Characteristics Associated With New Patient Appointment No-Shows at an Academic Ophthalmology Department in the United States - Chiam, M.; Kunselman, A.R.; Chen, M.C. (American Journal of Ophthalmology, 2021)
Purpose: This study aimed to identify patient and appointment characteristics associated with no-shows to new patient appointments at a US academic ophthalmology department. Design: Cross-sectional study. Methods: This was a study of all adult patients with new patient appointments scheduled with an attending ophthalmologist at Penn State Eye Center between January 1st and December 31st of 2019. A multiple logistic regression model was used to assess the association between characteristics and no-show status. Results: Of 4,628 patients, 759 (16.4%) were no-shows. From the multiple logistic regression model, characteristics associated with no-shows were age (Odds Ratio (OR) for 18-40 years vs. >60 years: 3.41, 95% Confidence Interval (CI) 2.57, 4.51, p <0.001 and OR for 41-60 years vs. >60 years: 2.14, 95% CI 1.67, 2.74, p<0.001), median household income (OR for <$35,667 vs. >$59,445: 1.59, 95% CI 1.08, 2.34, p<0.001), insurance (OR for None vs. Medicare: 6.92, 95% CI 4.41, 10.86, p<0.001 and OR for Medicaid vs. Medicare: 1.54, 95% CI 1.18, 2.01, p=0.002), race (OR for Black vs. White: 2.62, 95% CI 2.00, 3.43, p<0.001 and OR for Other vs. White: 2.02, 95% CI 1.58, 2.59, p<0.001), and commute distance (OR for 5-10 mi vs. ≤5 mi: 1.73, 95% CI 1.17, 2.55, p=0.006). Appointments with longer lead times and scheduled with glaucoma or retina specialists were also significantly associated with greater no-shows. Conclusion: Certain patient and appointment characteristics were associated with no-show status. These findings may assist in the development of targeted interventions at the patient, practice, and health system levels to improve appointment attendance.
Keywords: hydroxychloroquine; adult; article; clinical assessment; clinical feature; clinical practice; controlled study; cross-sectional study; diabetic retinopathy; disease association; female; glaucoma; health care; hospital management; household income; human; major clinical study; male; medicaid; medicare; ophthalmologist; ophthalmology; patient attendance; patient identification; ptosis (eyelid); race difference; retrospective study; United States

The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment - Shalaby, W.S.; Odayappan, A.; Venkatesh, R.; Swenor, B.K.; Ramulu, P.Y.; Robin, A.L.; Srinivasan, K.; Shukla, A.G. (American Journal of Ophthalmology, 2021)
Purpose: TO assess perceptions and implications of COVID-19 infection across the spectrum of individuals with visually impairment (VI) and those with normal sight. Design: Prospective cross-sectional comparative study. Methods: Setting: institutional. Patients: 232 patients and their caregivers. Four groups were created based on better eye characteristics: blind (best-corrected distance visual acuity [BCDVA] <3/60 or visual field <10 central degrees); severe VI (BCDVA ≤3/60 to <6/60; vertical cup-to-disc ratio ≥0.85 or neuroretinal rim width ≤0.1); moderate VI (BCDVA ≤6/60 to <6/18); or no or mild VI (controls: BCDVA ≥6/18) based on International Classification of Diseases-10 criteria and Foster and Quigley's consensus definition of glaucoma. Procedure: telephone questionnaires. Main outcome measures: differences in perceptions and implications of COVID-19 infection across various levels of VI. Caregiver perceptions were a secondary outcome measure. Results: Surveys were completed by 232 participants, with 58 participants in each VI group. Mean age was 58.9 ± 13.2 years old. Greater degrees of VI were associated with older age (P = .008) and lower education level (P = .046). Blind participants more commonly perceived vision as a risk factor for contracting COVID-19 (P = .045), were concerned about access to health care (P <.001), obtained news through word of mouth (P <.001), and less commonly wore masks (P = .003). Controls more commonly performed frequent handwashing (P = .001), were aware of telemedicine (P = .029), and had fewer concerns about social interactions (P = .020) than groups with substantial VI. All caregivers reported more frequent patient care since the COVID-19 pandemic began. Conclusions: The pandemic might have had a disproportionate impact on the visually impaired, and evidence-based assessments of COVID-19 health outcomes in this population are warranted.
Keywords: adult; age; aged; article; caregiver; clinical assessment; comparative study; coronavirus disease 2019; corrected distance visual acuity; education; eye; female; glaucoma; hand washing; health care access; human; International Classification of Diseases; major clinical study; male; mask; middle aged; pandemic; patient care; prospective study; questionnaire; risk factor; social interaction; telemedicine; telephone; vertical cup-to-disc ratio; visual field; visual impairment

Identifying priority review questions for Cochrane Eyes and Vision: Protocol for a priority setting exercise - Evans, J.R.; Gordon, I.; Lawrenson, J.G.; Parker, R.; Rowe, F.J.; Virgili, G.; Li, T.; Ramke, J. (BMJ Open, 2021)
Introduction Cochrane Eyes and Vision (CEV) is an international network of individuals working to prepare, maintain and promote access to systematic reviews of interventions to treat, prevent or diagnose eye diseases or vision impairment. CEV plans to undertake a priority setting exercise to identify systematically research questions relevant to our scope, and to formally incorporate input from a wide range of stakeholders to set priorities for new and updated reviews. Methods and analysis The scope of CEV is broad and our reviews include conditions that are common and have a high global disease burden, for example, cataract and dry eye disease, and conditions that are rare but have a high impact on quality of life and high individual cost such as eye cancer. We plan to focus on conditions prioritised by WHO during the development of the Package of Eye Care Interventions. These conditions were selected based on a combination of data on disease magnitude, healthcare use and expert opinion. We will identify priority review questions systematically by summarising relevant data on research in Eyes and Vision from a range of sources, and compiling a list of 10-15 potential review questions (new and/or updates) for each condition group. We will seek the views of external and internal stakeholders on this list by conducting an online survey. Equity will be a specific consideration. Ethics and dissemination The study has been approved by the ethics committee of the London School of Hygiene & Tropical Medicine. We will disseminate the findings through Cochrane channels and prepare a summary of the work for publication in a peer-reviewed journal.
Keywords: adult; cataract; dry eye syndrome; England; exercise; eye cancer; eye care; female; glaucoma; global disease burden; health care utilization; human; male; ophthalmology; professional standard; quality of life; refractive surgery; review; school hygiene; surgery; systematic review; tropical medicine; visual impairment

A cost-effectiveness analysis of iStent inject combined with phacoemulsification cataract surgery in patients with mild-to-moderate open-angle glaucoma in France - Nieland, K.; Labbé, A.; Schweitzer, C.; Gicquel, G.; Kleintjens, J.; Ostawal, A.; Treur, M.; Falvey, H. (PLoS ONE, 2021)
Objective To investigate the cost-effectiveness of implementing iStent inject trabecular bypass stent (TBS) in conjunction with cataract surgery (Cat Sx) in patients with mild-to-moderate glaucoma from a societal perspective in France. The secondary objective was to explore the economic impact of iStent inject TBS in patients who comply to different degrees with their anti-glaucoma medications. Methods A previously published Markov model was adapted to estimate the cost-effectiveness of treatment with iStent inject TBS + Cat Sx versus Cat Sx alone over a lifetime time horizon in patients with mild-to-moderate open-angle glaucoma in France. Progression was modeled by health states reflecting increasing stages of vision loss. Disease progression was obtained from the two-year randomized clinical trial assessing safety and effectiveness of both interventions. French specific health-state utilities and costs were obtained through a targeted literature review. Model structure and inputs were validated by French ophthalmologists. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY) gained. The robustness of results was tested through sensitivity analyses. Results iStent inject TBS + Cat Sx reduced the number of medications needed and risk of blindness. Incremental cost and QALYs were €75 and 0.065 leading to an incremental cost-effectiveness ratio (ICER) of €1,154/QALY gained. ICER ranged from dominating for non-persistent patients to €31,127 patients fully persistent with their medication regime. Results from one-way sensitivity analysis had a maximum ICER of €29,000 when varying input parameters. iStent inject TBS + Cat Sx had an 86% chance of being cost-effective at a willingness-to-pay threshold of €30,000 per QALY gained. Conclusion Results demonstrate that iStent inject TBS + Cat Sx is a cost-effective intervention for intraocular pressure reduction when compared to Cat Sx alone in France.
Keywords: glaucoma drainage implant; intraocular pressure reducer; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin; aged; article; blindness; cataract extraction; clinical effectiveness; controlled study; cost effectiveness analysis; disease exacerbation; disease severity; economic aspect; economic evaluation; France; health care utilization; health status; human; lifespan; Markov chain; open angle glaucoma; phacoemulsification; quality adjusted life year; randomized controlled trial; safety; sensitivity analysis; treatment outcome; visual impairment; Willingness To Pay

A Randomized Trial to Improve Adherence to Follow-up Eye Examinations Among People With Glaucoma - Leiby, B.E.; Hegarty, S.E.; Zhan, T.; Myers, J.S.; Katz, L.J.; Haller, J.A.; Waisbourd, M.; Burns, C.; Divers, M.; Molineaux, J.; Henderer, J.; Brodowski, C.; et al. (Preventing chronic disease, 2021)
INTRODUCTION: Appointment nonadherence is common among people with glaucoma, making it difficult for eye care providers to monitor glaucoma progression. Our objective was to determine whether the use of patient navigators, in conjunction with social worker support, could increase adherence to recommended follow-up eye appointments. METHODS: A randomized, controlled trial evaluated the effectiveness of an intervention that used patient navigators and social workers to improve patient adherence to follow-up eye care compared with usual care. Participants with glaucoma and other eye diseases (N = 344) were identified at primary care clinics in community settings through telemedicine screening of imaging and then randomized to enhanced intervention (EI) or usual care (UC). Data on participants' visits with local ophthalmologists were collected for up to 3 years from randomization. Groups were compared for timely attendance at the first visit with the local ophthalmologist and adherence to recommended follow-up visits. RESULTS: Timely attendance at the first visit was higher for EI than UC (74.4% vs 39.0%; average relative risk [aRR] = 1.85; 95% CI, 1.51-2.28; P < .001). Rates of adherence to recommended annual follow-up during year 1 were 18.6% in the EI group and 8.1% in the usual care group (aRR = 2.08; 95% CI, 1.14-3.76; P = .02). The aRR across years 2 and 3 was 3.92 (95% CI, 1.24-12.43; P = .02). CONCLUSION: An intervention using patient navigators and social workers doubled the rate of adherence to annual recommended follow-up eye care compared with usual care in community settings, and was effective at increasing connections with local ophthalmologists. Interventions to further improve long-term adherence are needed.
Keywords: adult; article; comparative effectiveness; eye care; eye examination; female; follow up; glaucoma; human; major clinical study; male; ophthalmologist; primary medical care; randomization; randomized controlled trial; risk factor; social worker; telemedicine

Incidence, individual, and macro level risk factors of severe binocular visual impairment and blindness in persons aged 50 and older - Kreft, D.; Doblhammer, G.; Guthoff, R.F.; Frech, S. (PLoS ONE, 2021)
Objective This study aims to estimate the incidence of severe binocular vision impairment and blindness (SVI/B) and to identify eye diseases and regional risk factors of persons with SVI/B at ages 50 years and older. Methods We designed an observational cohort study based on longitudinal, multifactorial, and administrative information of a random sample of 250,000 persons at ages 50+. All individuals were included in the process-produced health claims register of the Allgemeine Ortskrankenkasse in 2004, and were followed until 2015. We analyzed ten selected eye diseases and regional characteristics as risk factors for SVI/B using Cox models, adjusting for demographic characteristics and multi-morbidity. Results The age-standardized incidence was 79 new diagnoses of SVI/B per 100,000 person-years (95%-CI: 76-82); 77 for males (72-82) and 81 for females (77-85). By adjusting for multiple factors, the model revealed and confirmed that individuals who were very old (Hazard ratio90+: 6.67; 3.59-12.71), male (1.18; 1.01-1.38), had multi-morbidities (three+ diseases: 3.36; 2.51-4.49), or had diabetes (1.26; 1.07-1.49) had an increased risk of SVI/B. Compared to persons without the particular eye disease (all p<0.001), persons diagnosed with secondary glaucoma had a multiple-adjusted 4.66 times (3.17-6.85) higher risk, those with retinal vascular occlusion had a 4.51 times (3.27-6.23) higher risk, and those with angle-closure glaucoma had a 4.22 times (2.60-6.85) higher risk. Population density was not a risk factor, while persons living in wealthier regions had 0.75 times (p=0.003) to 0.70 times (p<0.001) the risk of SVI/B than persons in the least wealthy regions of Germany. Conclusion The study revealed and confirmed some profound risk factors of SVI/B at both the individual and the macro level. The sizes of the effects of the characteristics of the living context were smaller than those of the individual characteristics, especially for some severe eye diseases. While urbanity and access to health services had no effect, regional economic wealth was a risk factor for SVI/B. Future health care measures and advice by physicians should take these dimensions of inequalities in SVI/B into account.
Keywords: administrative claims (health care); adult; age related macular degeneration; aged; article; binocular vision; blindness; cataract; closed angle glaucoma; cohort analysis; comorbidity; controlled study; demography; diabetes mellitus; diabetic retinopathy; disease classification; disease severity; economic aspect; effect size; female; Germany; groups by age; health care access; health service; high risk population; human; incidence; longitudinal study; major clinical study; male; middle aged; myopia; observational study; physician; population density; public health insurance; retina blood vessel occlusion; risk factor; secondary glaucoma; social welfare; urbanization; very elderly; visual impairment

Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology - Hark, L.A.; Kresch, Y.S.; De Moraes, C.G.; Horowitz, J.D.; Park, L.; Auran, J.D.; Gorroochurn, P.; Stempel, S.; Maruri, S.C.; Stidham, E.M.; Banks, A.Z.; Saaddine, J.B.; et al. (Journal of Glaucoma, 2021)
Précis: The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. Purpose: To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. Materials and Methods: This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23 to 29 mm Hg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. Those with an abnormal image and/or IOP ≥30 mm Hg, are assigned as "fast-track" and referred to ophthalmology. Participants living in 7 developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in 3 developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. Conclusion: This study targets vulnerable populations where they live to ensure improved access to and utilization of eye care services in those who are least likely to seek eye care.
Keywords: NCT04271709; direct ophthalmoscope; spectacles; tonometer; Welch Allyn Panoptic; adult; article; cataract; community care; controlled study; coronavirus disease 2019; cost benefit analysis; eye care; eye examination; eye photography; follow up; glaucoma; health care access; housing; human; intraocular pressure; pandemic; patient referral; priority journal; prospective study; quality of life; randomized controlled trial; social determinants of health; study design; telemedicine; United States; vision test; visual acuity; visual impairment; vulnerable population; Welch Allyn Panoptic

Screening and Interventions for Glaucoma and Eye Health through Telemedicine (SIGHT) Studies - De Moraes, C.G.; Hark, L.A.; Saaddine, J. (Journal of Glaucoma, 2021)
Keywords: follow up; glaucoma; health care access; health care cost; health care utilization; health equity; health hazard; human; intervention study; mass screening; priority journal; quality of life; review; risk factor; social determinants of health; telemedicine

Alabama Screening and Intervention for Glaucoma and Eye Health through Telemedicine (AL-SIGHT): Study Design and Methodology - Rhodes, L.A.; Register, S.; Asif, I.; McGwin, G.; Saaddine, J.; Nghiem, V.T.H.; Owsley, C.; Girkin, C.A. (Journal of Glaucoma, 2021)
Précis: This paper presents the methods and protocol of a community-based telemedicine program to identify glaucoma and other eye diseases. Purpose: To describe the study rationale and design of the Alabama Screening and Intervention for Glaucoma and eye Health through Telemedicine project. Methods: The study will implement and evaluate a telemedicine-based detection strategy for glaucoma, diabetic retinopathy, and other eye diseases in at-risk patients seen at federally qualified health centers located in rural Alabama. The study will compare the effectiveness of the remote use of structural and functional ocular imaging devices to an in-person examination. Study participants will receive a remote ocular assessment consisting of visual acuity, intraocular pressure, visual field testing, and imaging of the retina and optic nerve with spectral-domain optical coherence tomography, and the data will be reviewed by an ophthalmologist and optometrist. It will also compare the effectiveness of financial incentives along with a validated patient education program versus a validated patient education program alone in improving follow-up adherence. Finally, cost and cost-effectiveness analyses will be performed on the telemedicine program compared with standard in-person care using effectiveness measured in numbers of detected eye disease cases. Conclusions: The study aims to develop a model eye health system using telemedicine to prevent vision loss and address eye health among underserved and at-risk populations.
Keywords: imaging system; Alabama; article; cataract; clinical examination; controlled study; cost effectiveness analysis; diabetic retinopathy; economic incentive; eye disease assessment; follow up; glaucoma; health disparity; human; intraocular pressure; optic nerve; patient compliance; patient education; perimetry; priority journal; retina; rural area; screening; spectral domain optical coherence tomography; study design; telediagnosis; visual acuity; visual impairment

Impact of COVID-19 on follow-up and medication adherence in patients with glaucoma in a tertiary eye care centre in south India - Subathra, G.N.; Rajendrababu, S.R.; Senthilkumar, V.A.; Mani, I.; Udayakumar, B. (Indian journal of ophthalmology, 2021)
Purpose: COVID-19 pandemic has affected the healthcare system worldwide hindering the continuum of treatment of chronic disease patients. The objective of the study is to analyze the barriers encountered by the glaucoma patients for the follow-up visit and medication adherence during the pandemic. Methods: This cross-sectional study included glaucoma patients who did not attend the scheduled appointment from April 1, 2020 to July 31, 2020 in a tertiary eye care center (88.21%). Eligible patients of age >18 years and advised antiglaucoma medication in Madurai Zone were interviewed with validated questionnaire through telephonic call. Results: 363 patients answered the questionnaire through telephonic interview. 57.3% of the patients were found to be non-adherent to medication. The main barriers for glaucoma follow-up visit during the pandemic were lockdown restriction, transport problem, and financial difficulties. The top barriers for medication adherence were non availability of medication (54.81%), financial difficulties (30.29%), did not feel much improvement with eye drops (20.19%). On multiple regression analysis, longer distance to hospital, low socioeconomic status, more than one antiglaucoma medication use, lack of awareness of glaucoma, non-complaint before COVID-19 and stress due to the pandemic were found to be significant factors for medication non adherence. Conclusion: COVID-19 pandemic has emphasized the need for reformation in health care system for accessibility of medical care to patients in rural areas. Decentralization of health system to primary care level and utilization of teleophthalmology should be considered by health care planners in future.
Keywords: adolescent; communicable disease control; cross-sectional study; follow up; glaucoma; human; India; medication compliance; ophthalmology; pandemic; telemedicine

Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT): Baseline Methodology for Implementing and Assessing a Community-based Program - Newman-Casey, P.A.; Musch, D.C.; Niziol, L.M.; Elam, A.R.; Zhang, J.; Moroi, S.E.; Johnson, L.; Kershaw, M.; Saadine, J.; Winter, S.; Woodward, M.A. (Journal of Glaucoma, 2021)
Precis: The Michigan Screening and Intervention for Glaucoma and eye Health through Telemedicine (MI-SIGHT) program leverages community-engaged research, telemedicine, and health coaching to overcome key logistical and psychosocial barriers to improve glaucoma screening in underserved communities. Purpose: To describe the methodology of the implementation and evaluation of the MI-SIGHT Program. Methods: The MI-SIGHT Program uses community engagement, telemedicine, and health coaching to overcome key logistical and psychosocial barriers to glaucoma identification and care among underserved populations. The MI-SIGHT Program will be evaluated in 2 community clinics: Hamilton Community Health Network, a federally qualified health center in Flint, Michigan, and the Hope Clinic, a free clinic in Ypsilanti, Michigan. A Community Advisory Board including the research team and health care providers, administrators, and patients from both clinics will guide program implementation. An ophthalmic technician at the community clinics will conduct screening tests for glaucoma and eye disease. The data will be transmitted through electronic health record to be reviewed by an ophthalmologist who will make recommendations for follow-up care. The ophthalmic technician will conduct a return visit to fit low-or no-cost glasses, help arrange follow-up with an ophthalmologist, and provide education. Those diagnosed with glaucoma or suspected glaucoma will be randomized to standard education or personalized glaucoma education and coaching. Costs will be assessed. Results: The authors hypothesize that the MI-SIGHT Program will detect a higher prevalence rate of glaucoma than that found in the general population, improve upon presenting visual acuity, enhance vision-related quality of life, and demonstrate that personalized glaucoma education and coaching improve adherence to follow-up care. Conclusion: The MI-SIGHT Program may serve as a model for glaucoma screening and care in high-risk communities.
Keywords: article; community care; electronic health record; follow up; glaucoma; health care cost; human; intervention study; mass screening; Michigan; prevalence; priority journal; quality of life; risk factor; telemedicine; visual acuity

