan; xalatan

Ageing males - An emerging area of concern - Eldemire-Shearer, D.; Paul, T.J.; Morris, C. (West Indian Medical Journal, 2002)
Keywords: adult; aged; aging; alcohol consumption; arthritis; article; cigarette smoking; controlled study; diabetes mellitus; female; glaucoma; health behavior; health care access; health care delivery; health care facility; health care utilization; health promotion; health status; heart disease; hospitalization; human; hypertension; Jamaica; life expectancy; male; medical decision making; morbidity; motivation; patient attitude; prostate cancer; risk factor; sex difference

Management of traumatic hyphema - Walton, W.; Von Hagen, S.; Grigorian, R.; Zarbin, M. (Survey of Ophthalmology, 2002)
Hyphema (blood in the anterior chamber) can occur after blunt or lacerating trauma, after intraocular surgery, spontaneously (e.g., in conditions such as rubeosis iridis, juvenile xanthogranuloma, iris melanoma, myotonic dystrophy, keratouveitis (e.g., herpes zoster), leukemia, hemophilia, von Willebrand disease, and in association with the use of substances that alter platelet or thrombin function (e.g., ethanol, aspirin, warfarin). The purpose of this review is to consider the management of hyphemas that occur after closed globe trauma. Complications of traumatic hyphema include increased intraocular pressure, peripheral anterior synechiae, optic atrophy, corneal bloodstaining, secondary hemorrhage, and accommodative impairment. The reported incidence of secondary anterior chamber hemorrhage, that is, rebleeding, in the setting of traumatic hyphema ranges from 0% to 38%. The risk of secondary hemorrhage may be higher in African-Americans than in whites. Secondary hemorrhage is generally thought to convey a worse visual prognosis, although the outcome may depend more directly on the size of the hyphema and the severity of associated ocular injuries. Some issues involved in managing a patient with hyphema are: use of various medications (e.g., cycloplegics, systemic or topical steroids, antifibrinolytic agents, analgesics, and antiglaucoma medications); the patient's activity level; use of a patch and shield; outpatient vs. inpatient management; and medical vs. surgical management. Special considerations obtain in managing children, patients with hemoglobin S, and patients with hemophilia. It is important to identify and treat associated ocular injuries, which often accompany traumatic hyphema. We consider each of these management issues and refer to the pertinent literature in formulating the following recommendations. We advise routine use of topical cycloplegics and corticosteroids, systemic antifibrinolytic agents or corticosteroids, and a rigid shield. We recommend activity restriction (quiet ambulation) and interdiction of non-steroidal anti-inflammatory agents. If there is no concern regarding compliance (with medication use or activity restrictions), follow-up, or increased risk for complications (e.g., history of sickle cell disease, hemophilia), outpatient management can be offered. Indications for surgical intervention include the presence of corneal blood staining or dangerously increased intraocular pressure despite maximum tolerated medical therapy, among others. © 2002 by Elsevier Science Inc. All rights reserved.
Keywords: acetylsalicylic acid; alcohol; aminocaproic acid; analgesic agent; antifibrinolytic agent; antiglaucoma agent; atropine; carbomer; conjugated estrogen; cycloplegic agent; dexamethasone; nonsteroid antiinflammatory agent; placebo; prednisone; prochlorperazine; steroid; tranexamic acid; warfarin; accommodation paralysis; adhesion; bleeding; blood stain; blunt trauma; clinical trial; disease association; disease severity; eye surgery; follow up; glaucoma; hemophilia; human; hyphema; iris; iris rubeosis; juvenile xanthogranuloma; laceration; leukemia; melanoma; mobilization; nausea; optic nerve atrophy; orthostatic hypotension; patient compliance; priority journal; review; sickle cell anemia; side effect; treatment outcome; uveitis; Varicella zoster virus; vertigo; vomiting; von Willebrand disease; amicar; aspirin; cyclokapron; decadron; premarin

Analysis of risk factors that may be associated with progression from ocular hypertension to primary open angle glaucoma - Landers, J.; Goldberg, I.; Graham, S.L. (Clinical and Experimental Ophthalmology, 2002)
Background: As a multifactorial disease, glaucoma may be associated with pressure-dependent and pressure-independent factors. Ocular hypertension (OHT) may develop into primary open angle glaucoma (POAG) for many patients. Groups with OHT and POAG were compared for pressure-dependent and independent risk factors. A high prevalence of any factor(s) could indicate a contribution to progression from OHT to POAG. Methods: A sample of patients with POAG (n = 438) and with OHT (n = 301) were selected from those attending a tertiary referral private glaucoma practice, and data were collected regarding age and intraocular pressure at the time of diagnosis, sex, family history of glaucoma, systemic hypertension, diabetes, Raynaud's phenomenon, migraine and myopia. Results: After multivariate analysis, older age at time of diagnosis (Χ25 = 73.89, P < 0.001), myopia (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.0-2.2; P < 0.05), a family history of glaucoma (OR = 1.6, 95% CI 1.1-2.3; P < 0.001) and a high intraocular pressure (Χ24 = 16.96; P = 0.002) were found to be more prevalent among those with POAG. No other significant differences could be found between the two groups. Conclusion: Patients who have OHT may be at higher risk of developing POAG if they also have myopia, a family history of glaucoma or are of older age.
Keywords: adult; age; aged; anamnesis; article; comparative study; confidence interval; controlled study; diabetes mellitus; disease association; female; health care facility; health care utilization; human; hypertension; information processing; intraocular hypertension; intraocular pressure; major clinical study; male; migraine; multivariate analysis; myopia; open angle glaucoma; patient referral; population risk; prevalence; private practice; Raynaud phenomenon; risk assessment; risk factor