Facilitators and Barriers to Glaucoma Screening Identified by Key Stakeholders in Underserved Communities: A Community-engaged Research Approach - Ballouz, D.; Cho, J.; Woodward, M.A.; Elam, A.R.; Musch, D.C.; Zhang, J.; Moroi, S.E.; Johnson, L.; Cederna, J.; Newman-Casey, P.A. (Journal of Glaucoma, 2021)
Précis: Community-engaged research (CER) enables researchers to identify community-specific barriers and facilitators to program implementation. Broadly applicable barriers to glaucoma care, such as Cost, Transportation, and Trust, and community-specific barriers, such as Language and Convenience/Access, were identified. Purpose: The aim was to identify the facilitators and barriers to implementing glaucoma screening programs in 2 community clinics. Methods: A concurrent mixed-methods process analysis using CER. Key stakeholders - including patients, providers, and staff members - from 2 community clinics were interviewed using a semistructured interview guide. Interviews had 2 parts: (1) asking patients about community-based facilitators and barriers to implementing glaucoma screening and care and (2) eliciting feedback about a personalized coaching program. The transcripts were coded using Grounded Theory. Number of participants and number of representative citations were counted per theme. The qualitative analysis was coded using Dedoose 8.3.17 (Los Angeles, CA). Results: Thematic saturation was reached after coding 12 interviews. 30 participants were interviewed, 13 from Hamilton Clinic (Flint, MI; 8 patients, 5 providers and staff members) and 17 from Hope Clinic (Ypsilanti, MI; 6 patients, 11 providers and staff members). The most commonly cited themes were: Priorities (98 citations, 30 participants), Knowledge (73, 26) Transportation (63, 26), Cost (60, 23), and Convenience/Access (63, 22). Broadly applicable barriers to glaucoma care, such as Cost, Transportation, and Trust were identified alongside community-specific barriers such as Language and Convenience/Access. Participants rated their likelihood to follow up with an ophthalmologist after participating in the personalized coaching program at a mean of 8.83 (on a scale of 1 to 10 with 10 being the most confident). Conclusions: CER enables researchers to identify community-specific barriers and facilitators, allowing more effective program implementation.
Keywords: article; attitude to health; clinical article; follow up; glaucoma; grounded theory; health care access; health care cost; health care personnel; human; mass screening; medically underserved; ophthalmologist; patient care; priority journal; qualitative analysis; semi structured interview; stakeholder engagement; telehealth; traffic and transport

Anesthesia considerations for cataract surgery in patients with schizophrenia: A narrative review - Kumar, C.M.; Palte, H.D.; Chua, A.W.Y.; Sinha, R.; Shah, S.B.; Imani, F.; Jalali, Z.M. (Anesthesiology and Pain Medicine, 2021)
Schizophrenia is ranked among the top 10 global burdens of disease. About 1% of people meet the diagnostic criteria for this disorder over their lifetime. Schizophrenic patients can develop cataract, particularly related to age and medications, requiring surgery and anesthesia. Many concerning factors, including cognitive function, anxiety, behavioral issues, poor cooperation and paroxysmal movements, may lead to general anesthesia as the default method. Antipsychotic agents should be continued during the periop-erative period if possible. Topical/regional anesthesia is suitable in most schizophrenic patients undergoing cataract surgery. It reduces potential drug interactions and many postoperative complications; however, appropriate patient selection is paramount to its success. General anesthesia remains the primary technique for patients who are considered unsuitable for the topical/regional technique. Early involvement of a psychiatrist in the perioperative period, especially for patients requiring general anesthesia, is beneficial but often under-utilized. This narrative review summarizes the anesthetic considerations for cataract surgery in patients with schizophrenia. Keywords.
Keywords: endotracheal tube; supraglottic airway device; atrial natriuretic factor; benzodiazepine; chlorpromazine; clozapine; dexmedetomidine; enflurane; epinephrine; fentanyl; haloperidol; ketamine; metoclopramide; midazolam; neuroleptic agent; ondansetron; opiate; paracetamol; phenylephrine; prochlorperazine; propofol; quetiapine; sevoflurane; tramadol; anxiety; apathy; body weight gain; cardiovascular disease; cataract; cataract extraction; chronic bronchitis; chronic obstructive lung disease; cognition; comorbidity; delirium; diabetes mellitus; drug interaction; dyslipidemia; electrocardiogram; general anesthesia; glaucoma; glucose intolerance; hallucination; heart arrhythmia; human; hypertension; hyperthermia; hypotension; intraocular pressure; local anesthesia; lung capacity; muscle rigidity; neuroleptic malignant syndrome; patient compliance; patient selection; perioperative period; peroperative complication; postoperative nausea and vomiting; postoperative pain; prevalence; psychosis; QT interval; QT prolongation; regional anesthesia; renin angiotensin aldosterone system; retina maculopathy; review; risk factor; schizophrenia; seizure; smoking; strabismus; surgical stress; tuberculosis

Ageing and vision loss: looking to the future - Swenor, B.K.; Ehrlich, J.R. (The Lancet Global Health, 2021)
Keywords: age related macular degeneration; aging; behavior change; cataract; diabetic retinopathy; glaucoma; health care access; health care quality; human; mental health; note; onchocerciasis; public health; sustainable development; trachoma; visual impairment

Epidemiology, economic and humanistic burdens of Ocular Surface Chemical Injury: A narrative review - Ahmmed, A.A.; Ting, D.S.J.; Figueiredo, F.C. (Ocular Surface, 2021)
Ocular surface chemical injury (OSCI) is a common type of ocular emergency that can potentially cause significant and permanent visual impairment. However, the global prevalence, demographic factors, socioeconomic burden, and psychological impact of OSCI have not been well investigated or reported. This review aims to provide a comprehensive overview of these aspects, highlight gaps in the literature, and advocate key strategies in reducing the incidence of OSCI. OSCI was responsible for 0.1–15% of all ocular emergency presentations, with an estimated incidence of 5.1–50 per 100,000 population-year. Young working adult men were the most at-risk group, though high rates of OSCI were also observed in young children in developed countries, especially from detergent pods. Low- and middle-income countries were noted to have higher proportions of assault-related and pediatric OSCI cases, often with more severe presentations. Direct and indirect costs for some hospitalized patients led to loss of all personal and household income after the injury. Emergency department costs in the United States were estimated at $106.7 million over four years and costs of treating long term complications such as glaucoma were estimated to be as high as $93,003 over five years. Significant negative impacts on visual and health-related quality of life and psychological well-being have been reported after injury, with higher rates of anxiety, depression, and psychological distress compared to the general population.
Keywords: Baerveldt glaucoma implant; keratoprosthesis; osteoodonto keratoprosthesis; protective equipment; punctal plug; acid; alkali; ammonia; calcium hydroxide; cement; cyclosporine; detergent; domestic chemical; formic acid; holoclar; hydrofluoric acid; hypochlorite sodium; lubricating agent; mitomycin; mustard gas; nitric acid; nutrition supplement; petroleum derivative; potassium hydroxide; sodium hydroxide; sulfuric acid; adult; aged; anxiety disorder; assault; chemical burn; chemical injury; child; comparative study; cornea disease; corneal scarring; daily life activity; depression; developed country; disease burden; distress syndrome; dry eye; economic development; emergency care; emergency ward; epidemiological data; ethnic group; eye injury; female; glaucoma; health care cost; health economics; health insurance; high risk population; hospital patient; household income; human; humanism; incidence; injury severity; limbal stem cell deficiency; low income country; major clinical study; male; middle income country; narrative; occupational accident; ocular surface chemical injury; ocular surface disease; patient compliance; pediatrics; penetrating keratoplasty; population; prevalence; psychological aspect; psychological well-being; quality of life; retrospective study; review; school child; social psychology; social status; socioeconomics; systematic review; tertiary health care; trabeculectomy; young adult

CLEAR - Orthokeratology - Vincent, S.J.; Cho, P.; Chan, K.Y.; Fadel, D.; Ghorbani-Mojarrad, N.; González-Méijome, J.M.; Johnson, L.; Kang, P.; Michaud, L.; Simard, P.; Jones, L. (Contact Lens and Anterior Eye, 2021)
Orthokeratology (ortho-k) is the process of deliberately reshaping the anterior cornea by utilising specialty contact lenses to temporarily and reversibly reduce refractive error after lens removal. Modern ortho-k utilises reverse geometry lens designs, made with highly oxygen permeable rigid materials, worn overnight to reshape the anterior cornea and provide temporary correction of refractive error. More recently, ortho-k has been extensively used to slow the progression of myopia in children. This report reviews the practice of ortho-k, including its history, mechanisms of refractive and ocular changes, current use in the correction of myopia, astigmatism, hyperopia, and presbyopia, and standard of care. Suitable candidates for ortho-k are described, along with the fitting process, factors impacting success, and the potential options for using newer lens designs. Ocular changes associated with ortho-k, such as alterations in corneal thickness, development of microcysts, pigmented arcs, and fibrillary lines are reviewed. The safety of ortho-k is extensively reviewed, along with an overview of non-compliant behaviours and appropriate disinfection regimens. Finally, the role of ortho-k in myopia management for children is discussed in terms of efficacy, safety, and potential mechanisms of myopia control, including the impact of factors such as initial fitting age, baseline refractive error, the role of peripheral defocus, higher order aberrations, pupil size, and treatment zone size.
Keywords: non contact tonometer; orthokeratology lens; spectacles; tonometer; hydrogen peroxide; povidone iodine; Acanthamoeba keratitis; age; article; artifact; astigmatism; cell density; clinical effectiveness; conjunctivitis; cornea cell; cornea thickness; corneal pachymetry; device safety; disease association; disease control; disease course; endothelium cell; eye axis length; human; hypermetropia; incidence; intraocular pressure; keratometry; microbial keratitis; myopia; optical coherence tomography; patient compliance; patient safety; patient satisfaction; presbyopia; quality of life; randomized controlled trial (topic); refraction error; risk factor; treatment duration; treatment outcome; viscoelasticity; visual acuity; visual analog scale

CLEAR - Evidence-based contact lens practice - Wolffsohn, J.S.; Dumbleton, K.; Huntjens, B.; Kandel, H.; Koh, S.; Kunnen, C.M.E.; Nagra, M.; Pult, H.; Sulley, A.L.; Vianya-Estopa, M.; Walsh, K.; Wong, S.; et al. (Contact Lens and Anterior Eye, 2021)
Evidence-based contact lens —>practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as —>minimising risks of lens wear through encouraging compliance) and an aftercare routine.
Keywords: multifocal contact lens; soft contact lens; spectacles; antidepressant agent; antiglaucoma agent; antihistaminic agent; decongestive agent; diuretic agent; dye; fluorescein sodium; nonsteroid antiinflammatory agent; rose bengal; age; anterior eye chamber; article; astigmatism; awareness; blepharitis; clinical decision making; clinical effectiveness; confocal microscopy; device safety; disease burden; disease control; disease severity; dry eye; evidence based practice; eye examination; eye infection; eye redness; family history; glaucoma; hand washing; hormone substitution; human; hypoxia; illumination; image analysis; infection risk; keratometry; lifestyle; meibography; meibomian gland dysfunction; microbial keratitis; myopia; ocular surface disease; optical coherence tomography; papillary conjunctivitis; patient compliance; patient decision making; patient education; patient preference; patient satisfaction; patient-reported outcome; personal experience; presbyopia; priority journal; quality of life; sleep; smoking; social acceptance; specular microscopy; tear film; treatment duration; two-dimensional imaging; visual disorder

CLEAR – Medical use of contact lenses - Jacobs, D.S.; Carrasquillo, K.G.; Cottrell, P.D.; Fernández-Velázquez, F.J.; Gil-Cazorla, R.; Jalbert, I.; Pucker, A.D.; Riccobono, K.; Robertson, D.M.; Szczotka-Flynn, L.; Speedwell, L.; Stapleton, F. (Contact Lens and Anterior Eye, 2021)
The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.
Keywords: bandage contact lens; contact lens; corneal collagen cross-linking device; hybrid lens; intrastromal corneal ring segment; keratoprosthesis; piggyback lens; rehabilitative contact lens; rigid corneal lens; scleral lens; antibiotic agent; asmofilcon A; ciprofloxacin; comfilcon A; copolymer; corticosteroid; cyanoacrylate; cyclosporine; edetic acid; fibrin; gentamicin; glue; hydrogel; kanamycin; lotrafilcon A; lotrafilcon B; nonsteroid antiinflammatory agent; ofloxacin; pilocarpine; samfilcon A; senofilcon A; silicone; tobramycin; unclassified drug; acute disease; albinism; amblyopia; amnion; aniridia; antibiotic prophylaxis; aphakia; article; astigmatism; atopic keratoconjunctivitis; bleb leak; blister; brittle cornea syndrome; chelation; childhood disease; chronic disease; chronic graft versus host disease; closed angle glaucoma; coloboma; color blindness; cornea disease; cornea laceration; cornea perforation; corneal abrasion; corneal epithelial defect; cosmetic tinted lens; device removal; disease classification; disinfection; education; epithelial basement membrane dystrophy; eye injury; eye surgery; filamentary keratitis; healing; human; hypoxia; keratectomy; keratoconjunctivitis; keratoconus; keratoglobus; keratomileusis; keratopathy; laser epithelial keratomileusis; limbal stem cell deficiency; Meesmann corneal dystrophy; microbial keratitis; migraine; mucous membrane pemphigoid; mydriasis; neurotrophic keratopathy; nystagmus; open angle glaucoma; ophthalmologist; optician; optometrist; orthoptist; patient compliance; patient selection; pellucid marginal degeneration; penetrating keratoplasty; personal experience; phacoemulsification; photophobia; photorefractive keratectomy; phototherapeutic keratectomy

Factors associated with blindness three months following treatment for acute primary angle glaucoma - Li, S.; Tang, G.; Fan, S.J.; Zhai, G.; Lv, J.; Zhang, H.; Lu, W.; Jiang, J.; Lv, A.; Wang, N.; Cao, K.; Zhao, J.; et al. (British Journal of Ophthalmology, 2021)
Aims To study the risk factors associated with blindness after treatment of acute primary angle closure (APAC), and to identify the critical time window to decrease rate of blindness. Methods In this multicentre retrospective case series, 1030 consecutive subjects (1164 eyes) with APAC in China were recruited. The rates of blindness were analysed up to 3 months after treatment of APAC. A logistic regression was used to identify the risk factors associated with blindness, including age, gender, distance to hospital, rural or urban settings, treatment method, education level, time from symptom to treatment (TST, hours) and presenting intraocular pressure (IOP). The critical time window associated with a blindness rate of ≤1% was calculated based on a cubic function by fitting TST to the rate of blindness at each time point. Results The rate of blindness after APAC was 12.54% after treatment. In multivariate regression, education level, TST and presenting IOP were risk factors for blindness (p=0.022, 0.004 and 0.001, respectively). The critical time window associated with a blindness rate of ≤1% was 4.6 hours. Conclusions and relevance Education level, TST and presenting IOP were risk factors for blindness after APAC. Timely medical treatment is key in reducing blindness after APAC.
Keywords: non contact tonometer; ophthalmic argon laser; Topcon CT-80; YAG laser; antiglaucoma agent; age; aged; article; blindness; China; closed angle glaucoma; disease association; early intervention; educational status; female; gender; health care access; human; intraocular pressure; iridotomy; laser surgery; lensectomy; logistic regression analysis; major clinical study; male; oculoplethysmography; postoperative period; priority journal; retrospective study; risk factor; time to treatment; trabeculectomy; urban rural difference; Topcon CT-80

Fluctuation in Blood Pressure and Intraocular Pressure in Normal Tension Glaucoma Using Ambulatory Monitoring - Tan, B.H.; Young, A.; Bianchi, E.; Brown, L.; Tatham, A.J. (Journal of Glaucoma, 2021)
Précis: Ambulatory blood pressure (BP) and intraocular pressure (IOP) monitoring of patients with normal tension glaucoma (NTG) revealed features of vascular dysregulation including hypertension, blunted nocturnal BP dipping, and morning BP surge. Purpose: The aim was to examine ambulatory fluctuations in IOP and BP in patients with NTG. Methods: A prospective study of 45 participants with NTG and 10 controls. All participants had a comprehensive ophthalmological examination followed by glaucoma medication washout. Patients using systemic antihypertensives were excluded. IOP and BP were recorded using home monitoring over 48 hours using a self-rebound tonometer and ambulatory blood pressure monitor. BP was recorded every 30 minutes by day and every 60 minutes overnight. IOP was recorded at 09:00, 11:00, 13:00, 16:00, 20:00, and 04:00. Results: Participants with NTG had a median mean deviation (MD) of -4.66 dB (interquartile range: -7.16 to -2.81 dB) in the worse eye. Among those with glaucoma, 18 of 45 (40%) had normal nocturnal BP dipping, 24 (53%) blunted dipping and 3 (6.7%) exaggerated dipping. Each 10 mm Hg lower minimum sleeping systolic BP was associated with a 0.9 dB (95% confidence interval: 0.1-1.6 dB) worse MD. Sixteen of 45 participants with glaucoma (35.6%) and 1 of 10 controls (10%) were found to have systemic hypertension on ambulatory blood pressure monitoring and 32 of those with glaucoma (71%) had a surge in morning BP, compared with 5 controls (50%). There was no difference in MD between patients with normal, exaggerated and blunted dipping (P=0.813). Conclusions: Though glaucoma has been associated with exaggerated nocturnal BP dipping, we found a higher proportion of patients had systemic hypertension, blunted nocturnal BP dipping, and a morning BP surge, measures also associated with vascular dysregulation.
Keywords: ABPM50; blood pressure monitor; tonometer; adult; aged; ambulatory monitoring; article; blood pressure fluctuation; blood pressure monitoring; clinical article; controlled study; disease severity; female; home monitoring; human; hypertension; intraocular pressure; low tension glaucoma; male; middle aged; observational study; patient participation; priority journal; prospective study; systolic blood pressure; ABPM50

Adherence to glaucoma medication, illness perceptions, and beliefs about glaucoma: Attitudinal perspectives among Turkish population - Guven, S.; Koylu, M.T.; Mumcuoglu, T. (European Journal of Ophthalmology, 2021)
Purpose: To evaluate the topical glaucoma eye drops adherence prevalence and its association with beliefs and illness perceptions about glaucoma in Turkey. We also aimed to explore the factors linked to patients’ total, voluntary, and involuntary non-adherence to medication in different patient attitudes. Material and Methods: A prospective study with cross-sectional design which included a total of 317 glaucoma patients who completed questionnaires. We assessed the adherence to medication, illness perceptions, and the beliefs about the glaucoma treatment by the “Reported Adherence to Medication scale,” “the Brief Illness Perception Questionnaire,” and “the Beliefs about Medicine-Specific Questionnaire,” respectively. According to the RAM scale, voluntary and involuntary non-adherence scores were also distinguished. Different adherence categories in RAM scale were compared with perception and belief measures. Patient attitudes were assessed from the BMQ. We also performed attitudinal type comparisons with different adherence groups. Results: The full adherence prevelance to glaucoma medication was 40%. The proportion of voluntary and involuntary non-adherence was 26% and 57%, respectively. The adherence groups were similar in terms of belief measures but statistically different according to illness perceptions (consequences (p = 0.002), timeline (p = 0.008), personal control (p = 0.001), identity (p = 0.019), concerns (p = 0.003)), and attitude types (ambivalent (p = 0.030) and accepting (p = 0.029)). Conclusion: New strategies are required to improve patient adherence to glaucoma medication in Turkey. The beliefs about the glaucoma treatment and illness perceptions are also needed to be enhanced.
Keywords: eye drops; adult; anxiety; article; attitude; blurred vision; Brief Illness Perception Questionnaire; controlled study; cross-sectional study; emotionality; female; glaucoma; human; major clinical study; medication compliance; Medicine Specific Questionnaire; middle aged; Mini Mental State Examination; patient compliance; perception; prevalence; prospective study; questionnaire; scoring system; Turk (people); Turkey (republic)