Discontinuation rates of topical glaucoma medications in a managed care population - Shaya, F.T.; Mullins, C.D.; Wong, W.; Cho, J. (American Journal of Managed Care, 2002)
Background: Rates of medication discontinuation reflect factors including effectiveness, tolerability, cost, and dosing frequency. Discontinuation data can be useful to physicians and health plan managers as they compare various glaucoma medications. Objective: To compare rates of discontinuation of therapy in patients initially prescribed monotherapy with a topical glaucoma medication. Methods: Members of a managed care plan who filled at least 1 prescription for latanoprost, timolol, or brimonidine during a 30-month period were eligible to participate in this study. Prescription refill records for all glaucoma agents used in the plan were extracted for the study period. Rates of discontinuation of initial glaucoma therapy were compared using Cox regression methods; Kaplan-Meier survival curves were generated. Results: A total of 72,744 prescriptions were eligible, of which 48,491 were for study drugs. Latanoprost was the most frequently dispensed therapy (accounting for 49.7% of study drugs), followed by timolol (30.6%), and brimonidine (19.6%). After inclusion and exclusion criteria were applied, 2283 patients were included in analyses. Latanoprost-treated patients were significantly less likely to discontinue medication than were those treated with timolol or brimonidine. Kaplan-Meier survival curves confirmed that latanoprost-treated patients exhibited the greatest persistency with therapy. Conclusion: In this managed care setting, rates of discontinuation in patients initially treated with latanoprost were lower than those of patients receiving comparator drugs.
Keywords: antiglaucoma agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carteolol; dorzolamide; ecothiopate iodide; latanoprost; levobunolol; pilocarpine; timolol; timolol maleate; travoprost; unoprostone isopropyl ester; adult; article; comparative study; controlled study; drug choice; drug cost; drug efficacy; drug exposure; drug tolerability; drug withdrawal; female; glaucoma; health care planning; health insurance; human; Kaplan Meier method; major clinical study; male; managed care; manager; medical decision making; monotherapy; patient compliance; prescription; priority journal; regression analysis; retrospective study; survival rate

Changing paradigms in the medical treatment of glaucoma - Soltau, J.B.; Zimmerman, T.J. (Survey of Ophthalmology, 2002)
Glaucoma is defined by a typical optic neuropathy accompanied by characteristic visual field loss and eventual blindness. The major risk factor for glaucoma is elevated intraocular pressure (IOP). Lowering IOP is currently the only proven method for reducing the risk of glaucomatous visual field loss and remains the primary goal of therapy. With the recent introduction of many new medications that lower IOP, the definition of what constitutes maximum tolerated medical therapy has been changing. The treatment can now be tailored better to each individual patient. The regimen needs to be affordable, easy to understand, and least interfering with the patient's quality of life. β-blockers still are the mainstay of initial therapy, but more and more prostaglandin analogs and also α-2 agonists are being used initially. Systemic carbonic anhydrase inhibitors and cholinergics are being used less frequently. © 2002 Elsevier Science Inc. All rights reserved.
Keywords: acetazolamide; epinephrine; alpha 2 adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbachol; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; clonidine; dipivefrine; dorzolamide; ecothiopate iodide; latanoprost; levobunolol; methazolamide; metipranolol; physostigmine; pilocarpine; prostaglandin derivative; timolol; travoprost; unoprostone isopropyl ester; accommodation; agranulocytosis; allergy; aplastic anemia; asthma; bradycardia; cataract; chronic obstructive lung disease; confusion; conjunctival hyperemia; depression; diarrhea; dry eye; fatigue; glaucoma; headache; human; intraocular pressure; iritis; libido; metabolic acidosis; miosis; myopia; nausea; nephrolithiasis; paresthesia; patient compliance; priority journal; quality of life; retina detachment; retina macula cystoid edema; review; risk factor; side effect; Stevens Johnson syndrome; treatment planning; visual field; visual impairment; xerostomia

The efficacy and safety of unfixed and fixed combinations of latanoprost and other antiglaucoma medications - Higginbotham, E.J.; Diestelhorst, M.; Pfeiffer, N.; Rouland, J.F.; Alm, A. (Survey of Ophthalmology, 2002)
Adjunctive therapy for the management of glaucoma is commonly used. Unfixed combinations of the prostaglandin analog latanoprost and other glaucoma medications have been demonstrated to effectively lower intraocular pressure (IOP). The range of reported additional reductions in IOP compared to a monotherapy baseline are as follows: latanoprost-timolol (13-37%), latanoprost-pilocarpine 2% (7-14%), latanoprost and carbonic anhydrase inhibitors (15-24.1%), and latanoprost and dipivefrin (15-28%). There is a fixed combination of latanoprost (0.005%) and timolol (0.5%) that has been investigated in Phase III trials in Europe and the United States. In these trials, it was noted that the efficacy of the fixed combination was superior to either of the monotherapy components. After 12 months of follow-up of patients on fixed combination, there was no evidence of long-term drift. The new formulation appears to be safe and does not demonstrate any more side effects than either of the components. The convenience of a fixed combination may enhance patient compliance. Unfixed combination therapy with latanoprost and other antiglaucoma medications and the fixed combination formulation of latanoprost and timolol provide an effective and safe option for lowering IOP in glaucoma patients. © 2002 by Elsevier Science Inc. All rights reserved.
Keywords: acetazolamide; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; brimonidine; carbonate dehydratase inhibitor; dipivefrine; dorzolamide; latanoprost; pilocarpine; prostaglandin derivative; timolol; aqueous humor flow; area under the curve; cell density; clinical trial; conjunctiva disease; cornea thickness; drug absorption; drug bioavailability; drug blood level; drug effect; drug efficacy; drug mechanism; drug safety; eye color; eye irritation; eyelash; follow up; geographic distribution; glaucoma; human; hyperemia; hypertrichosis; intraocular pressure; patient compliance; priority journal; macular edema; review; side effect; treatment outcome; visual field defect

Latanoprost versus combined timolol and dorzolamide - Bron, A.M.; Emmerich, K.-H. (Survey of Ophthalmology, 2002)
We reviewed available data comparing latanoprost and combined timolol and dorzolamide and the additive effect of latanoprost in patients receiving timolol and dorzolamide in combination using a literature search through the electronic Medline database and presentations from proceedings of recent glaucoma meetings. Several studies have shown that the intraocular pressure (IOP)-lowering effect of latanoprost once a day is equivalent to timolol 0.5% twice a day and concomitant or combined dorzolamide 2% twice a day. Adding latanoprost to timolol and dorzolamide leads to a further 16% reduction of IOP. We conclude that the effect on IOP reduction of latanoprost is similar to combined timolol and dorzolamide, and the additive effect of latanoprost to a combination of timolol and dorzolamide is clinically relevant. In most cases, the overall safety profile of latanoprost is better than combined timolol and dorzolamide. © 2002 by Elsevier Science Inc. All rights reserved.
Keywords: dorzolamide; dorzolamide plus timolol; latanoprost; prostaglandin derivative; timolol; aqueous humor flow; blepharitis; circadian rhythm; clinical practice; clinical trial; conjunctiva disease; conjunctival hyperemia; cornea disease; drug activity; drug cost; drug efficacy; drug indication; drug safety; dry eye; epiphora; eye color; eye irritation; eye pain; flu like syndrome; headache; human; intraocular hypertension; intraocular pressure; meta analysis; metabolic disorder; open angle glaucoma; patient compliance; photophobia; prescription; priority journal; respiratory tract disease; review; side effect; skin disease; uveitis; visual impairment; cosopt; xalatan