Challenges in acanthamoeba keratitis: A review - Varacalli, G.; Di Zazzo, A.; Mori, T.; Dohlman, T.H.; Spelta, S.; Coassin, M.; Bonini, S. (Journal of Clinical Medicine, 2021)
To review challenges in the diagnosis and management of Acanthamoeba keratitis (AK), along with prognostic factors, in order to help ophthalmologists avoid misdiagnosis, protracted treatment periods, and long-term negative sequelae, with an overarching goal of improving patient outcomes and quality of life, we examined AK studies published between January 1998 and December 2019. All manuscripts describing clinical manifestations, diagnosis, treatment, prognosis, and challenges in short-and long-term management were included. The diagnosis of AK is often challenging. An increased time between symptom onset and the initiation of appropriate therapy is associated with poorer visual outcomes. The timely initiation of standardized antiamoebic therapies improves visual outcomes, decreases the duration of treatment, and reduces the chances of needing surgical intervention. In clinical practice, AK diagnosis is often missed or delayed, leading to poorer final visual outcomes and a negative impact on patient morbidity and quality of life.
Keywords: benzalkonium chloride; biguanide; chlorhexidine; corticosteroid; diamidine derivative; fluorometholone; loteprednol etabonate; miltefosine; neomycin; nonsteroid antiinflammatory agent; poly(hexamethylenebiguanide); posaconazole; povidone iodine; propamidine; propamidine isethionate; steroid; tea tree oil; voriconazole; Acanthamoeba; Acanthamoeba keratitis; allergic reaction; clinical practice; combination drug therapy; confocal microscopy; corneal biopsy; deep lamellar endothelial keratoplasty; diagnostic error; diagnostic test accuracy study; drug dose reduction; drug efficacy; eye toxicity; histology; human; keratomileusis; low drug dose; Medline; monotherapy; morbidity; ophthalmologist; optical coherence tomography; patient compliance; penetrating keratoplasty; polymerase chain reaction; prognosis; quality of life; review; sensitivity and specificity; treatment duration; treatment outcome; Web of Science

Glaucoma Awareness and Knowledge Among Ethiopians in a Tertiary Eye Care Center - Heisel, C.J.; Fashe, C.M.; Garza, P.S.; Gessesse, G.W.; Nelson, C.C.; Tamrat, L.; Abuzaitoun, R.; Lawrence, S.D. (Ophthalmology and Therapy, 2021)
Introduction: Glaucoma outcomes are closely associated with patients’ awareness of the disease. However, little is known about glaucoma awareness and knowledge in Addis Ababa, a densely populated and ethnolinguistically diverse capital city in Ethiopia, the second largest country in Africa. Methods: We performed a cross-sectional survey in the ophthalmology waiting room at St. Paul’s Hospital, a tertiary care center in Addis Ababa. Respondents included patients, patient family members, and non-clinical staff. Participants were asked if they had read or heard about glaucoma to gauge basic awareness of the disease; those with awareness were asked to take a quiz to measure their objective glaucoma knowledge. We performed multivariable regression to identify factors associated with glaucoma awareness, quiz performance, and self-rated ability to use eye drops. Results: Of 298 respondents, 145 (48.7%) were female, and the average age was 44.9 ± 17.2 years. A majority (167; 56.0%) had primary school or less than primary school education. Only 131 (44.0%) had basic glaucoma awareness. Of these, 95 (72.5%) knew that glaucoma causes permanent vision loss, 103 (78.6%) knew glaucoma is often asymptomatic in early stages, 62 (47.3%) identified elevated intraocular pressure as a glaucoma risk factor, and 124 (94.7%) knew glaucoma was treatable. A majority of this subset (126; 96.2%) said they would be willing to use medicated eye drops, and 130 (99.2%) indicated a willingness to undergo surgery if recommended. Education level was independently associated with glaucoma awareness (p < 0.001) and glaucoma quiz performance (p = 0.03). Conclusion: In a population sample from an ophthalmology waiting room in Addis Ababa, glaucoma awareness was poor and most strongly associated with education level. Educational interventions at public health and provider-patient levels are warranted. Our results suggest high receptiveness to both medical and surgical treatment.
Keywords: eye drops; adult; anthropometry; article; awareness; blindness; controlled study; cross-sectional study; education; Ethiopian; ethnicity; eye care; female; glaucoma; health care personnel; human; intraocular pressure; knowledge; Likert scale; major clinical study; male; marriage; ophthalmology; patient compliance; perception deafness; perimetry; prevalence; primary school; public health; questionnaire; refraction error; risk factor; tertiary care center; visual acuity; visual impairment; waiting room

Comparison of Post-Cataract Surgery Visual Outcomes and Quality of Life in Patients Bilaterally Implanted with Multifocal Intraocular Lenses - Haldipurkar, S.S.; Shetty, V.; Shah, D.; Haldipurkar, T.; Kashelkar, P.; Khatib, Z.; Sankhe, P.; Mane, A.; Mhatre, P.; Setia, M.S. (Ophthalmology and Therapy, 2021)
Introduction: The present study compared visual outcomes in eyes with bilateral implantation of two multifocal intraocular lenses (MFIOLs)—the Eyecryl™ ACTV diffractive multifocal IOL (group 1) and AcrySof® IQ ReSTOR® multifocal IOL (group 2). Methods: This was a prospective, two-group observational longitudinal study of 118 eyes from 59 patients conducted at Laxmi Eye Institute, Panvel, India. We evaluated the patients at 1, 3, and 6 months. We assessed visual acuity, contrast sensitivity, higher-order aberrations, reading speed, defocus curve, stereopsis, quality of life (QOL), and adverse events in these participants. Results: The median (interquartile range) best-corrected distance visual acuity was 0.18 (0, 0.18) in group 1 and 0.18 (0, 0.18) in group 2 at 1, 3, and 6 months; the difference was not statistically significant (p = 0.48). The binocular defocus curve in both groups showed two peaks at 0.0 to −0.5 D and at −2.5 D. The mean (95% confidence interval) critical print size was significantly different between groups 1 and 2 at low illumination (0.918 [0.905, 0.931] vs 1.154 [1.128, 1.180]; p = 0.004). Contrast sensitivity was significantly better in group 1 under mesopic conditions but not under scotopic conditions. Though total QOL did not differ significantly between groups, the psychosocial quality of life was significantly better in group 1. About 23% of patients in group 2 reported unwanted images, compared with 0% in group 1 (p = 0.01). Conclusion: We found that the Eyecryl and AcrySof groups were comparable for best-corrected visual acuity, photopic contrast sensitivity, defocus curve, reading parameters, stereopsis, and quality of vision. However, the Eyecryl group had better mesopic contrast and a lower proportion of unwanted images. Psychosocial quality of life was significantly better in the Eyecryl group; however, satisfaction was similar between groups. The cost of one of the lenses is less than the other. Thus, individuals with limited resources may opt for the Eyecryl™ ACTV, with similar visual outcomes.
Keywords: atropine; cryof; e; eye drops; prednisolone; prednisolone acetate; yecryl; adult; article; astigmatism; best corrected visual acuity; capsulorhexis; cataract extraction; cognition; cornea edema; corrected distance visual acuity; diabetic retinopathy; eye axis length; female; glaucoma; health care access; human; implantation; keratometry; longitudinal study; macular degeneration; major clinical study; male; mesopic vision; outcome assessment; phacoemulsification; photopic vision; productivity; prospective study; quality of life; questionnaire; reading; refraction index; satisfaction; social psychology; stereoscopic vision; visual acuity; visual stimulation; cryof; e; yecryl

Cost-Related Medication Nonadherence in a Nationally Representative US Population with Self-Reported Glaucoma - Gupta, D.; Ehrlich, J.R.; Newman-Casey, P.A.; Stagg, B. (Ophthalmology Glaucoma, 2021)
Purpose: To determine the rates of cost-related nonadherence to medications among US adults with glaucoma and to determine if participants with glaucoma have more cost-related medication nonadherence than those without glaucoma. Design: Cross-sectional study. Participants: Participants in the 2016–2017 National Health Interview Survey (NHIS), a cross-sectional survey regarding health topics that is administered annually to a nationally representative sample of noninstitutionalized adults in the United States. Methods: We calculated proportions of NHIS participants with and without self-reported glaucoma who reported cost-related nonadherence over the previous 12 months. We analyzed responses to 7 survey items that dealt with medication cost-related issues to any/all of a participants’ medication: couldn't afford a prescribed medication; skipped medication doses to save money; took less medicine to save money; delayed filling a prescription to save money; asked doctor for lower cost medication to save money; bought prescription drugs from another country to save money; used alternative therapies to save money. We performed univariable and multivariable logistic regression to evaluate the association between self-reported glaucoma diagnosis and responses to these selected questions. Main Outcome Measures: Proportion of participants with and without self-reported glaucoma who reported cost-related nonadherence. Results: Participants with glaucoma reported they could not afford prescribed medication more frequently than participants without glaucoma (8.2% vs. 6.4% P = 0.024). Adjusted predicted proportions from a multivariable model demonstrated that participants with glaucoma responded that they had greater cost-related barriers to medication access. Conclusions: In this nationally representative sample of the US population, after adjustment for confounding variables, participants with glaucoma more frequently reported cost-related nonadherence to medications compared with participants without glaucoma. Providers prescribing medication to patients with glaucoma should be aware of these findings and consider the impact of medication cost on their patients’ ability to adhere to therapy.
Keywords: antiglaucoma agent; adult; aged; comorbidity; conference paper; controlled study; cost effectiveness analysis; cross-sectional study; drug cost; female; glaucoma; human; major clinical study; male; medicaid; medicare; multivariate logistic regression analysis; patient compliance; prescription; priority journal; United States; univariate analysis; very elderly; vision; visual acuity

Management of refractory Acanthamoeba keratitis, two cases - Soleimani, M.; Latifi, A.; Momenaei, B.; Tayebi, F.; Mohammadi, S.S.; Ghahvehchian, H. (Parasitology Research, 2021)
Acanthamoeba keratitis is a serious infection of the eye that can result in permanent visual impairment or blindness, caused by free-living amoebae of the genus Acanthamoeba. Early diagnosis is necessary for effective treatment of Acanthamoeba keratitis. Acanthamoeba is abundant in nature and can be found in water, soil, and air. Acanthamoeba keratitis is usually diagnosed by culture from a scraping of the eye or by confocal microscopy. In this paper, two complicated Acanthamoeba keratitis cases are reported.
Keywords: contact lens; antibiotic agent; betamethasone; chlorhexidine; cyclosporine; itraconazole; poly(hexamethylenebiguanide); voriconazole; Acanthamoeba; Acanthamoeba keratitis; adult; article; case report; cataract extraction; clinical article; confocal microscopy; cornea transplantation; corticosteroid therapy; disease severity; drug withdrawal; endophthalmitis; eye pain; female; human; infection control; nonhuman; nucleotide sequence; pars plana vitrectomy; patient compliance; penetrating keratoplasty; photophobia; priority journal; subcapsular cataract; systemic therapy; visual acuity

Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months - Jones, P.R.; Campbell, P.; Callaghan, T.; Jones, L.; Asfaw, D.S.; Edgar, D.F.; Crabb, D.P. (American Journal of Ophthalmology, 2021)
Purpose: To assess accuracy and adherence of visual field (VF) home monitoring in a pilot sample of patients with glaucoma. Design: Prospective longitudinal feasibility and reliability study. Methods: Twenty adults (median 71 years) with an established diagnosis of glaucoma were issued a tablet perimeter (Eyecatcher) and were asked to perform 1 VF home assessment per eye, per month, for 6 months (12 tests total). Before and after home monitoring, 2 VF assessments were performed in clinic using standard automated perimetry (4 tests total, per eye). Results: All 20 participants could perform monthly home monitoring, though 1 participant stopped after 4 months (adherence: 98% of tests). There was good concordance between VFs measured at home and in the clinic (r = 0.94, P < .001). In 21 of 236 tests (9%), mean deviation deviated by more than ±3 dB from the median. Many of these anomalous tests could be identified by applying machine learning techniques to recordings from the tablets' front-facing camera (area under the receiver operating characteristic curve = 0.78). Adding home-monitoring data to 2 standard automated perimetry tests made 6 months apart reduced measurement error (between-test measurement variability) in 97% of eyes, with mean absolute error more than halving in 90% of eyes. Median test duration was 4.5 minutes (quartiles: 3.9-5.2 minutes). Substantial variations in ambient illumination had no observable effect on VF measurements (r = 0.07, P = .320). Conclusions: Home monitoring of VFs is viable for some patients and may provide clinically useful data.
Keywords: camera; tablet computer; adult; aged; article; clinical article; clinical trial; diagnostic accuracy; diagnostic test accuracy study; feasibility study; female; glaucoma; home monitoring; human; male; measurement accuracy; measurement error; mobile application; patient compliance; perimetry; pilot study; priority journal; prospective study; reliability

Uptake, Persistence, and Performance of Weekly Home Monitoring of Visual Field in a Large Cohort of Patients With Glaucoma - Prea, S.M.; Kong, G.Y.X.; Guymer, R.H.; Vingrys, A.J. (American Journal of Ophthalmology, 2021)
Purpose: This study examines the short-term uptake, compliance, and performance of a tablet device used for home monitoring of visual field (VF-Home) by glaucoma patients. Design: Single-center, observational, longitudinal, compliance study. Methods: Participants who were glaucoma suspects or had stable glaucoma in at least one eye were recruited during a regular clinic review. Baseline in-clinic visual field (VF) was recorded with the Humphrey Field Analyser (HFA, SITA standard) and repeated at 6 months. Participants were tasked with performing 6 VF examinations from home, at weekly intervals, using a loaned iPad tablet. Uptake was defined as returning at least 1 test from home. Reliability and global indices from VF-Home were compared to in-clinic outcomes. Data are shown as either mean ± [standard deviation] or median [quartile 1-3 range], and group comparisons were achieved with bootstrap. Results: We recruited 186 eyes of 101 participants. VF-Home uptake was excellent, with 88% of participants successfully completing ≥1 home examination and 69% completing all 6 examinations. The median duration between tests was 7.0 [7.0-8.0] days. Barriers to uptake and compliance involved information technology (IT) logistical reasons, lack of motivation, or competing life demands. VF-Home gave greater fixation loss but a similar level of False Positives (FP) as the HFA. A high correlation was found for the mean defect between in-clinic and at-home outcomes (R = 0.85). Conclusions: VF-Home can return a high level of short-term compliance and results comparable to those found by in-clinic testing. IT logistical reasons and lack of motivation are barriers to uptake and compliance.
Keywords: Humphrey perimeter; tablet computer; adult; aged; article; bootstrapping; clinical outcome; cohort analysis; correlational study; female; glaucoma; home monitoring; human; information technology; longitudinal study; major clinical study; male; observational study; patient compliance; perimetry; priority journal; text messaging; visual field; iPad

Improving Racial Diversity in the Ophthalmology Workforce: A Call to Action for Leaders in Ophthalmology - Aguwa, U.T.; Srikumaran, D.; Brown, N.; Woreta, F. (American Journal of Ophthalmology, 2021)
Keywords: African American; Black person; coronavirus disease 2019; editorial; ethnic difference; glaucoma; health care access; health care disparity; health care need; health workforce; human; maternal mortality; minority group; minority health; ophthalmology; patient satisfaction; priority journal; race difference; racism; workforce

Economic and Clinical Burden Associated with Intensification of Glaucoma Topical Therapy: A US Claims-based Analysis - Patel, A.R.; Schwartz, G.F.; Campbell, J.H.; Chen, C.-C.; McGuiness, C.B.; Multani, J.K.; Shih, V.; Smith, O.U. (Journal of Glaucoma, 2021)
Precis:Incremental addition of intraocular pressure-lowering topical drops is associated with shorter-lasting benefit and higher health-related costs with each additional agent, suggesting a need for new treatment options to improve disease control and reduce treatment burden.Purpose:The purpose of this study was to evaluate treatment intensification as a driver of clinical and economic burden in patients receiving topical glaucoma medications for open-angle glaucoma/ocular hypertension.Methods:This retrospective analysis of administrative claims data (January 2011 to July 2017) from the IQVIA PharMetrics Plus database included diagnosed patients who initiated or intensified treatment with 1 to 4 topical glaucoma medications of a different drug class between January 2012 and July 2015 (index date being the first such event during this period). Patients with prior open-angle glaucoma surgery or an equal or greater number of topical glaucoma medication classes during the preindex period were excluded. Treatment intensification rates and eye-related outpatient costs were assessed over 24 months postindex.Results:Of 48,402 patients (mean age: 61.4 y), 22,874 (47.3%), 16,214 (33.5%), 7137 (14.7%), and 2177 (4.5%) received a first, second, third, or fourth medication class, respectively, as their first observed initial or intensified regimen. Among cohorts receiving 1, 2, 3, or 4 medication classes, 7.8%, 12.2%, 17.2%, and 22.6% of patients and 12.6%, 18.5%, 25.9%, and 33.7% of patients had subsequent treatment augmentation (class addition or glaucoma procedure, laser or surgical) within 12 and 24 months postindex, respectively. Eye-related outpatient costs over 24 months increased with each additional topical glaucoma medication class at index [mean (SD): $1610 ($3460), $2418 ($4863), $2872 ($5110), and $3751 ($6608) in the 1, 2, 3, or 4 class cohorts, respectively].Conclusion:Multiple-drop therapies yielded shorter-lasting benefits with each additional agent and were associated with the increased clinical and economic burden.
Keywords: canaloplasty device; EX-PRESS Glaucoma Filtration Device; glaucoma drainage implant; nonvalved ophthalmic drainage device; trabeculotome; antiglaucoma agent; apraclonidine; betaxolol; bimatoprost; brimonidine; brimonidine plus timolol; brinzolamide; carbachol; carteolol; dipivefrine; dorzolamide; dorzolamide plus timolol; ecothiopate iodide; latanoprost; levobunolol; metipranolol; pilocarpine; tafluprost; timolol; travoprost; administrative claims (health care); adult; article; cohort analysis; disease burden; female; glaucoma surgery; health care cost; health care utilization; health insurance; human; intraocular hypertension; laser coagulation; laser surgery; major clinical study; male; medicaid; medicare; middle aged; open angle glaucoma; outpatient care; patient care; priority journal; retrospective study; trabeculectomy; trabeculoplasty; treatment outcome; United States; CyPass Micro-Stent; EX-PRESS Glaucoma Filtration Device; iStent; XEN gel stent

Express Medicine - Potential for Home-Based Medical Care - Liu, Y.; Zheng, Y.; Bressler, N.M. (JAMA Ophthalmology, 2021)
Keywords: blood pressure monitor; fundus camera; imaging system; mobile health application; ophthalmological diagnostic device; optical coherence tomography device; portable ultrasound scanner; wearable computer; ambulatory care; assisted living facility; coronavirus disease 2019; diabetic macular edema; diagnostic imaging; doctor patient relationship; express medicine; eye disease; glaucoma; health care personnel; home care; home monitoring; human; intraocular pressure; medical care; note; nursing home; optical coherence tomography; pandemic; priority journal; teleconsultation; telemedicine; visual acuity

Association of a Health Coaching and Transportation Assistance Intervention at a Free Ophthalmology Homeless Shelter Clinic with Follow-up Rates - Hennein, L.; De Alba Campomanes, A.G. (JAMA Ophthalmology, 2021)
Importance: Eye health in the homeless population is important, yet follow-up to referral appointments in this population remains low. Objective: To investigate the association of health coaching and transportation vouchers with follow-up rates at a free ophthalmology homeless shelter clinic. Design, Setting, and Participants: A prospective cohort study was conducted from January 9, 2019, to March 4, 2020, among all 71 patients evaluated at a free ophthalmology clinic at a single homeless shelter in San Francisco, California. Exposures: If indicated, patients were referred for advanced ophthalmologic care at a county hospital and free eyeglasses from a nonprofit organization. Main Outcomes and Measures: The primary outcome was follow-up rates to referral appointments. The secondary outcomes were prespecified baseline variables hypothesized to be associated with follow-up. The intervention began September 4, 2019. Follow-up rates were compared between the preintervention (n = 37) and postintervention (n = 34) groups. The hypothesis was formulated before data collection. Results: Among the 71 patients, 50 (70.4%) were men, and the mean (SD) age was 51.9 (12.4) years. A total of 28 patients (39.4%) were referred for free eyeglasses, 14 (19.7%) to the county hospital for advanced care, and 7 (9.9%) to both. Of those referred, the difference in follow-up from the postintervention to preintervention groups was 53.8% (95% CI, 39.8%-67.9%; P <.001). Compared with patients who did not follow up, those who did had a mean difference of 59 more days at the shelter (95% CI, 39-80 days; P =.003). Among patients with a visual acuity of 20/40 or worse in the better-seeing eye, the mean difference between those who did not follow up and those who did was 61% (95% CI, 44%-78%; P =.003). The mean difference in follow-up between patients who were born in the US and patients not born in the US was 89% (95% CI, 79%-98%; P =.02). Of those in the postintervention group, the difference in presentation to follow-up for patients with a high school diploma compared with those without was 59% (95% CI, 37%-81%; P =.001). Conclusions and Relevance: This study suggests that a health coaching and bus token intervention improved follow-up rates at a free ophthalmology homeless shelter clinic by at least 39.8%; this improvement supports considering implementation of this intervention when developing public assistance programs if independent corroboration is provided. Barriers to follow-up included a shorter duration of stay at the homeless shelter, visual acuity better than 20/40, not being born in the US, and lower educational level, although the size of this study does not permit determining if some or all of these are associated with one another.
Keywords: spectacles; adult; age related macular degeneration; aphakia; article; astigmatism; blepharitis; California; cataract; choroidal nevus; cohort analysis; controlled study; diabetic retinopathy; dry eye; epiphora; epithelial basement membrane dystrophy; exophthalmos; eye care; female; follow up; glaucoma; health service; homeless person; human; hypermetropia; lattice degeneration; macular scar; major clinical study; male; myopia; non profit organization; ophthalmology; outcome assessment; patient referral; patient transport; presbyopia; primary medical care; priority journal; prospective study; ptosis (eyelid); refraction error; retina detachment; retina macula hole; retina pigment epitheliopathy; social care; strabismus; visual acuity; visual field defect; vitreous body detachment