Combined therapy of pilocarpine or latanoprost with timolol versus latanoprost monotherapy - Diestelhorst, M.; Nordmann, J.-P.; Toris, C.B. (Survey of Ophthalmology, 2002)
Adjunctive intraocular pressure (IOP)-lowering therapy is widely used today, as one-third of all patients being treated for glaucoma need additional therapy to reach and maintain healthy IOPs. Timolol, latanoprost, and pilocarpine are three potent drugs that have been used in combination to reduce IOP. Timolol reduces the production rate of aqueous humor to achieve the IOP decrease. Latanoprost and pilocarpine both affect aqueous outflow, although by different mechanisms. The IOP efficacy of combined therapy with timolol and pilocarpine compared with timolol and latanoprost or with latanoprost alone has been investigated in three multicenter, randomized, clinical trials in Europe. This is a review of those published trials. In 2 of the 3 studies, the additional IOP lowering effect of latanoprost 0.005% administered once daily was compared with pilocarpine 2% administered 3 times daily in patients with primary open-angle glaucoma (POAG) or ocular hypertension currently on monotherapy with timolol 0.5% twice daily. These 6-month studies found that the timolol and latanoprost combination reduced IOP more and was better tolerated with fewer side-effects than the timolol and pilocarpine combination. At 6 months, there was no evidence of long-term drift in IOP with timolol and latanoprost. This combined therapy provides an effective and safe option for lowering IOP in glaucoma patients. These results suggest that the timolol/latanoprost combination is preferable to the timolol/pilocarpine combination not only with regard to side effects but also to the magnitude of IOP reduction. Two of the 3 studies compared latanoprost monotherapy with timolol and pilocarpine combined therapy in patients with POAG, various other glaucomas, or ocular hypertension. Treatment was for 6 weeks or 6 months. In both studies, latanoprost was more effective and better tolerated than the combination of timolol and pilocarpine. These results suggest that latanoprost alone should be tried before the addition of pilocarpine to timolol therapy is considered. The convenience of daily administration of a single drop of latanoprost versus multiple drops of timolol and pilocarpine should improve patient compliance. © 2002 by Elsevier Science Inc. All rights reserved.
Keywords: latanoprost; pilocarpine; prostaglandin derivative; timolol; aqueous humor flow; clinical trial; conjunctival hyperemia; conjunctivitis; drug efficacy; drug indication; drug potency; drug safety; drug tolerability; eye pain; human; intraocular hypertension; intraocular pressure; miosis; open angle glaucoma; patient compliance; priority journal; review; visual acuity; visual impairment

Initial medical therapy for primary open-angle glaucoma - Robin, A.L. (Ophthalmic Practice, 2002)
Keywords: alpha adrenergic receptor stimulating agent; brimonidine; apraclonidine; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; brinzolamide; latanoprost; prostaglandin derivative; article; bradycardia; conjunctival hyperemia; disease course; drug mechanism; drug metabolism; drug safety; human; hypotension; intraocular pressure; open angle glaucoma; patient compliance; pruritus; trichiasis; visual field; alphagan p; alphagan; azopt; lumigan; xalatan

Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication - Pisella, P.J.; Pouliquen, P.; Baudouin, C.; Grasso, C.M. (Evidence-Based Eye Care, 2002)
Keywords: adrenergic receptor stimulating agent; antiglaucoma agent; benzalkonium chloride; carbonate dehydratase inhibitor; drug preservative; eye drops; prostaglandin derivative; clinical feature; drug formulation; dry eye; eye burning; eye toxicity; human; incidence; intraocular foreign body; intraocular pressure; lacrimal gland disease; ocular pruritus; open angle glaucoma; patient compliance; prevalence; priority journal; prospective study; short survey; symptomatology

Use of eye care and associated charges among the Medicare population: 1991-1998 - Ellwein, L.B.; Urato, C.J. (Archives of Ophthalmology, 2002)
Objective: To examine trends in the utilization and cost of eye care in the Medicare population. Methods: Data were obtained from fee-for-service physician claims (Part B) from a 5% sample of Medicare beneficiaries 65 years and older. Use of eye care services and procedures, frequency of ocular diagnoses, and allowed charges were compared for each year from 1991 through 1998. Results: The proportion of beneficiaries receiving eye care increased from 41.4% to 48.1% during the 8-year period. Part B charges attributable to eye care decreased from 12.5% to 10.4%, with annual inflation-adjusted charges per beneficiary decreasing from $235 to $176 (1998 dollars). The proportion of beneficiaries with cataract-related claims increased from 23.4% to 27.3%, accounting for approximately 60% of eye care charges each year; beneficiaries with retinal disease claims increased from 7.8% to 11.4%, capturing 15.4% of eye care charges in 1998, up from 10.7% in 1991; and beneficiaries with glaucoma claims increased from 6.8% to 9.5%, accounting for nearly 10% of eye care charges each year. Conclusions: The proportion of the Medicare population receiving eye care increased between 1991 and 1998. Nevertheless, eye care costs did not increase, primarily because of constraints in charges associated with the management of cataract.
Keywords: aged; article; cataract; cost benefit analysis; cost of illness; economic aspect; eye disease; female; geriatric disorder; glaucoma; health care utilization; human; major clinical study; male; managed care; medicare; priority journal

Paradoxical intraocular pressure elevation after combined therapy with latanoprost and bimatoprost - Herndon, L.W.; Asrani, S.G.; Williams, G.H.; Challa, P.; Lee, P.P. (Archives of Ophthalmology, 2002)
Keywords: bimatoprost; brimonidine; dorzolamide; dorzolamide plus timolol; latanoprost; timolol maleate; unoprostone isopropyl ester; adult; aged; article; case report; combination chemotherapy; drug efficacy; drug withdrawal; female; glaucoma; human; intraocular hypertension; intraocular pressure; intraocular pressure abnormality; iridectomy; male; patient compliance; priority journal; cosopt; timoptic