Text Parsing-Based Identification of Patients with Poor Glaucoma Medication Adherence in the Electronic Health Record - Hamid, M.S.; Valicevic, A.; Brenneman, B.; Niziol, L.M.; Stein, J.D.; Newman-Casey, P.A. (American Journal of Ophthalmology, 2021)
Purpose: To assess the feasibility of automated text parsing screening of physician notes in the electronic health record (EHR) to identify glaucoma patients with poor medication compliance. Design: Cross-sectional study. Methods: An automated EHR extraction identified a cohort of patients at the University of Michigan with a diagnosis of glaucoma, ≥40 years old, taking ≥1 glaucoma medication, and having no cognitive impairment. Self-reported medication adherence was assessed with 2 validated instruments: the Chang scale and the Morisky medication adherence scale. In tandem, a text parsing tool that abstracted data from the EHR was used to search for combinations of the following words in patient visit notes: “not,” “non,” “n't,” “no,” or “poor” accompanied by “adherence,” “adherent, “adhering,” “compliance,” “compliant,” or “complying.” The proportion of patients with self-reported poor adherence was compared between the EHR extraction and text parsing identification using a Fisher exact test. Results: Among 736 participants, 20.0% (n = 147) self-reported poor adherence and 6.1% (n = 45) had EHR documentation of poor adherence (P < .0001). Using text parsing as a pre-screening tool, 22 of the 45 patients (48.9%) with non-adherence identified by text parsing also self-reported poor medication adherence compared to the 20.0% by self-report overall (P < .0001). Conclusions: Text parsing physician notes to identify patients' noncompliance to their medications identified a larger proportion of patients who then self-reported poor medication adherence than an automated EHR pull alone but was limited by the small number of patients identified. Optimizing the documentation of medication adherence would maximize the utility of this automated approach to identify medication noncompliance.
Keywords: NCT03159247; medication adherence monitoring system; antiglaucoma agent; adult; aged; article; automated text parsing screening; automation; Chang scale; cognitive defect; cohort analysis; controlled study; cross-sectional study; electronic health record; feasibility study; female; Fisher exact test; glaucoma; human; major clinical study; male; medical documentation; Michigan; Morisky Medication Adherence Scale; patient assessment; patient compliance; priority journal; rating scale; self report; university

Rising to the challenge: estimates of the magnitude and causes of vision impairment and blindness - Keel, S.; Cieza, A. (The Lancet Global Health, 2021)
Keywords: contact lens; behavior change; blindness; cataract; decision making; diabetic retinopathy; epidemiological monitoring; evidence based medicine; eye care; glaucoma; global health; health care policy; health care survey; human; lifestyle modification; macular degeneration; magnitude estimation method; myopia; note; prevalence; provocation test; unmet medical need; visual acuity; visual impairment; World Health Organization

Tolerance and Adherence to Cationic 0.1% Cyclosporine in Ocular Graft-versus-Host Disease - Gehlsen, U.; Siebelmann, S.; Steven, P. (Ophthalmic Research, 2021)
Introduction: Anti-inflammatory, topical therapy of severe keratitis in dry eye disease (DED) and ocular graft-versus-host disease (oGvHD) includes steroids, cyclosporine (Cs), and others. In Germany, a commercial product containing 0.1% Cs in a cationic formulation is available since 2015. Objective: The aim of this study was to present real-life data using cationic 0.1% Cs in oGvHD patients. Methods: This was a retrospective study of 26 oGvHD and 41 DED patients with corneal staining of at least Oxford grade III. Parameters analyzed were Ocular Surface Disease Index, corneal staining, intraocular pressure, tear film break-up time, Schirmer, and visual acuity. In addition, it was evaluated how different Cs formulations were tolerated. Results: Corneal staining improved significantly in 1 eye in DED but not in oGvHD. In DED, cationic 0.1% Cs was not tolerated by 32% of the patients, in contrast to 0.05% Cs in castor oil not tolerated by 47% and liposomal 0.05% Cs by 63%. In oGvHD patients, cationic 0.1% Cs was not tolerated by 62%, 0.05% Cs in castor oil by 33%, and liposomal 0.05% Cs by 39% of the patients. Conclusions: This study demonstrates differences between the tolerance of different Cs formulations depending on the underlying cause of severe keratitis. Cationic 0.1% Cs is considerably less tolerated in oGvHD, and its use should be considered with care.
Keywords: contact lens; punctal plug; albumin; artificial tear; castor oil; cationic surfactant; cyclosporine; dexa-sine; dexapos comod; dexpanthenol; glucocorticoid; latanoprost; liposome; monodex; ofloxacin; rimexolone; tafluprost; tetryzoline; vitapos; zadithen ophtha sine; adult; aged; article; burning sensation; conjunctiva disease; cornea; drug dosage form comparison; drug formulation; drug tolerance; drug withdrawal; dry eye; eye disease; eye redness; eyelid disease; female; graft versus host reaction; human; keratitis; major clinical study; male; ocular graft versus host disease; ocular pruritus; patient compliance; priority journal; retrospective study; staining; treatment outcome; very elderly; bepanthen; berberil n; corneregel; dexa-sine; dexapos comod; floxal; ikervis; monodex; monoprost; restasis; taflotan; vexol; vitapos; zadithen ophtha sine

Medication adherence, self-efficacy and health literacy among patients with glaucoma: A mixed-methods study protocol - Achilleos, M.; Merkouris, A.; Charalambous, A.; Papastavrou, E. (BMJ Open, 2021)
Introduction As the world population ages, glaucoma is becoming an increasingly significant cause of blindness. A key component in the management of glaucoma is the use of prescribed medications and the adherence to treatment. However, there is evidence of low adherence to prescribed medication in chronic diseases, such as glaucoma. This study aims to explore the level of medication adherence, self-efficacy, social support and health literacy among the patients with glaucoma and to determine if there are any correlations between them. The ultimate aim is to use the information to develop an educational programme for patients with glaucoma at a later stage. Methods and analysis This is a mixed-methods study which includes two stages: a descriptive study (stage 1) and focus group discussions (stage 2). Sample: Patients with glaucoma or ocular hypertension, using at least one kind of drops, from two ophthalmology clinics. Selected measures include: The Glaucoma Treatment Compliance Assessment Tool, The European Health Literacy Survey Questionnaire, The Glaucoma Medication Self-Efficacy Questionnaire and The Multidimensional Scale of Perceived Social Support. Two focus groups will be used for the collection of qualitative data, aiming to enrich the study with the patients' experiences. The data will be analysed with SPSS, using descriptive and inferential statistics for stage 1 whereas content analysis will be used for the data from the focus group discussions (stage 2). Ethics and dissemination Permission to conduct the study was received from the National Bioethics Committee and the board of management of the two ophthalmology clinics. All participants will be informed fully on the purpose and methods of the study. Consent forms will be signed and at any time participants will have the right to withdraw. Confidentiality and the protection of data will be respected at all times.
Keywords: data analysis software; information processing device; antiglaucoma agent; eye drops; article; assessment of humans; content analysis; data analysis software; descriptive research; European health literacy survey questionnaire; glaucoma; glaucoma medication self efficacy questionnaire; glaucoma treatment compliance assessment tool; health literacy; human; intraocular hypertension; medication compliance; Multidimensional Scale of Perceived Social Support; patient compliance; qualitative research; self concept; social support; structured questionnaire; systematic review; SPSS

Analysis of the eye clinic visits of syrian immigrants at a state tertiary hospital - Dağ, U.; Çağlayan, M.; Alakuş, M.F.; Öncül, H. (Eastern Journal of Medicine, 2021)
The aim of this study was to investigate the demographic and clinical characteristics of Syrian immigrants visiting an ophthalmology clinic, and to evaluate the causes of severe vision loss and blindness in this population. The data of 1,498 Syrian patients who presented to our clinic with eye complaints between January 2013 and January 2019 were analyzed retrospectively. The cases were divided into three groups based on age: under 18, 18–65, and over 65 years old. Their diagnoses, severe vision loss incidences, and causes of blindness were investigated. The mean age was 36.15 ± 23 (0–91) years old, with 385 (25.7%) of the patients under the age of 18, 780 (52.1%) between the ages of 18 and 65, and 333 (22.2%) over 65 years old. In all three groups, the most common reasons for admission were treatable conditions, such as conjunctivitis, blepharitis, and dry eye. The most important cause of severe vision loss under the age of 18 was a refractive error, while the most important cause of blindness was a congenital cataract. Cataracts were the most important causes of severe vision loss in the 18–65 and over 65 years old age groups, while the most important causes of blindness were traumas and cataracts. By providing immigrants with fast, easy, and free access to health care services, the severe vision loss and blindness rates can be minimized.
Keywords: adolescent; adult; age related macular degeneration; aged; article; blepharitis; blindness; cataract; child; clinical feature; congenital cataract; conjunctivitis; diabetic retinopathy; dysphagia; ectropion; error; eye surgery; female; glaucoma; groups by age; health care access; health care cost; health service; human; immigrant; incidence; major clinical study; male; ophthalmology; ptosis (eyelid); refraction error; retrospective study; senescence; strabismus; Syrian; Syrian Arab Republic; tertiary care center; uveitis; visiting nursing service; visual acuity; visual impairment

Medical history, clinical features, treatment outcome and its predictors among infectious keratitis patients in jimma university medical center, southwest Ethiopia: Prospective observational study - Dago, T.R.; Woldemichael, D.K.; Daba, F.B. (Clinical Ophthalmology, 2021)
Background: Infectious keratitis is a major global cause of visual impairment and irrever- sible blindness among the corneal diseases. Its diagnosis and management remain getting challenge. The clinical and visual outcome remains poor in developing countries. The aim of this study was to determine treatment outcome and its predictors among patients with infectious keratitis. Methods: Prospective observational study was conducted among adult patients diagnosed with infectious keratitis at the Ophthalmology Department in Jimma University Medical Center from April 1 to September 30, 2019. The primary outcome indicator was response of the ulcer to empirical treatment. Ulcers that did not heal and required surgery had a poor outcome. Variables with a p-value of <0.25 were entered into a multivariate logistic regres- sion model to determine the independent predictors of poor treatment outcome and variables with a p-value of <0.05 were considered statistically significant. Results: The research involved 131 adult patients. Eighty-seven (66.4%) were males. The mean age was 39.38 (±18.9) years. Eighty-three (63.4%) patients had poor treatment out- come. Mean length of hospital stay was 17.38 (±12.563) days. Poor visual outcome was observed among 71 (54.2%) participants. Evisceration was done for seven (5.3%) patients. Independent predictors of poor treatment outcome include perforation at admission (AOR=6.1, 95%CI: 1.5-25.1), presence of comorbidity (AOR=7.7, 95%CI: 2.16-27.3), poor adherence (AOR=5.3, 95%CI: 1.8-25.9), traditional medicine use (AOR=6.7, 95%CI: 1.8-25.4), ulcer depth >1/3 (AOR=7.6, 95%CI: 2.48-48.23) and farm workers (AOR=3.59, 95%CI: 1.09-11.77). Major complications occurred after admissions were perforation (14.5%), followed by endophthalmitis (7.63%) and corneal opacity (6.87%). Conclusion and Recommendation: Our study found high poor treatment outcomes and high poor visual outcomes. Presence of comorbidity, perforation at admission, traditional medicine use, working on a farm, poor adherence, and ulcer depth were the predictors of poor treatment outcome. This high poor outcome requires a nationwide interventional study and urgent intervention that may reach rural communities.
Keywords: acetazolamide; aciclovir; amoxicillin plus clavulanic acid; ampicillin; artificial tear; cefepime; ceftazidime; ceftriaxone; chloramphenicol; ciprofloxacin; cloxacillin; cotrimoxazole; dexamethasone; diclofenac; erythromycin; eye drops; fluconazole; gentamicin; glycerol; herbaceous agent; ibuprofen; imipenem; meropenem; metronidazole; piperacillin plus tazobactam; sultamicillin; tetracycline; tobramycin; tramadol; tropicamide; vancomycin; adolescent; adult; agricultural worker; antibiotic resistance; antibiotic sensitivity; article; bacterial keratitis; blepharitis; blepharoconjunctivitis; blindness; cataract; clinical feature; comorbidity; computer assisted tomography; conjunctivitis; controlled study; cornea opacity; cornea ulcer; corneal scraping; disease severity; echooculography; endophthalmitis; entropion; Ethiopia; eye discharge; eye evisceration; eye pain; eye redness; female; fever; glaucoma; Haemophilus influenzae; hospital readmission; human; human tissue; hypopyon; image analysis; incidence; intraocular foreign body; keratomycosis; keratopathy; Klebsiella; length of stay; major clinical study; male; medical history; medication compliance; meibomian gland dysfunction; microbial keratitis; coinfection; nonhuman; observational study; patient compliance; perforating eye injury; photophobia; predictor variable; prospective study; pterygium; slit lamp microscopy; treatment outcome; upper respiratory tract infection; virus keratitis; visual acuity

Medication adherence and persistence of open-angle glaucoma patients in korea: A retrospective study using national health insurance claims data - Jang, Y.; Jee, D.; Lee, D.; Choi, N.-K.; Bae, S. (International Journal of Environmental Research and Public Health, 2021)
This study aimed to analyze medication adherence and persistence among open-angle glaucoma patients in Korea. A retrospective study was conducted using the Korean National Health Insurance (NHI) claims database from 2016 to 2019. Newly diagnosed open-angle glaucoma patients who were prescribed with the intraocular pressure (IOP)-lowering eyedrops were included. Adherence was measured using the medication possession ratio (MPR), and persistence was measured using the duration of therapy during the 24 month follow-up period. During the study period, 14,648 open-angle glaucoma patients were identified, and 3118 (21.3%) and 4481 patients (30.6%) were adherent to and persistent with their glaucoma treatment, respectively. The mean MPR was 48.8%, and the mean duration of therapy was 357.2 days. Logistic regression analysis showed that patients who are older, female, using prostaglandins as the index medication, and visiting secondary or tertiary hospitals were significantly associated with greater rates of adherence (odds ratio (OR) = 1.21, 1.12, 1.27, and 1.73, respectively) and persistence (OR = 1.11, 1.17, 1.16, 1.17, and 1.36, respectively) during the study period. Patients with open-angle glaucoma in Korea had substandard medication adherence and discontinued their treatment. Ophthalmologists should pay more attention to younger, male patients to improve adherence.
Keywords: beta adrenergic receptor blocking agent; prostaglandin; adult; age; article; clinical effectiveness; drug effect; drug efficacy; drug response; female; follow up; gender; human; intraocular pressure; Korea; major clinical study; male; medication compliance; monotherapy; national health insurance; open angle glaucoma; patient compliance; patient risk; prescription; retrospective study; risk factor; secondary care center; tertiary care center; treatment outcome

Patient and resource management of emergency walk-in clinic during a covid-19 pandemic state lockdown - Trivedi, V.; Torres, Y.R.; Patel, V.; Yoganathan, P. (Clinical Ophthalmology, 2021)
Objective: To gather data on the most common chief complaints, diagnoses, in-office procedures, and surgeries that presented to the Kresge Eye Institute’s Emergency Clinic in Detroit, Michigan during the COVID-19 state lockdown period to provide data for staff and resource allocation in future waves. Design: Retrospective study. Participants: All patients 18 years or older presenting for ophthalmic consultation to the Kresge Eye Institute Emergency Walk-in Clinic between March 23rd and April 17th, 2020 were included in the study. Methods: All patients who met the inclusion criteria were indexed based on their initial encounter date and patients were stratified by urgent and non-urgent ophthalmic reasons for evaluation. Patient demographics, medical history, chief complaint, diagnosis, and need for surgical intervention and procedures were obtained from the electronic medical records. Results: The most common diagnoses were corneal disease (31.4%), followed by vitreoretinal disease (25.3%), orbit-eyelid pathology (8.8%), and glaucoma-related issues (8.8%). The most common office procedure was intravitreal injections (37.5%) followed by foreign body removal (21.9%), and pan-retinal photocoagulation laser (21.9%). Retina surgery was the most common emergency surgery representing 73.3% of the total, the second most common was keratoplasty (13%). Conclusion: Future implementation of protocols for triaging based on chief complaints can aid in protecting patients and expanding the role of distanced assessment with telemedicine. Suggested management of an emergent clinic requires availability of retina and cornea specialists given the majority of visits, procedures, and surgeries were related to their area of expertise.
Keywords: adult; aged; article; cohort analysis; consultation; controlled study; cornea disease; coronavirus disease 2019; data analysis; demography; diagnostic procedure; electronic medical record; emergency care; emergency surgery; eyelid disease; female; foreign body aspiration; glaucoma; health care utilization; human; information processing; intravitreal drug administration; keratoplasty; laser coagulation; lockdown; major clinical study; male; medical history; pandemic; patient care; resource allocation; retina surgery; retrospective study; sampling; surgical approach; vitreoretinopathy

Assessment of medication therapy adherence in glaucoma: scoping review - Rosu, A.M.; Coelho, A.; Camacho, P. (Expert Review of Ophthalmology, 2021)
Introduction: Glaucoma is an asymptomatic disease, which can cause irreversible blindness, with a worldwide prevalence around 64.3 million people. Adherence to glaucoma treatment is crucial to control the disease and to prevent its complications. Low medication adherence results in a visual loss, which can leads to irreversible blindness. In this sense it is important to know and evaluate adherence to pharmacological therapy among patients with glaucoma. Areas covered: A scoping review was conducted, according to the methodology proposed by Arksey and O’Malley. The databases used were Medical Literature Analysis and Retrieval System Online (MEDLINE) and the Biblioteca do Conhecimento Online (B-on). Our research used as primary sources articles in Portuguese and English. Expert opinion: The identified adherence rates were very different, and the conditions how under medication adherence was assessed were highly variable. These conditions impossibilities a proper comparative study. Further efforts are needed to increase health literacy and thus identify and support patients with low medication adherence rates. It is important that health care personnel could improve patients’ knowledge about the importance of medication adherence, glaucoma disease, and the consequences that result from the lack of treatment.
Keywords: bimatoprost; eye drops; latanoprost; prostaglandin; travoprost; age; anxiety; arthritis; blindness; cerebrovascular accident; comorbidity; depression; drug cost; drug therapy; ethnicity; glaucoma; health care personnel; health literacy; hospitalization; human; income; medication compliance; monotherapy; patient compliance; posttraumatic stress disorder; prevalence; quality of life; questionnaire; retinal nerve fiber layer; review

Ocular imaging at the cutting-edge - Lai, T.Y.Y. (Eye (Basingstoke), 2021)
Keywords: fundus camera; smartphone; artificial intelligence; autofluorescence imaging; choroiditis; deep learning; diabetic retinopathy; diagnostic imaging; editorial; enhanced depth imaging optical coherence tomography; fluorescence angiography; fundus autofluorescence; glaucoma; health care access; health care quality; human; indocyanine green angiography; multimodal imaging; ophthalmologist; ophthalmology; optical coherence tomography; optical coherence tomography angiography; spectral domain optical coherence tomography; swept source optical coherence tomography; uveitis; wet macular degeneration