Topical Fk506 in inflammatory corneal and conjunctival diseases: A pilot study - Reinhard, T.; Reis, A.; Mayweg, S.; Oberhuber, H.; Mathis, G.; Sundmacher, R. (Klinische Monatsblatter fur Augenheilkunde, 2002)
Background: Topical corticosteroids are the only effective measure in serious inflammatory corneal and conjunctival diseases. Although results obtained with topical cyclosporin A are encuraging it is not effective in all patients. The mode of action of Fk506 is similar to that of cyclosporin A, i.e. it exerts an inhibitory effect on transcription of interleukin 2 in T lymphocytes. The immunosuppressive potential of Fk506, however, is much larger. Furthermore, it penetrates more easily into cornea and conjunctiva. To find out whether the theoretical advantages of topical Fk506 can be translated into clinical practice, a selected group of patients refractory to conventional therapy was treated in this pilot study. Patients and methods: Fk506 0.06% was administered initially three times daily in 15 patients with atopic blepharokeratoconjunctivitis, Mooren's ulcer, ocular pemphigoid, Thygeson's superficial punctate keratitis, nummular adenoviral keratitis, graft-versus-host reaction of the conjunctiva and steroid response glaucoma after penetrating keratoplasty. Results: Within a follow-up of 26 ± 15 weeks improvement was recorded in 5/15 patients and stabilization in 5/15 patients. In two patients progression of the disease was noted (one patient with progression of ocular pemphigoid, another patient with suspected automutilation). Premature withdrawal the drug was judged to be necessary in two patients with ocular surface disorders and in one patient with non-compliance. Conclusions: Topical Fk506 seems to be a promising new immunosuppressive drug for patients with atopic blepharokeratoconjunctivitis, Thygeson's superficial punctate keratitis and nummular adenoviral keratitis. Exact efficacy in these and other corneal and conjunctival inflammatory diseases has to be determined in randomised clinical studies. Before these studies may start the risk of side-effects must be reduced via an improvement of the drops.
Keywords: cyclosporine; interleukin 2; tacrolimus; adult; aged; article; clinical article; conjunctiva disease; cornea disease; drug effect; drug efficacy; female; human; immunosuppressive treatment; keratitis; male; patient compliance; penetrating keratoplasty; pilot study; side effect; T lymphocyte activation; fk 506

Eye disease and care in Latin America and the Caribbean - Silva, J.C.; Bateman, J.B.; Contreras, F. (Survey of Ophthalmology, 2002)
In the last decade, health indicators in Latin America and the Caribbean reflect advances. The per capita public expenditure on health care has increased in many countries. Despite these improvements, it is estimated that for every million population in Latin America and the Caribbean, 5,000 are blind and 20,000 are visually impaired; at least 66% of the blindness is attributable to treatable conditions such as cataract. The cataract surgery rate in the region remains low as compared to the industrialized countries, although it is higher than many other regions of the world. The availability of eye care services varies from country to country within the region, and the number of ophthalmologists per million population in the richest countries may be nine times more than in the poorest. Access, defined as the distance between the consumer and the services, is problematic in countries with isolated areas in the rainforest or high mountains, poor road systems, or lack of public transportation. Affordability is an important issue that limits utilization of services by the poorest segments of the population in nearly all countries in Latin America and the Caribbean. © 2002 by Elsevier Science Inc. All rights reserved.
Keywords: retinol; blindness; cataract; cataract extraction; Central America; commercial phenomena; diabetic retinopathy; economic aspect; eye disease; eye refraction; glaucoma; health care; health care utilization; health service; health status; human; industrialization; international cooperation; medical literature; medical research; medical specialist; onchocerciasis; organization; patient care; population research; priority journal; quality control; rain forest; retinol deficiency; review; socioeconomics; South and Central America; trachoma; visual impairment

Duration of therapy provided by bottle of ocular hypotensive eyedrops - Vaidergorn, P.G.; Susanna Jr., R.; Borges, A.S.; Giampani Jr., J. (Revista Brasileira de Oftalmologia, 2002)
Objective: To assess the mean extent of therapy yielded by bottle of some ocular hypotensive eyedrops: bimatoprost (Lumigan®, Allergan), latanoprost (Xalatan®, Pharmacia), travoprost (Travatan®, Alcon) and unoprostone (Rescula®, Novartis). Place: Glaucoma service, Ophthalmological Department, Clinics Hospital, University of São Paulo Medical School. Methods: The total drop contents of six bottles of each product were counted, so as to obtain a mean drop number. A mean number of drops per mi was calculated and also the time extent of therapeutics enhanced by each product. Results: The mean number of drops per mi was noted to vary across the group, that were: Xalatan®, 43,4 ± 1,6, Travatan®, 38,7 ± 2,2, Rescula®, 37,6 ± 1,3, and Lumigan®, 34,9 ± 1,8 drops per ml. As for the mean treatment extent, assuming one drop per instillation, without waste, a bottle of Xalatan® would last 54,2 ± 2,0 days, one of Lumigan® 52,3 ± 2,7 days, one of Rescula® 50,0 ± 1,7 days and one of Travatan® 48,4 ± 2,7 days. Conclusion: Among the items that might be considered when prescribing ocular hypotensive eyedrops, the number of drops, as well as the extent of therapeutics yielded per bottle could merit some attention.
Keywords: bimatoprost; eye drops; latanoprost; travoprost; unoprostone isopropyl ester; article; dose calculation; glaucoma; human; intraocular hypotension; outcomes research; patient compliance; prescription; risk assessment; treatment outcome; lumigan; rescula; travatan; xalatan

Reduction in the number of topical medications by latanoprost for primary open-angle glaucoma - Matsumoto, M.; Kimura, S.; Kohri, T.; Hikita, Y. (Japanese Journal of Clinical Ophthalmology, 2002)
We used topical latanoprost in 21 eyes of 11 patients of primary open-angle glaucoma. They had been using multiple topical medications before. Ten eyes had been treated by two medications. After switching to latanoprost only, the intraocular pressure (IOP) averaged 20.2±1.4 mmHg before and 17.5±4.9 mmHg after switching. The difference was significant (p=0.04). Eleven eyes had been treated by three medications. After switching to latanoprost and beta-blocker, the IOP averaged 17.2±2.8 mmHg before and 17.2±4.0 mmHg after switching. There was no significant difference. The findings show that reduction in the number of topical medications by latanoprost may result in good IOP control contributing to improved compliance.
Keywords: beta adrenergic receptor blocking agent; latanoprost; adult; aged; article; clinical article; drug efficacy; female; human; intraocular pressure; male; open angle glaucoma; patient compliance; receptor blocking