Epidemiology of pars plana vitrectomy in the elderly: A retrospective 10-year survey of 592 cases - Elyashiv, S.; Levin, M.F.; Zloto, O.; Neimark, E.; Najjar, R.; Moisseiev, J.; Vidne-Hay, O. (Clinical Interventions in Aging, 2021)
Purpose: To report the epidemiology of the surgical indications of pars plana vitrectomy in patients aged 75 years or older. Patients and Methods: The medical records of patients who underwent vitrectomy surgery in a single center between 2008 and 2018 were evaluated retrospectively for demographics, medical background, and surgical indications. Data on patients aged 75–85 were compared to those of patients older than 85 years and those recorded between 2008–2013 and 2014–2018. Results: A total of 592 patients were included, of whom 55% were males. The mean±standard deviation age of the cohort at presentation was 80.4±4.60 years, and the mean visual acuity was 1.3±0.93 logMAR. The main indications for surgery were retinal detachment (n=117, 19.7%), epiretinal-membrane/vitreomacular traction (n=140, 23.6%), dropped intraocular lens/retained lens (n=89, 15%), macular hole (n=64, 11%), submacular hemorrhage (n=40, 6.7%), diagnostic vitrectomy (n=37, 6.2%), non-diabetic vitreous hemorrhage (n=30, 5.1%), and diabetic vitreous hemorrhage and other diabetic complications (n=33, 5.6%). Patients aged 85 years and older had higher rates of urgent surgeries (65%), such as for submacular hemorrhage and trauma (p=0.0000039 and p=0.001, respectively), and lower rates of nonurgent surgeries, such as for epiretinal membrane and macular hole (p=0.000032 and p=0.02, respectively), compared to patients aged 75–84 years. Additionally, the surgical rate for submacular hemorrhage decreased during 2008–2014 compared to 2014–2018 (p=0.000014). Conclusion: Understanding the unique distribution of indications for vitrectomy among elderly patients is essential for appropriate management and treatment. Urgent cases represent 65% of the surgeries performed in the older population.
Keywords: lens implant; age distribution; aged; aging; article; diabetic complication; emergency surgery; endophthalmitis; epiretinal membrane; female; glaucoma; health care utilization; human; major clinical study; male; pars plana vitrectomy; retina detachment; retina disease; retina injury; retina macula hemorrhage; retina macula hole; retrospective study; risk factor; treatment indication; very elderly; visual acuity; vitreomacular traction; vitreous hemorrhage

Follow-up Adherence and Barriers to Care for Pediatric Glaucomas at a Tertiary Care Center - Mikolajczyk, B.; Greenberg, E.R.; Fuher, H.; Berres, M.; May, L.L.; Areaux, R.G. (American Journal of Ophthalmology, 2021)
Purpose: To determine the percent adherence to follow-up for patients with pediatric glaucomas seen at a tertiary care center and to elucidate risk factors. Design: Retrospective cohort study. Methods: Patients with pediatric glaucomas seen at the University of Minnesota over 8.5 years were classified as adherent, nonadherent, or lost to tertiary follow-up if they followed up within 0-30 days, between 31 and 180 days, or later than 180 days of the recommended appointment time or never, respectively. Results: Of 176 patients analyzed, 95 (54%) were adherent (51% male; mean [standard deviation (SD)] age: 56.1 [59.8] months), 5 (3%) were nonadherent (20% male; mean [SD] age: 25.0 [35.8] months), and 76 (43%) were lost to tertiary follow-up (55% male; mean [SD] age: 58.9 [53.1] months). Multiple logistic regression analysis of variables that were significant in isolation revealed that only race (white: odds ratio, 3.58; 95% confidence interval, 1.42-9.05; P = .007) and distance from the eye clinic (per 50 miles: odds ratio, 0.79; 95% confidence interval, 0.67-0.92; P = .003) significantly impacted adherence. Conclusions: This is the first study of adherence to follow-up recommendations for patients with pediatric glaucomas. Percent adherence to follow-up appointments was alarmingly low, and decreased adherence was observed with non-white race and increased distance to the eye clinic. Physicians should consider these risk factors when risk-stratifying patients with pediatric glaucomas for nonadherence to follow-up. Additional studies to improve adherence through interventions that reduce biases and barriers to follow-up are needed.
Keywords: article; best corrected visual acuity; Caucasian; child; controlled study; dependent variable; female; follow up; glaucoma; Hispanic; household income; human; logistic regression analysis; major clinical study; male; patient care; prediction; priority journal; risk factor; tertiary care center

The treatment of glaucoma using topical preservative-free agents: an evaluation of safety and tolerability - Konstas, A.G.; Labbé, A.; Katsanos, A.; Meier-Gibbons, F.; Irkec, M.; Boboridis, K.G.; Holló, G.; García-Feijoo, J.; Dutton, G.N.; Baudouin, C. (Expert Opinion on Drug Safety, 2021)
Introduction: Preservative-free (PF) medications represent a valuable treatment strategy in the lifelong management of glaucoma. By removing preservative toxicity, PF formulations provide tangible clinical benefits to glaucoma patients worldwide. They improve tolerability and adherence, leading to a positive impact in long-term intraocular pressure (IOP) control. Areas covered: A critical review of the subject is provided, including selected evidence on the safety and tolerability of currently available topical PF formulations. Cumulative evidence confirms that topical PF medications are at least equally efficacious to their preserved equivalents. There is convincing short-term evidence for superior tolerability and safety of PF formulations compared to preserved medications. The long-term benefits and success of PF therapy requires further elucidation. Expert opinion: Successful stepwise administration of medical therapy for glaucoma remains elusive. There is a greater risk for ocular toxicity and therapy failure with preserved topical glaucoma therapy. Currently available and emerging PF therapy options potentially optimize lifelong stepwise glaucoma therapy and may enhance outcome. To avert complications from preservatives leading to poor adherence, ideally, future antiglaucoma therapy should become 100% PF. There are still key aspects of PF therapy that warrant further investigation.
Keywords: antiglaucoma agent; benzalkonium chloride; bimatoprost plus timolol; brimonidine; dorzolamide plus timolol; drug preservative; prostaglandin derivative; tafluprost; tafluprost plus timolol; timolol; drug safety; drug tolerability; eye toxicity; filtering operation; glaucoma; glaucoma surgery; human; intraocular hypertension; intraocular pressure; ocular surface disease; patient compliance; review; topical treatment; treatment failure

Cholesterol and glaucoma: a systematic review and meta-analysis - Posch-Pertl, L.; Michelitsch, M.; Wagner, G.; Wildner, B.; Silbernagel, G.; Pregartner, G.; Wedrich, A. (Acta Ophthalmologica, 2021)
Purpose: Intraocular pressure is the main risk factor for glaucoma; however, additional risk factors may also matter. This systematic review and meta-analysis were conducted to summarize the evidence regarding the association of cholesterol parameters (total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels) and glaucoma. Methods: Four electronic databases were searched for all publications containing ‘glaucoma’ and one of various forms of ‘cholesterol’ or ‘lipoprotein’. Two independent reviewers screened abstracts and potentially full texts of identified articles for eligibility. Risk of bias was assessed with the Newcastle–Ottawa Scale. A random-effects meta-analysis was used to investigate the differences in total cholesterol, LDL and HDL levels between patients with and without glaucoma. Results: Overall, 29 observational studies were included in the systematic review and 26 reported quantitative information to investigate differences in cholesterol parameters between patients with glaucoma (N = 7196) and patients without glaucoma (N = 350 441). Patients with glaucoma had significantly higher total cholesterol levels than patients without glaucoma (Mean Difference (MD) 7.9 mg/dl, 95% CI 3.3 to 12.5, p = 0.001) and lower mean HDL levels (MD −2.0 mg/dl, 95% CI: −3.1 to −0.9, p = 0.001). Patients with glaucoma had higher mean LDL levels than patients without glaucoma, albeit not statistically significant (MD 6.1 mg/dl, 95% CI: −4.3 to 16.4, p = 0.251). Conclusion: This systematic review and meta-analysis of observational studies found an association of glaucoma and high total cholesterol and low HDL levels, respectively. Although this supports the hypothesis that lipid levels pose an additional risk for glaucoma development, heterogeneity was substantial and causality cannot be presumed from identified observational studies.
Keywords: adult; article; eligibility; female; gene expression; glaucoma; human; male; meta analysis; Newcastle-Ottawa scale; observational study; protein expression; quantitative analysis; risk assessment; systematic review; total cholesterol level; cholesterol; endogenous compound; high density lipoprotein; hydroxymethylglutaryl coenzyme A reductase inhibitor; low density lipoprotein

Surgical and laser interventions for pseudoexfoliation glaucoma systematic review of randomized controlled trials - Pose-Bazarra, S.; López-Valladares, M.J.; López-de-Ullibarri, I.; Azuara-Blanco, A. (Eye (Basingstoke), 2021)
To assess the comparative effectiveness and safety of different surgical and laser techniques in people with pseudoexfoliation glaucoma (PXFG). We conducted a systematic review including randomized controlled trials (RCT) that compared any pair of surgical or laser treatment versus other type of intervention in PXFG. RCT were identified by a highly sensitive search of electronic databases and two individuals independently assessed trial eligibility, abstracted data and assessed risk of bias. We performed Bayesian Meta-Analysis when outcomes were comparable. The search strategy identified 6171 records. Six studies (262 subjects) were included. Two trials analyzed the same pair of surgical interventions comparing phacoemulsification as solo procedure or combined with trabecular aspiration and we performed meta-analysis. Other RCTs compared the following interventions: trabecular aspiration associated with phacoemulsification versus phacotrabeculectomy, non-penetrating deep sclerectomy associated or not with phacoemulsification, selective versus argon laser trabeculoplasty and one-site versus two-site phacotrabeculectomy. For IOP data, none of the trials reported a difference between pairs of surgical techniques, nor changes in visual acuity or number of post-operative medications. The overall risk of bias is moderate to high. There are no apparent differences in efficacy and safety, although with large uncertainty, between surgical or laser techniques for PXFG. Based on the low-quality evidence from the six studies included in this review, it is not possible to justify the preferential use of non-penetrating surgery, MIGS or trabecular aspiration (with or without cataract surgery) in PXFG. Further research is needed to determine the optimal management of this condition.
Keywords: adult; argon laser; cataract extraction; controlled study; drug safety; eligibility; female; human; intraocular pressure; low level laser therapy; male; meta analysis; phacoemulsification; pseudoexfoliation; randomized controlled trial (topic); review; risk assessment; sclerectomy; surgery; surgical technique; systematic review; trabeculoplasty; uncertainty; visual acuity

Patient and Clinician Satisfaction With Shared Medical Appointments for Glaucoma - Tam, E.K.; De Arrigunaga, S.; Shah, M.; Kefella, H.; Soriano, S.; Rowe, S. (Seminars in Ophthalmology, 2021)
Shared Medical Appointments (SMAs) are patient-centered care tools designed to administer patient counseling and education, typically delivered individually, in a group setting. SMAs are effective in facilitating peer-learning, resulting in improvement in knowledge and health behavior. This study aimed to implement what we know of as the first ophthalmology SMA done in the United States. We evaluated the implementation feasibility, patient and provider experience, changes in patient knowledge, and provider stress. Five glaucoma patients who expressed issues with adherence during their clinic visit at Boston Medical Center (BMC) who were interested in the SMA were recruited. Patients and staff had a positive experience with the SMA. There was a marked increase in patient glaucoma knowledge and a decrease in average staff member stress level score during the SMA. From all standpoints, including billing and management, we conclude that SMA implementation is feasible in ophthalmology departments in academic settings.
Keywords: adult; article; clinical article; controlled study; feasibility study; female; glaucoma; human; male; Massachusetts; ophthalmology; physiological stress; satisfaction; shared medical appointment

Intraocular Pressure Telemetry for Managing Glaucoma during the COVID-19 Pandemic - Mansouri, K.; Kersten-Gomez, I.; Hoffmann, E.M.; Szurman, P.; Choritz, L.; Weinreb, R.N. (Ophthalmology Glaucoma, 2021)
Purpose: To evaluate in glaucoma patients the feasibility and use of remote monitoring of intraocular pressure (IOP) with an implanted telemetry sensor during the coronavirus disease 2019 (COVID-19) lockdown. Design: Cross-sectional study. Participants: Patients previously implanted with a telemetric IOP sensor (Eyemate; Implandata GmbH) were included. Methods: Intraocular pressure measurements acquired by the patients during the lockdown were collected by physicians who were located remotely. A questionnaire was sent to 10 participating study centers to evaluate the clinical impact of remote monitoring of IOP via the IOP sensor system. Main Outcome Measures: Number of patients who obtained home IOP measurements. Results: Data were available from all centers and from 37 eyes of 37 patients (16 patients with a sulcus-based sensor and 21 patients with a suprachoroidal sensor). Thirty-four patients obtained IOP measurements during the lockdown. Mean age of the patients was 69.3 ± 9.6 years, and 48.6% were women. A total of 8415 IOP measurements from 370 measurement days were obtained. Based on remote IOP measurements, treatment was changed in 5 patients. In another 5 patients, treatment change was considered when physicians received the IOP measurements after the lockdown. Nine of the 10 study centers judged remote IOP measurements to have a clinical impact. Conclusions: These results show the feasibility of patient-acquired measurement of IOP in conjunction with remote IOP monitoring by physicians with an implantable sensor. The data obtained impacted clinical decision making, including adjustment of ocular hypotensive therapy and avoiding unnecessary office visits during the COVID-19 pandemic.
Keywords: aged; ambulatory care; article; clinical article; clinical decision making; clinical evaluation; coronavirus disease 2019; cross-sectional study; drug therapy; feasibility study; female; glaucoma; human; intraocular pressure; lockdown; male; outcome assessment; pandemic; physician; questionnaire; remote sensing; sensor; antihypertensive agent

Clinical and Economic Burden of Glaucoma by Disease Severity: A United States Claims-Based Analysis - Shih, V.; Parekh, M.; Multani, J.K.; McGuiness, C.B.; Chen, C.-C.; Campbell, J.H.; Miller-Ellis, E.; Olivier, M.M.G. (Ophthalmology Glaucoma, 2021)
Purpose: To provide updated estimates of the clinical and economic burden in patients with ocular hypertension (OHT) or open-angle glaucoma (OAG) by disease severity in the United States and to estimate incremental costs associated with disease progression. Design: Retrospective cohort study. Participants: Patients with 1 or more International Classification of Diseases, 10th Revision, Clinical Modification, diagnoses for OAG or OHT who are 40 years of age or older. Methods: Patients were identified from IQVIA's PharMetrics Plus database during the index period (October 1, 2015, to August 31, 2017). Patients had continuous health plan enrollment for 12 months or more before and after the index date (first OAG or OHT diagnosis during index period) and were stratified by baseline disease severity based on diagnosis code. Annual eye-related outpatient healthcare use and costs were estimated on a per-user basis. A generalized linear model was used to estimate adjusted mean costs by severity and to evaluate the impact of observed disease worsening on costs. A multivariate logistic regression analysis evaluated the relationship between severity and odds of falls or fractures. Main Outcome Measures: Total eye-related outpatient costs and odds of falls or fractures. Results: One hundred seventy-seven thousand three hundred fifty-two OHT and OAG patients were identified (67.8% with OAG). Open-angle glaucoma patients showed higher eye-related outpatient costs than OHT patients (median, $516 [interquartile range (IQR), $323–$898] vs. $344 [IQR, $197–$617], respectively). Patients with severe OAG showed higher eye-related outpatient costs than moderate and mild OAG patients (median, $639 [IQR, $381–$1264] vs. $546 [IQR, $345–$950] vs. $476 [IQR, $304–$765], respectively; P < 0.0001), as well as higher glaucoma-related pharmacy costs (median, $493 [IQR, $122–$1457] vs. $244 [IQR, $84–$1113] vs. $139 [IQR, $66–$818], respectively; P < 0.0001). In adjusted analyses, disease worsening was associated with at least 2-fold higher annual eye-related outpatient costs (P < 0.0001). Severe OAG patients had significantly higher odds of fall or fracture compared with OHT patients (odds ratio, 1.34; 95% confidence interval, 1.13–1.59). Conclusions: Updated estimates showed highest eye-related costs for those with severe disease and disease progression among patients with OAG and OHT. Severe OAG was associated with increased risk of falls or fractures compared with patients with OHT. Therapies that delay disease progression may provide clinical and economic benefits.
Keywords: adult; cohort analysis; conference paper; female; fracture; health care utilization; human; hypertensive patient; ICD-10-CM; intraocular hypertension; major clinical study; male; open angle glaucoma; outcome assessment; outpatient; retrospective study; United States

Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations: 1-Month Feasibility Results - Hark, L.A.; Tan, C.S.; Kresch, Y.S.; De Moraes, C.G.; Horowitz, J.D.; Park, L.; Auran, J.D.; Gorroochurn, P.; Stempel, S.; Maruri, S.C.; Besagar, S.; Saaddine, J.B.; et al. (Current Eye Research, 2021)
Purpose/Aim: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers (CHW) and patient navigators. In the study, trained CHWs conducted vision screening and patient navigators scheduled on-site eye exams and arranged appointments for those referred to ophthalmology to improve adherence to follow-up eye care. Materials and Methods: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in Upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity with correction, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening were scheduled with an on-site optometrist for an eye exam; those with ocular pathologies were referred to an ophthalmologist. Participants were also administered the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ-8) and Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test by community health workers. Results:Participants (n = 42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n = 33) failed vision screening. Of those who failed, 84.8% (n = 28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses. Conclusion: This study demonstrates the feasibility of using CHWs and patient navigators for reducing barriers to vision screening and optometrist-based eye exams in vulnerable populations, ultimately improving early detection of eye disease and linking individuals to additional eye care appointments. The full five-year study aims to further examine these outcomes.
Keywords: accident; aged; article; cataract; clinical article; controlled study; eye care; feasibility study; female; follow up; glaucoma; health auxiliary; Hispanic; human; injury; intraocular pressure; National Eye Institute Visual Function Questionnaire; New York; ophthalmologist; ophthalmology; optometrist; photography; preliminary data; refraction error; retina; senior center; spectacles; vision test; visual acuity; visual impairment; vulnerable population

Phacoemulsification with Goniosynechialysis versus Phacoemulsification Alone in Angle-Closure Glaucoma: A Meta-Analysis of Randomized Controlled Trials - Yu, J.-G.; Zhao, F.; Xiang, Y. (Journal of Ophthalmology, 2021)
Purpose. This meta-analysis aimed to compare the efficacy and safety of phacoemulsification with goniosynechialysis (Phaco-GSL) with those of phacoemulsification alone (Phaco-alone) in patients with angle-closure glaucoma and cataract. Methods. Randomized controlled trials (RCTs) were selected through a search of electronic databases. Trial eligibility and risk of bias were assessed using Cochrane review methods. Primary measures included the intraocular pressure (IOP), number of antiglaucoma medications, peripheral anterior adhesion (PAS) extent, and their pre- A nd postoperative changes. For continuous parameters, we calculated weighted mean differences and 95% confidence intervals. Statistical analysis was performed using RevMan 5.3 software. Results. Eight RCTs were included, where 224 and 236 eyes were in the Phaco-GSL and Phaco-alone groups, respectively. Both postoperative IOP and number of medications were not significantly different between the study groups at the six- A nd twelve-month follow-up. However, the 12-month postoperative PAS extent was significantly smaller in the Phaco-GSL group than in the Phaco-alone group. Similarly, changes from the preoperative to 12-month postoperative PAS extent were significantly greater in the Phaco-GSL group than in the Phaco-alone group, but IOP and the number of medication changes were not different. Conclusions. Our results provide evidence that Phaco-GSL provides advantages over Phaco-alone treatment regarding PAS reduction. In terms of IOP and medication reduction, both groups were comparable. Thus, Phaco-GSL can be considered for the treatment of patients with angle-closure glaucoma and cataract due to its ease, safety, and potential benefit for the anterior chamber angle.
Keywords: adult; anterior eye chamber angle; article; cataract; closed angle glaucoma; comparative effectiveness; controlled study; drug safety; eligibility; female; follow up; human; intraocular pressure; male; meta analysis; phacoemulsification; randomized controlled trial (topic); risk assessment; software; systematic review

Obesity and risk of age-related eye diseases: a systematic review of prospective population-based studies - Ng Yin Ling, C.; Lim, S.C.; Jonas, J.B.; Sabanayagam, C. (International Journal of Obesity, 2021)
Background: Obesity is a public health challenge worldwide. The relationship between obesity and age-related eye diseases including cataract, glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy (DR) have remained elusive. Design and methods: We conducted a systematic review of three electronic databases for longitudinal population-based studies that described associations between measures of obesity including body mass index (BMI), waist-circumference (WC), and waist-to-hip ratio (WHR), and age-related eye diseases. Results: Our search yielded 1731 articles, of which 14, 10, 16 and 8 articles met our eligibility criteria for cataract, glaucoma, AMD and DR, respectively. BMI-defined obesity was positively associated with incident cataract, incident AMD and incident DR in Western populations, but in Asian populations associations for incident AMD were not significant and associations for incident DR were inverse. WC-defined obesity was associated with incident glaucoma in non-Western populations. WHR-defined obesity but not BMI-defined obesity was associated with the incidence or progression of AMD in two Western studies. Conclusions: Overall, we found strong evidence supporting associations between obesity and age-related eye diseases. Further research on the association of abdominal obesity and effect of weight loss and physical activity on age-related eye diseases is warranted to support clinical and public health recommendations.
Keywords: abdominal obesity; age related macular degeneration; Asian; body mass; body weight loss; cataract; diabetic retinopathy; eligibility criteria; glaucoma; human; incidence; physical activity; prospective study; public health; review; systematic review; waist circumference; waist hip ratio

What Do We Really Know about the Effectiveness of Glaucoma Interventions?: An Overview of Systematic Reviews - Qureshi, R.; Azuara-Blanco, A.; Michelessi, M.; Virgili, G.; Barbosa Breda, J.; Cutolo, C.A.; Pazos, M.; Katsanos, A.; Garhöfer, G.; Kolko, M.; Prokosch-Willing, V.; Al Rajhi, A.A.; et al. (Ophthalmology Glaucoma, 2021)
Purpose: To identify systematic reviews of interventions for glaucoma conditions and to assess their reliability, thereby generating a list of potentially reliable reviews for updating glaucoma practice guidelines. Design: Cross-sectional study. Participants: Systematic reviews of interventions for glaucoma conditions. Methods: We used a database of systematic reviews and meta-analyses in vision research and eye care maintained by the Cochrane Eyes and Vision United States Satellite. We examined all Cochrane systematic reviews of interventions for glaucoma conditions published before August 7, 2019, and all non-Cochrane systematic reviews of interventions for glaucoma conditions published between January 1, 2014, and August 7, 2019. Main Outcome Measures: We assessed eligible reviews for reliability, extracted characteristics, and summarized key findings from reviews classified as reliable. Results: Of the 4451 systematic reviews in eyes and vision identified, 129 met our eligibility criteria and were assessed for reliability. Of these, we classified 49 (38%) as reliable. We found open-angle glaucoma (22/49) to be the condition with the most reviews and medical management (17/49) and intraocular pressure (IOP; 43/49) to be the most common interventions and outcomes studied. Most reviews found a high degree of uncertainty in the evidence, which hinders the possibility of making strong recommendations in guidelines. These reviews found high-certainty evidence about a few topics: reducing IOP helps to prevent glaucoma and its progression, prostaglandin analogs are the most effective medical treatment for lowering IOP, laser trabeculoplasty is as effective as medical treatment as a first-line therapy in controlling IOP, the use of IOP-lowering medications in the perioperative or postoperative periods to accompany laser (e.g., trabeculoplasty) reduces the risk of postoperative IOP spikes, conventional surgery (i.e., trabeculectomy) is more effective than medications in reducing IOP, and antimetabolites and β-radiation improve IOP control after trabeculectomy. The evidence is weak regarding the effectiveness of minimally invasive glaucoma surgeries. Conclusions: Most systematic reviews evaluating interventions for glaucoma are of poor reliability. Even among those that may be considered reliable, important limitations exist in the value of information because of the uncertainty of the evidence as well as small and sometimes unimportant clinical differences between interventions.
Keywords: adult; article; beta radiation; controlled study; cross-sectional study; drug therapy; eligibility criteria; eye care; female; human; intraocular pressure; laser; male; open angle glaucoma; perioperative period; postoperative period; prevention; reliability; spike; systematic review; trabeculectomy; trabeculoplasty; uncertainty; United States; vision; antimetabolite; prostaglandin

Antimuscarinic use among older adults with dementia and overactive bladder: a Medicare beneficiaries study - Kachru, N.; Holmes, H.M.; Johnson, M.L.; Chen, H.; Aparasu, R.R. (Current Medical Research and Opinion, 2021)
Objectives: This study examined the incidence and predictors of antimuscarinic medication use including non-selective antimuscarinics among older adults with dementia and overactive bladder (OAB). Methods: The study used a new-user cohort design involving older adults (≥65 years) with dementia and OAB based on 2013–2015 Medicare data. Antimuscarinics included non-selective (oxybutynin, tolterodine, trospium, fesoterodine) and selective (solifenacin, darifenacin) medications. Descriptive statistics and multivariable logistic regression models were used to determine the incidence and predictors of new antimuscarinic use including non-selective antimuscarinics, respectively. Results: Of the 3.38 million Medicare beneficiaries with dementia, over one million (1.05) had OAB (31.03%). Of those, 287,612 (27.39%) were reported as prevalent antimuscarinics users. After applying continuous eligibility criteria, 21,848 (10.34%) incident antimuscarinic users were identified (77.6% non-selective; 22.4% selective). Most frequently reported antimuscarinics were oxybutynin (56.3%) and solifenacin (21.4%). Multivariable analysis revealed that patients ≥75 years, of black race, and those with schizophrenia, epilepsy, delirium, and Elixhauser’s score were less likely to initiate antimuscarinics. Women, those with abnormal involuntary movements, bipolar disorder, gastroesophageal reflux disease, insomnia, irritable bowel syndrome, muscle spasm/low back pain, neuropathic pain, benign prostatic hyperplasia, falls/fractures, myasthenia gravis, narrow-angle glaucoma, Parkinson's disease, syncope, urinary tract infection and vulvovaginitis were more likely to initiate antimuscarinics. Further, patients with muscle spasms/low back pain, benign prostatic hyperplasia and those taking higher level anticholinergics had lower odds of receiving non-selective antimuscarinics, whereas white patients, black patients and those with schizophrenia and delirium were more likely to receive them. Conclusions: Nearly one-third of dementia patients had OAB and over one-fourth of them used antimuscarinics. Majority of the incident users were prescribed non-selective antimuscarinics with several demographic and clinical factors contributing to their use. Given the high prevalence of OAB among dementia patients, there is a need to optimize their antimuscarinic use, considering their vulnerability for anticholinergic adverse effects.
Keywords: aged; article; beer; bipolar disorder; Black person; closed angle glaucoma; cohort analysis; controlled study; delirium; demography; drug therapy; dyskinesia; eligibility criteria; Elixhauser comorbidity index; epilepsy; faintness; female; fracture; gastroesophageal reflux; human; incidence; insomnia; irritable colon; low back pain; male; medicare; myasthenia gravis; neuropathic pain; overactive bladder; Parkinson disease; prevalence; prostate hypertrophy; schizophrenia; urinary tract infection; vulvovaginitis; darifenacin; fesoterodine; oxybutynin; solifenacin; tolterodine; trospium chloride

The Burden of Caring for and Treating Glaucoma: The Patient Perspective - Stagg, B.C.; Granger, A.; Guetterman, T.C.; Hess, R.; Lee, P.P. (Ophthalmology Glaucoma, 2021)
Purpose: To understand the treatment burden experienced by patients receiving care for primary open-angle glaucoma. Design: Semistructured, one-on-one, qualitative interviews. Participants: Patients with primary open-angle glaucoma and age ≥40 years who were scheduled for a follow-up glaucoma appointment at the Kellogg Eye Center. Researchers used purposeful sampling to ensure that there was representation of a range of ages, disease stages, total number of medical conditions, distance traveled to clinic, history of glaucoma surgery, employment, and education. Interviews were conducted until thematic saturation was obtained. Methods: Participants were interviewed using a semi-structured interview guide that addressed aspects of glaucoma care that give them burden, how this burden impacts their lives, and factors that influence the burden and its impact. Researchers analyzed the transcripts using inductive thematic analysis and grounded theory to generate themes that emerged from the interviews and to map these themes into a conceptual model of glaucoma treatment burden. Main Outcome Measures: Themes related to glaucoma treatment burden generated by qualitative analysis. Results: A total of 22 patients participated in the study. Study participants described 10 categories of glaucoma care activities that cause treatment burden, 8 themes for consequences of glaucoma treatment burden, and 25 themes of factors that influenced the workload created by the various glaucoma care activities and the consequences that they experienced because of these activities. Conclusions: Participants expressed that the treatment of glaucoma creates a burden for patients that is distinct from the burden of the disease process itself and that this burden negatively affects their quality of life and can potentially cause vision-threatening issues with medication and appointment adherence. We observed considerable variation in the extent to which participants experienced this burden and its consequences, much of which was explained by the influencing factors the participants described. Understanding glaucoma treatment burden and its influencing factors is important as we work to deliver patient-centered care and prevent vision loss.
Keywords: adult; article; blindness; care behavior; case report; clinical article; conceptual model; education; employment; female; follow up; genetic transcription; glaucoma surgery; grounded theory; human; male; medication compliance; open angle glaucoma; outcome assessment; patient care; prevention; qualitative analysis; qualitative research; quality of life; semi structured interview; thematic analysis; vision; workload

Demographic, Clinical, and Psychosocial Predictors of Change in Medication Adherence in the Support, Educate, Empower Program - Miller, D.J.; Niziol, L.M.; Elam, A.R.; Heisler, M.; Lee, P.P.; Resnicow, K.; Musch, D.C.; Darnley-Fisch, D.; Mitchell, J.; Newman-Casey, P.A. (Ophthalmology Glaucoma, 2021)
Purpose: To investigate whether demographic, clinical, or psychosocial factors act as moderators of change in medication adherence in the Support, Educate, Empower (SEE) program. Design: Prospective, single-arm pilot study with a pre–post design. Participants: Patients with glaucoma aged ≥ 40 years and taking ≥ 1 glaucoma medication were recruited from the University of Michigan Kellogg Eye Center. Those who had electronically measured adherence ≤ 80% in the 3-month eligibility monitoring period were enrolled in the SEE program. Methods: Medication adherence was monitored electronically during the 7-month intervention and calculated as the percentage of doses taken correctly. Change in adherence at different points in the SEE program and cumulative change in adherence were modeled with linear regression, and baseline demographic, clinical, and psychosocial factors were investigated for significant associations. Main Outcome Measures: Demographic, clinical, and psychosocial variables associated with change in medication adherence in the SEE program. Results: Thirty-nine participants completed the SEE program. These participants were on average 63.9 years old (standard deviation [SD], 10.7 years), 56% (n = 22) were male, 44% (n = 17) were White, and 49% (n = 19) were Black. Medication adherence improved from an average of 59.9% (SD, 18.5%) at baseline to 83.6% (SD, 17.5%) after the final SEE session, for an increase of 23.7% (SD, 17.5%). Although participants with lower income (< $25 000 and $25 000–50 000 vs. >$50 000) had lower baseline adherence (48.4% and 64.1% vs. 70.4%), these individuals had greater increases in adherence during the first month of medication reminders (19.6% and 21.6% vs. 10.2%; P = 0.05 and P = 0.007, respectively). Participants taking fewer glaucoma medications also had significantly greater increases in adherence with medication reminders (P < 0.001). Those with higher levels of glaucoma-related distress (GD) had lower baseline adherence and greater increases in adherence with glaucoma coaching (P = 0.06). Conclusions: Patient-level factors associated with relatively greater improvements in medication adherence through the SEE Program included lower income, fewer glaucoma medications, and increased GD. These findings demonstrate that the SEE program can improve glaucoma self-management even among participants with social and psychological barriers to medication adherence.
Keywords: adult; clinical article; conference paper; controlled study; demography; distress syndrome; education; eligibility; female; glaucoma; human; linear regression analysis; male; medication compliance; Michigan; middle aged; motivational interviewing; outcome assessment; pilot study; prospective study; self care

Glaucomatous Optic Neuropathy: Associated with Cognitive Impairment? - Norouzpour, A. (Journal of Glaucoma, 2021)
Keywords: antiglaucoma agent; cell loss; cognition; cognitive defect; correlation analysis; disease association; disease course; disease severity; glaucoma; glaucomatous optic neuropathy; human; information processing; letter; nerve degeneration; optic nerve disease; patient compliance; patient monitoring; priority journal; risk assessment; visual discrimination; visual evoked potential

Adherence and Persistence with First-Line Therapy and Compliance with Glaucoma Guidelines Using Japanese Health Care/Pharmacy Claims Database - Shirai, C.; Matsuoka, N.; Nakazawa, T. (Journal of Ocular Pharmacology and Therapeutics, 2021)
Purpose: This study evaluated Japanese patients' adherence to first-line therapy and physicians' compliance with the guidelines (GLs) for glaucoma in daily practice. Methods: This retrospective, noninterventional cohort study used a Japanese health care/pharmacy claims database from 2011 to 2016. We compared adherence based on the primary outcomes assessed as proportion of days covered (PDC) and persistence between patients who received first-line monotherapy followed by second-line fixed-combination therapy (GL-compliant cohort) and those who received first-line fixed-combination therapy (GL-noncompliant cohort). Furthermore, we explored treatment patterns, glaucoma consultation, and key factors associated with GL noncompliance. Results: Among 11,666 patients who received first-line therapy, 1,183 (10.1%) and 542 (4.6%) were in the GL-compliant and GL-noncompliant cohorts, respectively. Prostaglandin (70.7%) and subsequent prostaglandin/β blocker (BB) (20.9%) within 12 months were most used by the GL-compliant cohort. Prostaglandin/BB (48.9%) and carbonic anhydrase inhibitor/BB (51.1%) were prescribed for the GL-noncompliant cohort. The mean PDC [standard deviation (SD)], persistence rate (95% confidence interval), and consultation (SD) over 12 months were 60.9% (34.0), 16.0% (14.0-18.1), and 5.23 (3.21) times, respectively, in the GL-compliant cohort and 59.7% (35.8), 22.0% (18.6-25.5), and 4.76 (3.19) times, respectively, in the GL-noncompliant cohort. No significant differences were observed between the 2 cohorts. No clinically relevant factor associated with GL noncompliance was found. Conclusions: Around 5% of patients were prescribed a fixed-combination eye drop as first-line therapy not in accordance with GLs. The similarity of adherence and persistence between the 2 cohorts indicates that first-line fixed-combination therapy could be considered for glaucoma treatment.
Keywords: alpha 1 adrenergic receptor blocking agent; alpha 2 adrenergic receptor blocking agent; alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; antihypertensive agent; beta adrenergic receptor blocking agent; brinzolamide plus timolol; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; muscarinic agent; prostaglandin derivative; Rho kinase inhibitor; tafluprost; timolol; timolol plus travoprost; travoprost; adult; article; cohort analysis; consultation; controlled study; female; glaucoma; human; Japanese (people); major clinical study; male; monotherapy; observational study; patient compliance; protocol compliance; reference database; retrospective study; topical treatment; treatment duration; treatment planning

Naturalistic evaluation of prescription pattern in glaucoma clinic of a tertiary care hospital: A developing country's perspective - Niraj, N.; Shafiq, N.; Kaushik, S.; Mothsara, C.; Garg, G.; Malhotra, S. (Journal of Pharmacy and Bioallied Sciences, 2021)
Background: Glaucoma is a chronic, gradual and progressive eye disorder characterized by visual loss and involving the typical changes in optic nerves and associated structures. Currently, the mainstay treatment lies in the reduction of intraocular pressure (IOP) involving the usage of two or three medications concurrently. However, prescription pattern of antiglaucoma drugs remains largely unstudied so far. Therefore, there is a dire need of drug utilization studies to ensure rational prescribing for better treatment outcomes. Aim: This study was conducted to assess the prescription pattern in glaucoma patients to encourage rational use of drugs. Materials and Methods: The pertinent data of confirmed glaucoma patients were entered in a predesigned case record form (CRF) including patient demographic details, type of glaucoma, number of drug prescribed, drug dosage and dosage formulation with prior patient consent, and finally, the data were analyzed using Microsoft Excel. Results: A total of 247 glaucoma patients were recorded in the study. The mean SD number of drugs per prescription was 2.18 (1.68). Monotherapy was prescribed to 72 (29.15%) patients, and the most common monotherapy prescribed was timolol, whereas in fixed-dose combinations (FDCs), brimonidine and timolol FDCs were most commonly encountered. Furthermore, prescriptions consisting of generic drugs only and prescribed as per the National List of Essential Medicines (NLEM) were 48 (19.43%) and 41 (16.59%), respectively. Conclusion: This study showed the judicious use of medications in tune with principles of rational drug use in our center, and the rationale practices can be extended to the peripheral centers of the country for better drug utilization.
Keywords: acetazolamide; bimatoprost; brimonidine; brinzolamide; dorzolamide; generic drug; latanoprost; levobunolol; pilocarpine; prescription drug; timolol; travoprost; adult; closed angle glaucoma; combination drug therapy; demography; developing country; drug use; female; glaucoma; human; informed consent; major clinical study; male; middle aged; monotherapy; observational study; open angle glaucoma; patient compliance; prescription; priority journal; review; tertiary care center

Novel utilisation of ultrawide-field fundus photography for detecting retinal nerve fibre layer defects in glaucomatous eyes - Kim, M.J.; Lee, J.H.; Park, J.I.; Choi, J.Y.; Sohn, J.; Hwang, H.S.; Hwang, D.D.-J. (British Journal of Ophthalmology, 2021)
Background/aims: Evaluation of the retinal nerve fibre layer (RNFL) is important for identifying glaucomatous damage. Ultrawide-field fundus photography (UWP) imaging is increasingly used in the ophthalmological field; however, it is unknown whether it can be used for detecting RNFL defects (RNFLDs). We investigated whether RNFLD can be detected with UWP images and compared the clinical effectiveness of three types of images for detecting RNFLD: conventional red-free RNFL photography (RFP), non-mydriatic UWP and digitally converted green separation of non-mydriatic UWP (G-UWP). Methods: Eyes with glaucoma or glaucoma suspect and normal control eyes meeting the eligibility criteria were consecutively enrolled from September 2019 to April 2020. Their conventional RFP, non-mydriatic UWP and G-UWP images were assessed for detecting RNFLD to evaluate the sensitivity and specificity for detecting RNFLD. Results: Three image sets of 196 participants (84 normal control, 25 glaucoma suspect and 87 glaucoma) were obtained. The sensitivity of G-UWP (94.6%; 95% CI 88.7 to 98.0) and RFP (92.9%; 95% CI 86.4 to 96.9) was higher than that of UWP (82.1%; 95% CI 73.8 to 88.7; p<0.05). The sensitivities of G-UWP and RFP are comparable. The specificity of G-UWP (78.6%; 95% CI 68.3 to 86.8) and UWP (75.0%; 95% CI 64.4 to 83.8) was comparable, but both were lower than that of RFP (98.8%; 95% CI 93.5 to 100.0; p<0.05). Conclusion: Non-mydriatic UWP images can be used to detect RNFLD. Non-mydriatic G-UWP showed comparable sensitivity but lower specificity to conventional RFP. Non-mydriatic G-UWP could be used as a convenient and useful diagnostic tool for screening glaucoma in clinical settings.
Keywords: adult; article; comparative effectiveness; controlled study; eligibility criteria; eye fundus; female; glaucoma; human; major clinical study; male; photography; retinal nerve fiber layer; sensitivity and specificity

Uveitis in juvenile idiopathic arthritis - Petty, R.E.; Zheng, Q. (World Journal of Pediatrics, 2020)
Keywords: slit lamp; adalimumab; antinuclear antibody; azathioprine; caspase recruitment domain protein 15; corticosteroid; cyclosporine; HLA B27 antigen; HLA DR antigen; infliximab; interleukin 23 receptor; liver X receptor; methotrexate; mycophenolate mofetil; prednisolone acetate; programmed death 1 ligand 1; programmed death 1 receptor; tocilizumab; amblyopia; anterior eye chamber; arthritis; article; band keratopathy; Blau syndrome; cataract; differential diagnosis; eye pain; eye redness; eye synechia; follow up; gene locus; genetic profile; genetic susceptibility; headache; human; juvenile rheumatoid arthritis; liver toxicity; macular edema; mucocutaneous lymph node syndrome; neutropenia; ophthalmologist; patient compliance; patient education; photophobia; polyarthritis; prognosis; psoriatic arthritis; rheumatologist; risk factor; secondary glaucoma; single nucleotide polymorphism; slit lamp microscopy; uveitis; visual impairment; Vogt Koyanagi syndrome; humira; remicade