Risk factors for contact lens associated microbial keratitis - Weissman, B.A.; Mondino, B.J. (Contact Lens and Anterior Eye, 2002)
Although the risk of developing contact lens associated microbial keratitis is small, the potential consequences of this condition, such as vision loss, are serious. This paper presents an analysis of the risk factors that have been identified for contact lens induced microbial keratitis, which include extended wear, hypoxia, non-compliance, blepharitis, diabetes mellitus, epithelial trauma, steroid use, therapeutic lens use, tobacco use, and possibly travel to warm climates. By remaining mindful of these risk factors, practitioners can take action and offer advice to patients so as to optimize the safety of contact lens wear. © 2002 British Contact Lens Association. Published by Elsevier Science Ltd. All rights reserved.
Keywords: steroid; article; blepharitis; cigarette smoking; contact lens; cornea epithelium; Corynebacterium diphtheriae; diabetes mellitus; disease association; drug use; extended wear contact lens; general practitioner; Haemophilus; human; hypoxia; keratitis; Listeria; Neisseria gonorrhoeae; patient compliance; patient counseling; priority journal; risk assessment; risk factor; safety; Staphylococcus; tissue injury; travel; tropic climate; visual impairment

Pharmacotherapy of glaucoma - Saxena, R.; Prakash, J.; Mathur, P.; Gupta, S.K. (Indian Journal of Pharmacology, 2002)
There has been a dramatic change in the medical therapy of glaucoma during the last two decades. Until the 1980s, miotics were the drugs of first choice for treating this disease but at present, β-blockers are regarded as the first choice drugs. Apart from β-blockers, a number of newer drugs which have fewer systemic and ocular side effects and act by different mechanisms have become commercially available for ophthalmic use. Important among these are latanoprost, unoprostone, brimonidine, apraclonidine, dorzolamide and brinzolamide. In addition, attempts have been made to enhance patient compliance and ocular delivery of already available antiglaucoma drugs like pilocarpine. Notable among the delivery systems are electronic devices, ocular inserts, transdermal and mechanical drug delivery systems and liposomes. Use of viscoelastic vehicles (soluble polymers to soluble gels) in ophthalmic formulations, emulsions and soluble ophthalmic drug inserts (SODI) have also enhanced the patient compliance and drug absorption by ocular tissues in patients on long term glaucoma therapy. The present review deals with various classes of β-blockers, prostaglandin analogs, carbonic anhydrase inhibitors, adrenergic agents, drugs affecting cholinergic pathway and hyperosmotic agents employed in the management of glaucoma. It also throws light on the role of neuroprotective agents and other drugs under investigation.
Keywords: acetazolamide; epinephrine; adrenergic receptor stimulating agent; agn 191129; antiglaucoma agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; cholinesterase inhibitor; dipivefrine; dorzolamide; drug vehicle; ecothiopate; latanoprost; levobunolol; liposome; metoprolol; mifepristone; miotic agent; neuroprotective agent; osmotic agent; physostigmine; pilocarpine; polymer; prostaglandin derivative; timolol; unclassified drug; unindexed drug; unoprostone; clinical trial; dose response; drug absorption; drug bioavailability; drug choice; drug cost; drug delivery system; drug distribution; drug elimination; drug formulation; drug mechanism; drug penetration; drug tissue level; electronics; emulsion; eye disease; glaucoma; human; long term care; monotherapy; patient compliance; review; systemic disease; viscoelasticity; agn 191129; agn 192024; ru 486

Visual loss in urban and rural chronic glaucoma patients in Ghana - Ntim-Amponsah, C.T. (Tropical Doctor, 2002)
The visual acuity of newly diagnosed glaucoma patients in a rural and an urban area were compared in a hospital-based cross-sectional study in Ghana. Age at presentation was strikingly higher in the rural group due to local factors which result in a difference-in-age structure of the rural and urban population. The crude relative frequency of bilateral blindness was significantly higher for rural than urban. However, with age adjusted relative frequencies for bilateral blindness there was no significant difference between rural and urban patients. There was significant difference between them for those aged 51-71 when blindness in one or both eyes were considered together. There was more consistent blindness in the rural community: the difference was attributed to local factors such as better access to eye care in the urban group.
Keywords: adolescent; adult; age distribution; aged; article; blindness; controlled study; female; Ghana; glaucoma; health care access; human; major clinical study; male; onset age; rural area; urban area; visual acuity; visual impairment

Case reports of three atypical infiltrative keratitis events with high Dk soft contact lens wear - Skotnitsky, C.; Jalbert, I.; O'Hare, N.; Sweeney, D.F.; Holden, B.A. (Cornea, 2002)
Purpose. We report three atypical infiltrative keratitis events in patients that had successfully worn highly oxygen permeable (Dk) soft contact lenses on an extended wear (EW) schedule for at least 15 months. These cases highlight the role of patient/practitioner education, patient compliance, examination, and appropriate referrals that are required to reduce the risk of complications during lens wear. Methods and Results. Each patient had been wearing high Dk soft lenses on an EW schedule with monthly replacement for at least 15 months and presented with severe pain, redness, and photophobia. The events were characterized by focal infiltrate(s) with an overlying epithelial defect in the superior periphery to mid-periphery of the cornea and extensive diffuse infiltration. Conclusions. The signs and symptoms of each case were more severe than is typically associated with contact lens-related infiltrative keratitis. Because of the slow progression of signs and relatively fast resolution, the cases were not found to be microbial keratitis. Although high Dk soft contact lenses overcome hypoxia-associated complications associated with extended wear, patients and practitioners must be vigilant as adverse events can still occur and in rare instances can be severe. Education and patient compliance are a crucial part of successful management of patients on EW schedules. Constant reinforcement is necessary to ensure patient compliance.
Keywords: oxygen; adult; article; case report; disease course; female; human; hydrogel; hypoxia; keratitis; pain; patient compliance; patient education; patient referral; permeability; photophobia; priority journal; soft contact lens; staining

Selective laser trabeculoplasty: A new treatment option for open angle glaucoma - Latina, M.A.; Tumbocon, J.A.J. (Current Opinion in Ophthalmology, 2002)
Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering the intraocular pressure in patients with open angle glaucoma. The preservation of the trabecular meshwork architecture and the demonstrated efficacy in lowering intraocular pressure makes the SLT a reasonable and safe alternative to argon laser trabeculoplasty. In addition, SLT is a potentially repeatable procedure because of the lack of coagulation damage to the trabecular meshwork and the demonstrated efficacy in patients with previously failed argon laser trabeculoplasty treatment. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or are noncompliant with their glaucoma medications, while not interfering with the success of future surgery. Due to its nondestructive properties and low complication rate, SLT has the potential to evolve as an ideal first-line treatment in open angle glaucoma. © 2002 Lippincott Williams & Wilkins, Inc.
Keywords: argon laser; clinical trial; human; intraocular pressure; laser surgery; open angle glaucoma; patient compliance; priority journal; review; trabecular meshwork; trabeculoplasty; treatment failure; treatment outcome

Community screening for eye disease by laypersons: The Hoffberger program - Quigley, H.A.; Park, C.K.; Tracey, P.A.; Pollack, I.P. (American Journal of Ophthalmology, 2002)
PURPOSE: To describe the results of a community-based eye screening program in Baltimore. DESIGN: Cross-sectional study. METHODS: This was a retrospective study of the results of screening both eyes of 5352 persons who presented at multiple community sites. The screening examination had eight risk factor questions, visual acuity measurement, and a screening field test and was carried out by technicians and lay volunteers. Screened persons (screenees) received a definitive eye examination at no out-of-pocket cost, transportation was offered, and inexpensive eyeglasses were provided if needed. The main outcome measures were the rate of appointment keeping and the eye diseases identified. Telephone interviews were used to assess reasons for missing appointments and satisfaction with visits. RESULTS: Screenees had a median age of 45 years, were 71% black, 59% female, and had estimated median annual family income of $24,000. Among 1331 screenees who scheduled a definitive examination appointment, 552 (41%) completed the visit. Data on definitive diagnosis was available in 480 out of 552 persons (87%). Reasons given for failing to come for definitive examination were: no appointment given (26%), forgot (20%), lack of transportation (9%), and lack of insurance coverage (6%). Of those who accepted a second visit date after defaulting, only 25% (41/167) appeared. Of 17 persons identified with glaucoma at screening, 4 had previously been diagnosed, but had ceased active care. CONCLUSION: After community screening for eye disease, efforts to provide definitive ophthalmic examination were only modestly effective. Failure of screenees to come for examination and loss to follow up were identified as serious problems. © 2002 by Elsevier Science Inc. All rights reserved.
Keywords: adult; article; community care; controlled study; cost; eye disease; female; follow up; glaucoma; health care need; health care personnel; health insurance; human; interview; major clinical study; male; mass screening; outcomes research; patient compliance; patient transport; priority journal; risk factor; spectacles; telephone; visual acuity; volunteer

Timolol maleate 0.5% versus timolol maleate in gel forming solution 0.5% (Timolol GFS) in open angle glaucoma in India. Preliminary safety and efficacy study - Kumar, H.; Sudan, R.; Sethi, H.S.; Sony, P. (Indian Journal of Ophthalmology, 2002)
Purpose: To compare the efficacy and safety profile of Timolol maleate 0.5% versus Timolol gel forming solution (GFS) 0.5% in open angle glaucoma in Indian eyes. Methods: In a prospective crossover study 52 patients of open angle glaucoma, well controlled intraocular pressure (IOP) on 0.5% timolol maleate solution were switched over to timolol GFS once a day, after a washout period of one month. A diurnal IOP measurement was done after 6 weeks and compared with patients on timolol maleate 0.5% twice a day. In addition, side effects reported or observed were compared. Results: Statistically significant difference was not observed in ocular hypotensive effect of the two treatments. The side-effects in both the treatment groups were similar except for higher incidence of blurring of vision in patients on timolol GFS. The compliance was better with timolol GFS, but was not statistically significant. Conclusion: The results of this study suggest that the more convenient 0.5% timolol in gel forming solution can be offered as an equally efficacious and well-tolerated alternative to twice daily 0.5% timolol solution in open angle glaucoma.
Keywords: timolet gfs; timolol maleate; adult; aged; article; blepharitis; circadian rhythm; clinical trial; controlled clinical trial; controlled study; crossover procedure; drug efficacy; drug formulation; drug safety; drug tolerability; fatigue; female; foreign body; gel; headache; human; hyperemia; insomnia; intraocular hypotension; intraocular pressure; major clinical study; male; open angle glaucoma; patient compliance; preliminary communication; prospective study; pruritus; tear flow; tonometry; treatment outcome; visual impairment; timolet gfs

Discussion - Serle, J.B. (Ophthalmology, 2002)
Keywords: brimonidine; latanoprost; depression; drug cost; drug efficacy; drug tolerability; glaucoma; herpes simplex keratitis; human; intraocular pressure; note; patient compliance; photophobia; priority journal; quality of life; retina macula cystoid edema; uveitis; wheezing; xerostomia

Primary drug treatment for glaucoma: Beta-blockers versus other medications - Stamper, R.L. (Survey of Ophthalmology, 2002)
This set of Viewpoints articles examines the merits of beta-blockers versus other medications as the primary drug treatment for glaucoma. Ophthalmologists must balance issues such as efficacy, compliance, cost, and side effects when deciding on the appropriate medication to prescribe. Dr. Stamper stresses the advantages of tailoring the choice of medication to the needs of the individual patient. Drs. Wigginton and Higginbotham review the benefits of beta-blockers and present some of the disadvantages of the non-beta-blocker class of medications. © 2002 by Elsevier Science Inc. All rights reserved.
Keywords: alpha adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; carbonate dehydratase inhibitor; dorzolamide; dorzolamide plus timolol; drug preservative; latanoprost; levobunolol; prostaglandin derivative; purite; quinidine; timolol; travoprost; unclassified drug; unoprostone isopropyl ester; bradycardia; bronchospasm; dose response; drug choice; drug contraindication; drug cost; drug effect; drug efficacy; drug formulation; drug mechanism; glaucoma; human; intraocular pressure; patient compliance; priority journal; review; side effect; treatment indication; treatment outcome; alphagan; azopt; cosopt; iopidine; lumigan; rescula; travatan; trusopt; xalatan

II. Choosing beta-blockers for initial medical therapy for glaucoma - Wigginton, S.A.; Higginbotham, E.J. (Survey of Ophthalmology, 2002)
Keywords: acetazolamide; adrenalin borate; adrenergic receptor blocking agent; anesthetic agent; antiglaucoma agent; beta adrenergic receptor blocking agent; betaxolol; brimonidine; brinzolamide; calcium channel blocking agent; carteolol; clonidine; diltiazem; dorzolamide; dorzolamide plus timolol; high density lipoprotein; latanoprost; levobunolol; metipranolol; nifedipine; pilocarpine; timolol; timolol maleate; unclassified drug; unindexed drug; verapamil; cost benefit analysis; dose response; dose time effect relation; drug choice; drug contraindication; drug cost; drug efficacy; drug half life; drug mechanism; glaucoma; human; intraocular pressure; neuroprotection; nonhuman; patient compliance; prescription; priority journal; review; side effect; treatment outcome; alphagan; azopt; betagan; betoptic; cosopt; ocupress; optipranolol; timoptic; trusopt; xalatan