Escitalopram for recurrent isolated sleep paralysis - Hintze, J.P.; Gault, D. (Journal of Sleep Research, 2020)
Recurrent isolated sleep paralysis can be very disturbing and provoke anxiety. The majority of patients can be treated conservatively with cognitive and behavioural therapies. However, some patients may benefit from a pharmacologic intervention. With only scant available evidence, there are currently no standardized pharmacologic treatment recommendations for recurrent isolated sleep paralysis. We report the first two cases of escitalopram used to successfully treat recurrent isolated sleep paralysis. Escitalopram, the most selective of the selective serotonin reuptake inhibitors, generally improves subjective sleep quality, making it an appealing treatment option.
Keywords: bimatoprost; escitalopram; folic acid; infliximab; methotrexate; methylphenidate; naproxen; adult; anxiety; apnea hypopnea index; article; case report; cataplexy; clinical article; daytime somnolence; drug dose titration; dyspnea; Epworth sleepiness scale; fear; female; follow up; glaucoma; human; hypersomnia; hypnagogic hallucination; juvenile rheumatoid arthritis; male; medical specialist; parasomnia; patient compliance; periodic limb movement disorder; polysomnography; priority journal; recurrent disease; recurrent isolated sleep paralysis; REM sleep; sleep latency; sleep quality; sleep waking cycle; stage 1 sleep; young adult

A standard set of person-centred outcomes for diabetes mellitus: results of an international and unified approach - Nano, J.; Carinci, F.; Okunade, O.; Whittaker, S.; Walbaum, M.; Barnard-Kelly, K.; Barthelmes, D.; Benson, T.; Calderon-Margalit, R.; Dennaoui, J.; Fraser, S.; Haig, R.; et al. (Diabetic Medicine, 2020)
Aims: To select a core list of standard outcomes for diabetes to be routinely applied internationally, including patient-reported outcomes. Methods: We conducted a structured systematic review of outcome measures, focusing on adults with either type 1 or type 2 diabetes. This process was followed by a consensus-driven modified Delphi panel, including a multidisciplinary group of academics, health professionals and people with diabetes. External feedback to validate the set of outcome measures was sought from people with diabetes and health professionals. Results: The panel identified an essential set of clinical outcomes related to diabetes control, acute events, chronic complications, health service utilisation, and survival that can be measured using routine administrative data and/or clinical records. Three instruments were recommended for annual measurement of patient-reported outcome measures: the WHO Well-Being Index for psychological well-being; the depression module of the Patient Health Questionnaire for depression; and the Problem Areas in Diabetes scale for diabetes distress. A range of factors related to demographic, diagnostic profile, lifestyle, social support and treatment of diabetes were also identified for case-mix adjustment. Conclusions: We recommend the standard set identified in this study for use in routine practice to monitor, benchmark and improve diabetes care. The inclusion of patient-reported outcomes enables people living with diabetes to report directly on their condition in a structured way.
Keywords: adult; ankle brachial index; article; autonomic neuropathy; case mix; cataract; cerebrovascular accident; cerebrovascular disease; chronic kidney failure; clinical outcome; clinician; consensus; Delphi study; demography; depression; diabetes control; diabetic complication; diabetic ketoacidosis; diabetic patient; diabetic retinopathy; dialysis; distress syndrome; emergency ward; epidemiologist; erectile dysfunction; female; glaucoma; glycemic control; health care cost; health care delivery; health care utilization; health practitioner; heart failure; heart infarction; hereditary motor sensory neuropathy; hospitalization; human; hyperglycemia; hyperosmolarity; hypoglycemia; insulin dependent diabetes mellitus; ischemic heart disease; leg amputation; leg ulcer; lifestyle; lipodystrophy; macular edema; male; non insulin dependent diabetes mellitus; outcome assessment; patient care; patient health questionnaire; patient-reported outcome; periodontal disease; peripheral neuropathy; peripheral occlusive artery disease; psychological well-being; social support; survival; systematic review; visual impairment

Early disability in ambulatory patients with multiple sclerosis: optical coherence tomography versus visual evoked potentials, a comparative study - Thabit, M.N.; Farouk, M.M.; Awni, M.; Mohamed, A.-A.B. (Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2020)
Background: Multiple sclerosis (MS) is a common cause of neurological disabilities in adults and commonly affects the visual pathway. The objective of this study is to assess and compare the sensitivity of visual evoked potentials (VEP) and optical coherence tomography (OCT) as measures of early disability in ambulatory patients with MS. Methods: Forty-four patients with MS with Expanded Disability Status Scale (EDSS) of ≤ 4.5 (ambulatory patients) and 14 healthy controls participated in this study. Patients were classified into 3 groups according to EDSS. Patients with EDSS of 0–1.5 formed the “No disability,” patients with EDSS of 2–3 formed the “Minimal to mild disability,” and finally patients with EDSS of 3.5–4.5 formed the “Moderate to significant disability” groups. N75/P100 amplitude, P100 latency, retinal nerve fiber layer (RNFL) thickness, and ganglion cell layer complex (GCLC) thickness were measured. Results: Patients showed significantly lower N75/P100 amplitude, higher P100 latency, lower RNFL, and GCLC thicknesses compared to controls. However, there were non-significant changes in P100 latency, N75/P100 amplitude, and GCLC thickness among the 3 groups for both patients with and without history of optic neuritis (ON). On contrary, RNFL thickness was significantly different between the three groups for both patients with and without history of ON. Factorial ANOVA revealed non-significant disability × History of ON interaction. Conclusion: Compared to VEP parameters, RNFL thickness was a sensitive correlate with the various degrees of early disability in fully ambulatory patients with MS whatever the history of ON.
Keywords: adult; ambulatory care; article; best corrected visual acuity; clinical article; comparative study; controlled study; cross-sectional study; disease duration; Expanded Disability Status Scale; female; glaucoma; human; intraocular pressure; male; multiple sclerosis; nuclear magnetic resonance imaging; observational study; optic disk; optic nerve atrophy; optical coherence tomography; physical disability; prospective study; refraction error; retina fovea; retina ganglion cell; retinal nerve fiber layer; retinal nerve fiber layer thickness; scanning laser ophthalmoscopy; visual evoked potential; visual stimulation

Demographic and Clinical Factors that Influence the Visual Response to Anti-Vascular Endothelial Growth Factor Therapy in Patients with Neovascular Age-Related Macular Degeneration: A Systematic Review - Gill, C.R.; Hewitt, C.E.; Lightfoot, T.; Gale, R.P. (Ophthalmology and Therapy, 2020)
Background: Neovascular age-related macular degeneration (nAMD) is a leading cause of blind registrations in the developed world. Standard therapy includes the use of anti-vascular endothelial growth factor (anti-VEGF) drugs, and whilst the clinical efficacy is well established, there is variability in the clinical effect of visual outcome. The purpose of this systematic review is to identify whether there is evidence for the influence of demographic and clinical factors on the effectiveness of anti-VEGF therapy in patients with nAMD, in settings comparable to the National Health Service (NHS). Methods: This systematic review followed the PRISMA guidelines for systematic reviews. Electronic databases Medline, EMBASE, Web of Science, CINAHL and the Cochrane Library were searched for studies dated from 2005 onwards. Studies were appraised using the Newcastle–Ottawa Score, and a narrative synthesis was used. Eligibility Criteria: Population: Patients with nAMD being treated with anti-VEGF therapy. Comparator: Presence or absence of potential predictive demographic and clinical factors. Settings: Comparable settings to NHS hospitals. Outcomes: Predicting demographic and clinical factors. Study designs: Randomised controlled trials, prospective cohort studies, retrospective cohort studies and case series dated from 2005. Results: Thirty papers were identified in this review. The evidence suggests that the number of anti-VEGF injections that patients receive, age and lesion size at baseline are factors that influence how effective anti-VEGF therapy is in the short and long term. There was also evidence that suggested that baseline visual acuity influenced the effectiveness of anti-VEGF therapy at longer time points of more than 2 years. Due to a lack of standardised statistical reporting among the included studies, it was not possible to undertake a meaningful statistical synthesis or meta-analysis. Conclusions: This review has demonstrated that there is some evidence of clinical and demographic factors that affect the effectiveness of anti-VEGF therapy and hence variation in visual acuity (VA) outcome. However, this review was unable to identify as wide a range of factors as was hoped. The findings of this review are important because some of the factors, such as VA and lesion size at diagnosis and the number of injections, are potentially modifiable through improvements in early diagnosis and service provision. Future work also needs to focus on the importance of this variation, such as the effect on patients’ quality of life, and how variation can be minimised. Systematic Review Registration: This review has been registered with PROSPERO (Registration number CRD42018094191).
Keywords: acetylsalicylic acid; clopidogrel; vasculotropin; warfarin; blindness; body fluid; central retinal thickness; clinical trial (topic); cohort analysis; diabetes mellitus; disease burden; drug efficacy; early diagnosis; glaucoma; human; multiple cycle treatment; Newcastle-Ottawa scale; outcome assessment; patient compliance; priority journal; prospective study; quality of life; randomized controlled trial (topic); retinal fluid; retrospective study; review; systematic review; treatment duration; treatment outcome; tumor volume; visual acuity; visual impairment; visual response; visual system function; wet macular degeneration

Management of Chronic Migraine in Children and Adolescents: A Brief Discussion on Preventive Therapies - Kacperski, J.; Green, A.; Qaiser, S. (Pediatric Drugs, 2020)
Pediatric migraine is a debilitating disease that affects about 10% of school-aged children. Like other pain disorders, migraines can be accompanied with sleep, mood, and cognitive difficulties, leading to interruptions in daily tasks required at both school and home. This paper serves as a review of the most current pharmacological treatments available for managing migraine in the pediatric population. Because the management of migraine is complex, we discuss the importance of multidisciplinary care involving pharmacological and non-pharmacological measures, behavioral modifications, and a shared treatment plan between the clinician, patient, and parent/care giver. A diverse group of medications are used to prevent migraine attacks including antiepileptics, antidepressants, antihistamines, and antihypertensive agents, in addition to newer classes of medications; yet there remains a serious lack of controlled studies in the pediatric population. Further clinical research is necessary to have Food and Drug Administration (FDA)-approved medications readily available for migraine sufferers.
Keywords: transcutaneous vagus nerve stimulator; amitriptyline; anticonvulsive agent; antidepressant agent; antihistaminic agent; antihypertensive agent; beta adrenergic receptor blocking agent; beta endorphin; botulinum toxin A; calcitonin gene related peptide; calcitonin gene related peptide receptor antagonist; calcium channel blocking agent; cinnarizine; cyproheptadine; erenumab; flunarizine; fremanezumab; gabapentin; galcanezumab; levetiracetam; monoclonal antibody; neurotransmitter; nonsteroid antiinflammatory agent; pancreas enzyme; propranolol; topiramate; ubrogepant; unindexed drug; valproate semisodium; valproic acid; zonisamide; abnormal laboratory result; acute disease; adolescent; agitation; alopecia; anorexia; behavior change; behavior modification; biofeedback; body weight gain; body weight loss; caregiver; child; clinical assessment; clinical research; cognitive behavioral therapy; cognitive defect; constipation; daytime somnolence; decreased appetite; depression; dizziness; drowsiness; drug approval; drug dose comparison; drug dose titration; drug efficacy; drug formulation; drug indication; drug tolerability; drug withdrawal; dry eye; exercise induced asthma; extended release formulation; family counseling; follow up; Food and Drug Administration; gastroenteritis; glaucoma; human; hyperammonemia; hypotension; increased appetite; injection site pain; injection site reaction; language disability; lifestyle modification; lymphocytopenia; metabolic acidosis; migraine; monotherapy; mood change; multidisciplinary team; nausea; nephrolithiasis; neuromodulation; orthostatic hypotension; paresthesia; patient compliance; patient education; Pediatric Migraine Disability Assessment; practice guideline; primary headache; priority journal; prospective study; recommended drug dose; relaxation training; retrospective study; review

Screening and avoidance of blindness: One cannot exist without the other - Gertig, D.; Smith, J.R. (Clinical and Experimental Ophthalmology, 2020)
Keywords: artificial intelligence; blindness; diabetic retinopathy; editorial; evidence based medicine; glaucoma; health care access; health care cost; human; medical practice; ophthalmology; practice guideline; prognosis; public health; retrolental fibroplasia; screening

Plateau iris syndrome and angle-closure glaucoma in a patient with nail-patella syndrome - Gardin, M.A.; Khor, C.C.; Silva, L.; Krefting, E.A.; Ritch, R. (American Journal of Ophthalmology Case Reports, 2020)
Purpose: To describe a case of plateau iris syndrome (PIS) and angle-closure glaucoma (ACG) in a patient with nail-patella syndrome (NPS). Observation: A 33 year-old woman of Slovakian ancestry from Norway with a history of NPS presented with angle-closure secondary to plateau iris. At the time of her NPS diagnosis, she had no ocular pathology. Genetic testing revealed a rare de novo mutation in LMX1B [c.668G>C (p.Arg223Pro)]. Two years later, she experienced acute bilateral ocular pain and blurred vision in the setting of one year of reported visual loss. Subsequent ophthalmic examinations revealed closed angles and plateau iris OU with ACG OD and angle-closure OS. Perimetry showed superonasal visual field defects OD and no defects OS. Ocular coherence tomography (OCT) revealed thinning of the inferior pole of the optic nerve OD. Medical management proved ineffective. A laser peripheral iridotomy (LPI) OD was performed, without resolution of the angle-closure, and a diagnosis of plateau iris syndrome (PIS) was made. She was then treated with an argon laser peripheral iridoplasty (ALPI) and clear lens extraction with a posterior chamber intraocular lens (PCIOL) and goniosynechialysis OD, but her IOP remained elevated OU. She was referred to New York Eye and Ear Infirmary of Mount Sinai, where an LPI OS was performed, but angle-closure persisted, consistent with PIS. An ALPI OS with touch-up was performed, and her IOP normalized with dark-room gonioscopy revealing open angles OU. Conclusions And importance: NPS has been associated with ocular hypertension (OHTN) and open-angle glaucoma (OAG); however, to our knowledge, no association between NPS and angle-closure has previously been reported. The case described here, of a patient with a rare de novo mutation and ocular findings of PIS with associated ACG, represents a novel genetic and clinical presentation of NPS.
Keywords: argon laser; posterior chamber lens; YAG laser; brimonidine; brinzolamide; chloramphenicol; dexamethasone; dorzolamide plus timolol; mirtazapine; pilocarpine; prednisolone; accommodation; adult; article; best corrected visual acuity; blurred vision; body weight gain; breast development; case report; clinical article; closed angle glaucoma; cornea thickness; cup-to-disc ratio; decreased appetite; depression; dislocation; elbow; eye examination; eye pain; female; finger malformation; foot malformation; gene mutation; genetic screening; gonioscopy; headache; human; hypermetropia; hypoplasia; intraocular hypertension; intraocular pressure; iridotomy; iris disease; low level laser therapy; middle phalanx; muscle mass; musculoskeletal pain; nail hypoplasia; nail patella syndrome; Norway; ocular pruritus; open angle glaucoma; optic nerve; optical coherence tomography; patient compliance; perimetry; plateau iris syndrome; pronation; radial head; supination; tarsometatarsal joint; treatment failure; ulnar styloid process; visual field defect; visual impairment

“You saved my life.”—A Trainee's Reflection on COVID-19 and Social Justice - Quan, A.V.; Patel, N.A. (American Journal of Ophthalmology, 2020)
Keywords: glaucoma drainage implant; catharsis; coronavirus disease 2019; diabetic retinopathy; editorial; emergency ward; ethnic group; eye pain; glaucoma surgery; health care access; health care need; health disparity; health literacy; human; neovascular glaucoma; priority journal; resident; social justice; surgical drainage

Assessment of the impact of medPlan®, a medication reminder mobile application, in glaucoma patients in Benin City, Nigeria - Osahon, P.T.; Mote, L.A.; Ntaji, V.I. (Tropical Journal of Pharmaceutical Research, 2020)
Purpose: To assess the impact of medPlan®, a medication reminder mobile application in glaucoma patients in Benin City, Nigeria. Methods: In a randomized control trial with 2 months follow-up period, 200 patients receiving drug therapy for glaucoma were randomized into either into a control or study group. The study group comprised participants who made use of a medication reminder mobile application, medPlan®, while the control group consisted of those patients who did not use the application. Adherence to medication was measured for all the patients in both groups. Data was collected using a carefully designed questionnaire and statistically analyzed. Results: This study recorded 100 % response rate from the participants. In the study group, 56 % were very adherent while 18 % were moderately adherent, and 26 % were non-adherent respondents as against 45 % very adherent, 13 % moderately adherent and 42 % non-adherent respondents from the control group. In addition, 78 % of those in the study group agreed that there was improvement in their medication adherence since they started using the medication reminder application. This showed a significant positive impact of the medication reminder application (p = 0.0110) on adherence to medication. Conclusion: Medication adherence was improved in glaucoma patients who used medPlan®, a smartphone medication reminder application. This study lays a foundation for further research on medication reminder mobile applications.
Keywords: adult; article; controlled study; disease assessment; exercise; female; follow up; glaucoma; human; knowledge; major clinical study; male; medication compliance; middle aged; mobile application; Nigeria; patient compliance; randomized controlled trial; structured questionnaire; validation study

Impact of the coronavirus pandemic on pediatric eye-related emergency department services - Shah, K.; Camhi, S.S.; Sridhar, J.; Cavuoto, K.M. (Journal of AAPOS, 2020)
Literature describing the trends and utilization of pediatric eye-related emergency department (ED) visits is limited. We performed a retrospective cohort study of 311 pediatric patients visiting Bascom Palmer Eye Institute (BPEI) ED between March and May 2020 to quantify the effect of the coronavirus (COVID-19) on ophthalmology care utilization. In our study, pediatric ED visits declined by half at the onset of the pandemic in March. The number of visits reached the lowest point in early April and increased to 48% of the pre-COVID volume by the end of May. Despite changes in volume, patient demographics and clinical diagnoses were relatively consistent throughout the pandemic.
Keywords: adolescent; adult; article; chalazion; child; cohort analysis; conjunctival hemorrhage; conjunctivitis; cornea ulcer; coronavirus disease 2019; demography; dermatitis; diplopia; dry eye; emergency ward; eye disease; eye injury; eye irritation; eye pain; female; glaucoma; health care utilization; hordeolum; human; intraocular foreign body; keratitis; major clinical study; male; pandemic; papilledema; pediatric emergency medicine; pediatric patient; priority journal; retina detachment; retrospective study; strabismus; visual impairment

A(eye): A Review of Current Applications of Artificial Intelligence and Machine Learning in Ophthalmology - Armstrong, G.W.; Lorch, A.C. (International Ophthalmology Clinics, 2020)
Keywords: artificial intelligence; cataract; clinical practice; computer assisted diagnosis; congenital cataract; diabetic patient; diagnostic accuracy; glaucoma; health care access; health care cost; health care utilization; human; keratoconus; machine learning; multimodal imaging; ophthalmologist; ophthalmology; optical coherence tomography; patient counseling; review; screening test; systemic disease; telemedicine

Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: A prospective observational study - Waterman, H.; Read, S.; Morgan, J.E.; Gillespie, D.; Nollett, C.; Allen, D.; Weiss, M.; Anderson, P. (British Journal of Ophthalmology, 2020)
Background/aims Assess whether a new clinical pathway for glaucoma was acceptable to patients and healthcare professionals and whether it provided useful clinical information on non-responsiveness and non-adherence to the treatment of elevated intraocular pressure with latanoprost eye drops. Methods A single arm non-randomised prospective observational study incorporating new glaucoma/ocular hypertension patients. To assess issues of acceptability, qualitative observation and interviews were conducted with patients and healthcare professionals. To determine clinical responsiveness, intraocular pressures were measured before and 4 hours after a clinician-instilled eye drop over two distinct appointments. Adherence data were collected using a Medicine Event Monitoring System. Economic analyses compared the costs between novel and standard care pathways. Results Of 72 patients approached, 53 entered the study (74.3%) and 50 completed all procedures (94.3%). Intraocular pressure was reduced more than 15% in 83 out of 92 study eyes by final visit (90.2%). The non-response rate was 5.1% once the effect of low adherence was minimised. For the 1376 drop instillation days under observation, eye drops were instilled as prescribed on 1004 days (73.0%), over-instilled on 137 days (9.9%) and not instilled on 235 days (17.1%). The Cardiff Model of Glaucoma Care involved negligible cost, although acceptance for healthcare professionals showed variation. Conclusions The Cardiff Model of Glaucoma Care offers novel clinical and adherence insights at marginal costs while acceptable to patients. Healthcare professionals felt that 4 hour and 4 week follow-up appointments could cause administrative problems. A streamlined version of the pathway has therefore been developed to facilitate clinical adoption. Trial registration number ISRCTNID:ISRCTN75888393
Keywords: ISRCTN75888393; latanoprost; adult; aged; article; blepharitis; blurred vision; clinician; economic aspect; female; glaucoma; health care personnel; human; information processing; interview; intraocular hypertension; intraocular pressure; major clinical study; male; observational study; patient care; patient compliance; pressure measurement; priority journal; program acceptability; prospective study; qualitative research; treatment response