Utilisation of eye care services by urban and rural Australians - Keeffe, J.E.; Weih, L.M.; McCarty, C.A.; Taylor, H.R. (British Journal of Ophthalmology, 2002)
Aim: To investigate factors related to the use of eye care services in Australia. Methods: Health, eye care service use, and socio-demographic data were collected in a structured interview of participants in a population based study. All participants had a standard eye examination. Results: Men (OR 1.3 CL 1.02, 1.7), those who spoke Greek (OR 2.1 CL 1.1, 3.8) or Italian (OR 1.9 CL 1.0, 3.3), and those without private health insurance (OR 1.59 CL 1.22, 2.04) were more likely to have not used eye care services. Ophthalmology services were utilised at lower rates in rural areas (OR 0.14 CL 0.09, 0.2). Approximately 40% of participants with undercorrected refractive error, cataract, and undiagnosed glaucoma had seen either an ophthalmologist, optometrist, or both within the last year. Conclusion: Despite the similarity in prevalence of eye disease in urban and rural areas, significant differences exist in the utilisation of eye care services. Sex, private health insurance, urban residence, and the ability to converse in English were significant factors associated with eye healthcare service use. Many participants had undiagnosed eye disease despite having seen an eye care provider in the last year.
Keywords: article; Australia; cataract; eye disease; female; glaucoma; health care utilization; health insurance; human; major clinical study; male; priority journal; refraction error; urban rural difference

A study of patients attending for eye surgery at a rural hospital in the Republic of Benin - Potter, A.R. (Tropical Doctor, 2002)
Keywords: adolescent; adult; aged; article; Benin; cataract; cataract extraction; child; controlled study; entropion; female; glaucoma; glaucoma surgery; health care utilization; human; major clinical study; male; rural health care; World Health Organization

The pattern and severity of primary glaucoma in Qatar - Al Mansouri, F. (Qatar Medical Journal, 2002)
Purpose: To describe the pattern of both types of primary glaucoma in Qatari adult patients and to outline the main problem related to its management. Material and Methods: A random sample of Qatari patients with primary glaucoma either open angle or angle closure glaucoma in whom the diagnosis was made after the age of 30 years was studied over the last 2 years (1997-1998) by standard questionnaire as regards their personal and medical profile, and assessed ophthalmologically both subjectively and objectively. Results: 195 patients were studied, of whom 29.7% had angle closure glaucoma. Early presentation was clearly shown in both type of glaucoma. Legal blindness was present in significant proportion of patients. Comment: Glaucoma in Qatari patients presents at an early age, with substantial loss of visual function at presentation. Poor compliance is an obstacle for management in both types of glaucomas. The need for an educational campaign and a program for early detection is highly advised.
Keywords: adult; aged; article; blindness; closed angle glaucoma; controlled study; disease severity; early diagnosis; female; health education; health program; health status; human; major clinical study; male; onset age; open angle glaucoma; patient care; patient compliance; primary glaucoma; Qatar; questionnaire; randomization; visual system examination

2001: A contact lens (space) odyssey - Efron, N. (Contact Lens and Anterior Eye, 2001)
Keywords: hydrogen peroxide; naproxen; oxygen; animal experiment; animal model; confocal microscopy; contact lens; contrast sensitivity; controlled study; cornea edema; cornea ulcer; disposable equipment; editorial; gas permeability; history; human; hydration; microbiology; Haplorhini; nonhuman; patient compliance; priority journal; rating scale; soft contact lens; temperature measurement

A case of vitrectomy for Behçet's disease with rubeosis iridis - Ueno, F.; Sakaguchi, Y.; Naito, T.; Shiota, H. (Folia Ophthalmologica Japonica, 2001)
Background: The visual prognosis of Behçet's disease with rubeosis iridis is generally very poor and surgical treatment for Behçet's disease is controversial. We report a case of Behçet's disease with rubeosis iridis in which surgery had merit. Case Report: A 40-year-old male presented with vitritis in both eyes as a manifestation of Behçet's disease. Topical steroid and systemic colchicine were administered but the patient's compliance with therapy was poor. Rubeosis iridis, vitreous hemorrhage, and fibrous proliferation developed after several acute exacerbations. Visual acuity in the patient's right eye was hand motion and the intraocular pressure (IOP) in this eye was 10 mmHg. Pars plana vitrectomy, panretinal photocoagulation, and silicone oil tamponade, which was left in place for 6 months postoperatively, were performed. Rubeosis iridis disappeared by 10 days after surgery and best postoperative visual acuity in the right eye was 0.5. Visual acuity in the right eye decreased to 0.08 because of cataract formation. However, there was no serious recurrence or exacerbation of uveitis during 15 months of follow-up after the operation. Conclusion: This case suggests that the surgical treatment for Behçet's disease with rubeosis iridis may help to prevent rubeotic glaucoma and improve the visual prognosis.
Keywords: colchicine; steroid; adult; Behcet disease; case report; cataractogenesis; cell proliferation; ciliary disk; conference paper; disease exacerbation; follow up; human; intraocular pressure; iris rubeosis; laser coagulation; male; patient compliance; postoperative care; prognosis; steroid therapy; surgical technique; uveitis; visual acuity; visual impairment; vitrectomy; vitreous disease; vitreous hemorrhage

The latest viewpoint on prostaglandin analogues - Samples, J.; Schacknow, P.; Barnebey, H.; Robin, A.L.; Craven, E.R.; Weiner, A. (Formulary, 2001)
Dr. Robin: Our treatment of glaucoma has changed dramatically over the last 5 years with the introduction of prostaglandin analogues. These analogues have increased systemic safety and lowered IOP more than other classes of medication. They offer a compliance advantage with once-a-day dosing, and their efficacy in lowering IOP may be equivalent to combined therapy with other medications. All the analogues, however, are not the same. There are differences in occurrence of hyperemia and systemic side effects, packaging, and, most importantly, racial differences in efficacy. Travoprost clearly lowers IOP better in blacks than in nonblacks. Dr. Barnebey: The prostaglandin analogues have emerged as first-line treatment for glaucoma. They offer around-the-clock protection by flattening the diurnal curve, and they are more predictable in their response rate. As Dr. Robin pointed out, prostaglandin analogues are not all alike; they differ in terms of efficacy and safety. Dr. Samples: Travoprost also works well to reduce IOP to medically acceptable levels when combined with β-blockers and other classes of medication. The side effect profile with travoprost has been very good with respect to patient acceptance. The fact that it does not require refrigeration is a great advantage in terms of how it is distributed through managed care environments that must pay to ship products cold.
Keywords: acetazolamide; epinephrine; antiglaucoma agent; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; brinzolamide; dorzolamide; eye drops; latanoprost; levobunolol; methazolamide; pilocarpine; prostaglandin derivative; prostanoid receptor; timolol; travoprost; unclassified drug; unoprostone isopropyl ester; clinical trial; cost effectiveness analysis; drug cost; drug efficacy; drug labeling; drug mechanism; drug packaging; drug potency; drug receptor binding; drug response; drug safety; drug stability; drug storage; drug structure; drug tolerability; glaucoma; hirsutism; human; hyperemia; intraocular pressure; managed care; nonhuman; patient compliance; pharmacogenetics; review; side effect; skin discoloration; structure activity relation

Pharmacia launches dual glaucomatherapy (Manufacturing Chemist, 2001)
Keywords: antiglaucoma agent; latanoprost; latanoprost plus timolol; timolol maleate; unclassified drug; clinical trial; drug mechanism; drug tolerability; glaucoma; intraocular pressure; monotherapy; note; patient compliance; xalacom; xalatan

Instillation of drugs in the eye: importance of proper instructions to patients - Gautam, C.S.; Bhanwra, S.; Goel, N.K.; Gupta, S.K.; Sood, S. (Indian Journal of Pharmacology, 2001)
Keywords: antidiabetic agent; beta adrenergic receptor blocking agent; eye drops; drug contamination; drug instillation; glaucoma; human; hygiene; interview; letter; major clinical study; medical student; patient compliance; patient information; patient positioning; prescription; questionnaire

The impact of non-compliance on the cost-effectiveness of pharmaceuticals: A review of the literature - Hughes, D.A.; Bagust, A.; Haycox, A.; Walley, T. (Health Economics, 2001)
Non-compliance with drug therapies not only limits their effectiveness, but in some instances, is associated with grave clinical sequelae and substantial economic burden. It is important, therefore, to consider non-compliance in economic evaluations. A review of pharmacoeconomic evaluations, which have applied sensitivity analysis to non-compliance rates, was undertaken to evaluate the impact of non-compliance on the cost-effectiveness of different drug therapies. Although 22 evaluations satisfied the inclusion criteria, additional information was obtained from the authors of most studies, as the published details were inadequate. The majority of evaluations assumed altered effectiveness owing to reduced compliance in the absence of supportive clinical evidence. Because of the disparity in the nature of the outcomes, the measures of non-compliance and the time horizon of the studies evaluated, it was not possible to compare the magnitude of the impact of non-compliance among different drug disease combinations. However, it was evident that non-compliance always results in a reduction in efficacy, but its impact on costs varied substantially. The importance of incorporating measures of compliance is highlighted, as failing to account for 'real world' compliance rates in pharmacoeconomic evaluations may lead to selection of sub-optimal treatment strategies. Copyright © 2001 John Wiley & Sons, Ltd.
Keywords: aciclovir; alendronic acid; amoxicillin; bismuth salicylate; calcium; ceftriaxone; clarithromycin; dipeptidyl carboxypeptidase inhibitor; doxycycline; etidronic acid; ganciclovir; hydrochlorothiazide; imipramine; beta1b interferon; isosorbide mononitrate; metronidazole; mevinolin; mirtazapine; nefazodone; neuroleptic agent; nicotine; omeprazole; paroxetine; pilocarpine; conjugated estrogen plus norgestrel; proton pump inhibitor; tetracycline; tolterodine; unindexed drug; warfarin; angina pectoris; article; bacterial infection; bladder disease; controlled study; cost effectiveness analysis; depression; diabetic nephropathy; drug cost; duodenum ulcer; economic aspect; evaluation study; fracture; human; ischemic heart disease; medical information; medical literature; multiple sclerosis; open angle glaucoma; osteoporosis; outcomes research; patient compliance; pharmaceutics; priority journal; publishing; retinitis; review; satisfaction; schizophrenia; sensitivity and specificity; smoking cessation; thromboembolism; time; virus infection

Racial disparities in vision impairment and blindness: Causes and future research direction - Wilson, M.Roy (Ophthalmology, 2001)
Keywords: blindness; cataract; editorial; environmental sanitation; geographic distribution; health care access; human; morbidity; open angle glaucoma; phenotype; prevalence; priority journal; race difference; risk factor; sickle cell anemia; social status; sun exposure; visual impairment

Status of follow-up visits of patients with open-angle glaucoma - Yoshikawa, K.; Matsumoto, S. (Japanese Journal of Clinical Ophthalmology, 2001)
We reviewed 331 patients with open-angle glaucoma or ocular hypertension regarding their follow-up visits during one year or longer after the initial diagnosis. Out of the series, 188 patients (56.8%) visited us at an interval of 1 to 2 months, 41 patients (12.4%) at an interval of 3 to 6 months, 31 patients (9.4%) at an interval of 6 to 12 months, and 47 patients (14.2%) discontinued follow-up visits. Twenty-four patients (7.2%) failed to show up after the initial diagnosis. Regular follow-up visits were made by patients when 1) their stay in the outpatient clinic was short (p<0.02), 2) they were aged 60 years or over (p<0.001), or 3) they were under medication or had received surgery before (p < 0.001). These findings show that continued treatment is a major motivation of follow-up visits. Out of 93 patients who did not receive medications, however, 54 patients (58%) visited us at an interval of 1 to 2 months.
Keywords: adolescent; adult; aged; female; follow up; human; intraocular hypertension; length of stay; major clinical study; male; open angle glaucoma; outpatient; patient compliance; review; school child; surgical technique

Glaucoma care in West Africa - Budenz, D.L.; Singh, K.; Grehn, F. (Journal of Glaucoma, 2001)
The authors draw on the peer review literature and 8 years of personal experience to provide an overview of the prevalence and management of glaucoma in West Africa.
Keywords: Africa; diagnostic procedure; disease course; glaucoma; glaucoma surgery; health care access; human; onset age; prevalence; priority journal; review