Interstitial Keratitis with Lipid Keratopathy Mimicking Corneal Opacity Induced by Brimonidine Tartrate Eye Drops - Kasuya, Y.; Sano, I.; Makino, S. (Klinische Monatsblatter fur Augenheilkunde, 2020)
Keywords: betamethasone sodium phosphate; brimonidine; latanoprost plus timolol; lipid; aged; best corrected visual acuity; blood vessel permeability; case report; cataract; clinical article; clinical feature; cornea neovascularization; cornea opacity; disease association; drug withdrawal; eye examination; female; human; interstitium; keratitis; keratopathy; lipid storage; open angle glaucoma; ophthalmoscopy; patient compliance; short survey; steroid therapy; topical treatment; treatment response

A geodemographic service coverage analysis of travel time to glaucoma specialists in Florida - Rothman, A.L.; Stoler, J.B.; Vu, D.M.; Chang, T.C. (Journal of Glaucoma, 2020)
Precis:Approximately 1 in 9 Florida residents over the age of 65 years (438,642 people) live more than an hour away from a glaucoma specialist, which represents a significant barrier to care.Purpose:To describe access to glaucoma care for Florida's elderly population using travel time to American Glaucoma Society (AGS) member offices.Methods:For this cross-sectional service coverage analysis, a list of AGS member locations was extracted from the AGS website, and addresses were geocoded using ArcGIS Online. Driving time regions were created using the service area tool in ArcGIS Pro 2.4 and overlaid with 2010 United States Census and 2016 American Community Survey data for all Florida residents age 65 or older.Results:Fifty-eight AGS member providers with 65 locations were identified and geocoded. There were 3,797,625 individuals aged over 65 years in Florida, of which 1,153,320 (30.4%) lived within 15 minutes of driving time from an AGS provider's office, 2,586,825 (68.1%) within 30 minutes, 3,358,983 (88.4%) within 60 minutes, and 3,491,815 (91.9%) within 120 minutes. The areas with the lowest access include rural areas near Lake Okeechobee and the Florida Panhandle. The population living beyond a 60-minute drive was more likely to be White, non-Hispanic and older, but less likely to be living below the federal poverty level or receiving public assistance than the population living within a 60-minute drive.Conclusions:There is a significant travel burden for the elderly community of Florida to reach AGS providers. Additional studies could help identify other social barriers to accessing glaucoma providers in Florida and beyond in an effort to improve patient compliance and, ultimately, vision outcomes.
Keywords: aged; aging; article; Caucasian; community living; controlled study; cross-sectional study; Florida; glaucoma; health care access; human; medical specialist; patient care; pilot study; poverty; priority journal; rural area; social care; social determinants of health; time; travel

Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients - Guerrero-Fernández de Alba, I.; Orlando, V.; Monetti, V.M.; Mucherino, S.; Gimeno-Miguel, A.; Vaccaro, O.; Forjaz, M.J.; Poblador Plou, B.; Prados-Torres, A.; Riccardi, G.; Menditto, E. (Frontiers in Pharmacology, 2020)
Objectives: Little is known about the specific comorbidities contributing to higher costs in patients with type-2 diabetes mellitus (T2DM), particularly in older cases. We aimed to evaluate the prevalence, type, and cost of comorbidities occurring in older T2DM patients versus older non-T2DM patients, and the factors associated with high cost (HC) T2DM patients. Methods: Retrospective cohort study using information from the Campania Region healthcare database. People aged ≥65 years who received ≥2 prescriptions for antidiabetic drugs were identified as “T2DM patients.” Comorbidities among T2DM and non-T2DM groups were assessed through the RxRiskV Index (modified version). T2DM individuals were classified according to the total cost distribution as HC or “non-high cost.” Two sub-cohorts of HC T2DM patients were assessed: above 90th and 80th percentile of the total cost. Age- and sex-adjusted logistic regression models were created. Results: Among the T2DM cohort, concordant and discordant comorbidities occurred significantly more frequently than in the non-T2DM cohort. Total mean annual cost per T2DM patient due to comorbidities was €7,627 versus €4,401 per non-T2DM patient. Among T2DM patients identified as being above 90th and 80th percentiles of cost distribution, the total annual costs were >€19,577 and >€2,563, respectively. The hospitalization cost was higher for T2DM cases. Strongest predictors of being a HC T2DM patient were having ≥5 comorbidities and renal impairment. Conclusion: HC patients accrued >80% of the total comorbidities cost in older T2DM patients. Integrated care models, with holistic and patient-tailored foci, could achieve more effective T2DM care.
Keywords: antidiabetic agent; insulin; narcotic analgesic agent; aged; angina pectoris; article; blood clotting disorder; cerebrovascular disease; chronic respiratory tract disease; cohort analysis; comorbidity; controlled study; depression; drug cost; epilepsy; female; gastroesophageal reflux; glaucoma; gout; health care cost; health care utilization; heart arrhythmia; heart disease; hospitalization cost; human; hyperlipidemia; hypertension; hyperuricemia; hypothyroidism; inflammatory pain; ischemic heart disease; kidney disease; major clinical study; male; non insulin dependent diabetes mellitus; osteoporosis; pain; peptic ulcer; prediction; prevalence; prostate hypertrophy; retrospective study

Eye Care Utilization in A Community-oriented Mobile Screening Programme for Improving Eye Health in Iran: A Cluster Randomized Trial - Katibeh, M.; Sabbaghi, H.; Kalantarion, M.; Nikkhah, H.; Mousavi, B.; Beiranvand, R.; Ahmadieh, H.; Kallestrup, P. (Ophthalmic Epidemiology, 2020)
Purpose: To evaluate the effect of a mobile-based screening programme on eye care utilization in Iran. Method: In this cluster randomized community trial, a representative sample of residents aged≥50 years from urban and rural areas in four districts in Tehran province were enrolled. The clusters were randomly assigned to one of the three parallel arms; the mHealth arm with digital data collection, vision screening test and retina evaluation using an integrated mobile application, the conventional arm with manual data collection and screening tests using Snellen chart and Fundus photography at the local primary healthcare facility, and the control arm with manual data collection without screening tests. The main outcome measure was eye care utilization which was defined as at least one visit to an optometrist or ophthalmologist. Results: Of 3312 eligible individuals, 2520 (76.1%) participated. In the first 3 months after the screening programme, eye care utilization was higher among those who were referred by the mHealth method (35.6% 95%CI: 31.1–40.4%) compared to those referred by the conventional method (32.7%, 95%CI: 27.5–38.2%) and to those observed in the control arm (4.5%, 95%CI: 3.2–6.0). Eye care utilization improved (OR = 1.5, 95%CI: 1.2–1.9) among the referred people after the screening programme compared to the utilization before this programme; however, this improvement was significantly higher in the mHealth method (OR: 1.7, 95%CI: 1.2–2.4) compared to the conventional method (OR: 1.2, 95%CI: 0.8–1.8). Conclusion and relevance: The mobile-based screening programme can significantly improve eye care utilization at the community level.
Keywords: NCT03922347; fundus camera; Galaxy S8; healthcare software; mobile health application; Peek Acuity; Snellen chart; Visucam Pro NM; steroid; adult; age related macular degeneration; aged; article; cataract; cataract extraction; clinical outcome; cluster analysis; community program; community trial; controlled study; evaluation study; eye care; eye examination; eye photography; female; follow up; glaucoma; health care utilization; health insurance; human; Iran; major clinical study; male; mass screening; middle aged; ophthalmologist; optometrist; patient referral; primary health care; priority journal; randomized controlled trial; retina detachment; rural area; self report; smoking; steroid therapy; urban area; visual acuity; Galaxy S8; Peek Acuity; Visucam Pro NM

Current and new pharmacotherapeutic approaches for glaucoma - Shalaby, W.S.; Shankar, V.; Razeghinejad, R.; Katz, L.J. (Expert Opinion on Pharmacotherapy, 2020)
Introduction: Glaucoma is the leading cause of irreversible blindness worldwide. Medical therapy is the main line of treatment of open-angle glaucoma (OAG) and ocular hypertension. Despite the expansion of the glaucoma lineup with the newly approved medication classes, many barriers and issues still exist with topical therapy. Novel non-topical drug delivery may address such issues, adding more options to glaucoma pharmacotherapy. Areas Covered: This review outlines current topical therapies for glaucoma, in addition to new medications under trials. The issues with topical therapy, in general, are discussed, as well as the new non-topical drug delivery systems. The authors performed a comprehensive search for published studies on glaucoma medical therapy using the electronic database of PubMed and manual search for each medication and non-topical delivery options. The extra- and intraocular delivery methods and the new topical glaucoma medications under research are covered. Expert opinion: Medical management of glaucoma represents a challenge for both patients and clinicians. Noncompliance (e.g. difficulty with administering the eye drops), cost, side effects, and intraocular pressure fluctuation are the major problems with topical therapy. To overcome such barriers, research should continue in developing new medications and innovation of non-topical drug delivery systems.
Keywords: biodegradable implant; contact lens; bimatoprost; Evolute; GB-401; IBI-60089; iDose; implant delivery device; injectable implant; intravitreal implant; microinjector; ophthalmic drug delivery device; Ophthalmic MicroPump; OTX-TP; punctal plug; Travoprost XR; adenosine receptor stimulating agent; adrenalin hydrogen tartrate; alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; bimatoprost; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; eye drops; oligonucleotide; omidenepag isopropyl; ono 9054; prostaglandin; prostaglandin derivative; Rho kinase inhibitor; unclassified drug; drug approval; drug cost; drug delivery system; glaucoma; human; medication compliance; nonhuman; patient compliance; pharmaceutical care; phase 2 clinical trial (topic); phase 3 clinical trial (topic); review; topical treatment; de 117; ono 9054; Durasert; DURYSTA; Evolute; GB-401; IBI-60089; iDose; NOVADUR; Ophthalmic MicroPump; OTX-TP; Travoprost XR

Systemic Corticosteroid-Related Complications and Costs in Adults with Persistent Asthma - Zeiger, R.; Sullivan, P.; Chung, Y.; Kreindler, J.L.; Zimmerman, N.M.; Tkacz, J. (Journal of Allergy and Clinical Immunology: In Practice, 2020)
Background: Systemic corticosteroids (SCS) may cause complications for patients with asthma. Objective: We sought to better understand the burden of SCS use in persistent asthma, including health care costs. Methods: Adult patients with persistent asthma were identified in the IBM MarketScan Databases from January 2003 to July 2016. The index date was set as the first SCS prescription for SCS users or an algorithm-matched date for non-SCS users. Patients were required to have ≥1 year of data before and after the index date. Based on the number of SCS claims in the first year after index, patients were categorized into 3 SCS groups: 0 SCS claims, 1 to 3 claims, and 4+ claims. Inverse probability of treatment weights were applied to adjust for differences between SCS and non-SCS users. Analyses included weighted and multivariate modeling to assess SCS-related complications and costs during a 3-year follow-up. Results: A total of 86,786 SCS users (1-3 claims: 76,690; 4+ claims: 10,096) and 91,409 non-SCS users were included; 45% remained 3 years after index. In multivariate analysis, the 3-year risk of developing any chronic complication was 6% greater for those with 1 to 3 claims and 26% greater for those with 4+ claims compared with non-SCS users (P < .001). Multivariate-adjusted health care costs over 3 years were significantly greater as 4+ users incurred $22,311 greater total costs, $4627 greater asthma-related costs, and $2647 greater chronic complication–related costs than non-SCS users (P < .001). Conclusions: In this study, adults with persistent asthma receiving SCS treatment had greater odds of complications and greater associated costs over 3 years than matched non-SCS asthma patients.
Keywords: corticosteroid; administrative claims (health care); adult; algorithm; article; asthma; avascular necrosis; cataract; cerebrovascular accident; cohort analysis; data base; depression; digestive system ulcer; disease burden; dyslipidemia; dyspepsia; female; follow up; fracture; gastrointestinal hemorrhage; glaucoma; health care cost; health care planning; health care utilization; heart infarction; human; hypertension; infection; kidney disease; major clinical study; male; metabolic syndrome X; non insulin dependent diabetes mellitus; obesity; observational study; osteoporosis; probability; retrospective study; risk factor; sepsis; systemic therapy; thromboembolism

Predicting Adherence with the Glaucoma Treatment Compliance Assessment Tool - Sanchez, F.G.; Mansberger, S.L.; Newman-Casey, P.A. (Journal of Glaucoma, 2020)
Précis:Univariate and multivariable models using the Glaucoma Treatment Compliance Assessment Tool (GTCAT) statements identified multiple, patient-specific factors associated with adherence that could be used to inform personalized interventions to optimize glaucoma adherence.Purpose:The purpose of this study was to determine the health behavior factors related to glaucoma adherence in patients with self-reported poor adherence.Methods:A research coordinator used the Chang Adherence Measure and the Morisky Medication Adherence Scale to identify subjects with poor self-reported glaucoma medication adherence and enrolled them in a 3-month study to electronically monitor medication adherence. At enrollment, the coordinator administered the GTCAT. We calculated the percentage of prescribed doses taken over a 3-month period using an electronic dose monitor (AdhereTech). We used Rasch analysis, and univariate and multivariable regression to determine the GTCAT statements that predicted electronically monitored adherence.Results:The mean adherence was 73.8% (SD=21.04%, range: 13% to 100%). Rasch analysis showed that the GTCAT had a good overall fit and no differential bias (Anderson likelihood ratio test >0.05). Multiple GTCAT statements were associated with adherence, which represented increased knowledge, increased cues-to-action, decreased barriers, less depression, and increased self-efficacy (P<0.09 for each). The full GTCAT or a subset of statements had a high association with adherence (R2 range: 0.44 to 0.51, P<0.005 for all). The GTCAT identified >50% of patients who wanted more education about glaucoma; >68% who did not use reminders; and >40% who reported having difficulty using the eye drops.Conclusions:The GTCAT identified multiple factors associated with adherence. Clinicians and researchers could use this tool to identify specific barriers to adherence and develop potential interventions to improve adherence.
Keywords: NCT03159247; patient monitor; antiglaucoma agent; eye drops; adult; aged; Anderson likelihood ratio test; article; behavior assessment; best corrected visual acuity; Chang Adherence Measure; construct validity; controlled study; cues to action; depression; electronic dose monitor; female; glaucoma; Glaucoma Treatment Compliance Assessment Tool; health behavior; human; knowledge; major clinical study; male; medication compliance; Morisky Medication Adherence Scale; multiple regression; multivariate analysis; patient; patient attitude; patient compliance; patient education; Patient Health Questionnaire 9; patient identification; personalized medicine; prediction; predictive validity; prescription; priority journal; Rasch analysis; self concept; self report; statistical analysis; univariate analysis

The Relationship of Travel Distance to Postoperative Follow-up Care on Glaucoma Surgery Outcomes - Funk, I.T.; Strelow, B.A.; Klifto, M.R.; Knight, O.J.; Van Buren, E.; Lin, F.-C.; Fleischman, D. (Journal of Glaucoma, 2020)
Précis:This study addresses the paucity of literature examining glaucoma patients' distance from clinic on postoperative follow-up outcomes. Greater distance from clinic was associated with higher likelihood of loss to follow-up and missed appointments.Purpose:To investigate the relationship of patient travel distance and interstate access to glaucoma surgery postoperative follow-up visit attendance.Methods and Participants:Retrospective longitudinal chart review of all noninstitutionalized adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018. Patients were stratified into groups on the basis of straight-line distance from residence to University of North Carolina at Chapel Hill's Kittner Eye Center and distance from residence to interstate access. Corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data were recorded. Means were compared using 2-tailed Student t-test, Pearson χ2, analysis of variance, and multivariate logistical regression determined odds ratios for loss to follow-up.Results:In total, 199 patients met all inclusion criteria. Six-month postoperatively, patients >50 miles from clinic had greater odds of loss to follow-up compared with patients <25 miles (odds ratios, 3.47; 95% confidence interval, 1.24-4.12; P<0.05). Patients >50 miles from clinic had significantly more missed appointments than patients 25 to 50 miles away, and patients <25 miles away (P=0.008). Patients >20 miles from interstate access had greater loss to follow-up than those <10 miles (t(150)=2.05; P<0.05). Mean distance from clinic was 12.59 miles farther for patients lost to follow-up (t(197)3.29; P<0.01). Patients with Medicaid coverage had more missed appointments than those with Medicare plans (t(144)=-2.193; P<0.05).Conclusions:Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up. Glaucoma specialists should consider these factors when choosing surgical interventions requiring frequent postoperative evaluations.
Keywords: adult; analysis of variance; article; controlled study; female; follow up; glaucoma surgery; human; implantation; major clinical study; male; medicaid; medical record review; medicare; North Carolina; postoperative care; retrospective study; trabeculectomy; travel; visual acuity

Case Report: Bilateral Granulomatous Anterior Uveitis in HIV-patient with Disseminated Talaromycosis (penicilliosis) Marneffei Infection - Khieu, C.; Apivatthakakul, A.; Kunavisarut, P.; Pathanapitoon, K. (Ocular Immunology and Inflammation, 2020)
We report on a 22-years-old Thai male patient with congenital HIV infection. Due to his non-adherence to antiretroviral treatment he developed disseminated Talaromyces marneffei infection and was treated with intravenous amphotericin B. Despite this treatment, he presented with bilateral granulomatous anterior uveitis. Uveitis improved only after intracameral injection of amphotericin B.
Keywords: amphotericin B; anti human immunodeficiency virus agent; antiglaucoma agent; prednisolone acetate; adult; antifungal therapy; case report; clinical article; cornea edema; eye inflammation; eye pain; eye redness; fever; fungal eye infection; fungus growth; granulomatous anterior uveitis; highly active antiretroviral therapy; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; intraocular hypertension; iridocyclitis; letter; loss of appetite; male; patient compliance; penicilliosis; photophobia; real time polymerase chain reaction; skin defect; slit lamp microscopy; Talaromyces marneffei; treatment refusal; weakness; young adult

Trends in licence approvals for ophthalmic medicines in the United Kingdom - Morgan-Warren, P.J.; Morarji, J.B. (Eye (Basingstoke), 2020)
Objectives: The grant of marketing authorisation (MA) for new medicines requires comprehensive assessment by regulatory authorities. This study sought to identify ophthalmic medicines granted United Kingdom MA and consider trends in licence approvals. Methods: This retrospective study reviewed published lists of products granted MA by the UK Medicines & Healthcare products Regulatory Agency between January 2001 and December 2018, inclusive. Eye drops and medicinal products intended for ophthalmic use were identified. All regulatory data sources consulted are in the public domain. Data analyses were descriptive. Results: A total of 295 MAs were issued for ophthalmic products between 2001 and 2018, inclusive. Of these 229 (78%) were for single-active substances and 66 (22%) fixed-dose combination (FDC). Approvals for products with single-active substance included ocular hypotensives (115; 50%), antibiotics (48; 22%), allergy medicines (30; 13%), lubricants (18; 8%) and anti-inflammatories (11; 5%). Approvals for FDCs were predominantly ocular hypotensives (56; 85%), with timolol combined with carbonic anhydrase inhibitors (27; 48%) and prostaglandin analogues (26; 46%) accounting for the majority of glaucoma FDCs. Other FDCs were approved for antibiotic/inflammatory (5; 7.5%), pupillary mydriasis (2; 3%), allergy (2; 3%) and ocular surface lubrication (1; 1.5%) products. A median of 16 licences were approved per year (range 7 [2005] to 35 [2011]). Conclusions: The majority of MAs granted were for single-agent products, particularly ocular hypotensives and antibiotic preparations. Most products were generic versions of well-established active substances. A trend for increased approvals for FDCs is evident, particularly for the treatment of raised IOP.
Keywords: acetazolamide; azelastine; azithromycin; betaxolol; bimatoprost; brimonidine; brinzolamide; carbomer; carboxymethylcellulose; carteolol; chloramphenicol; ciprofloxacin; cromoglycate disodium; dexamethasone; eye drops; framycetin; hydroxypropylmethylcellulose; ketotifen; latanoprost; levofloxacin; moxifloxacin; naphazoline; nedocromil; olopatadine; pilocarpine; povidone; propamidine; tobramycin; travoprost; unindexed drug; article; combination drug therapy; drug approval; European Medicines Agency; Food and Drug Administration; human; licence; major clinical study; patient compliance; retrospective study; United Kingdom

What Does Telemedicine Mean for the Care of Patients With Glaucoma in the Age of COVID-19? - Parrish, R.K.; Higginbotham, E.J. (American Journal of Ophthalmology, 2020)
Keywords: smartphone; beta adrenergic receptor blocking agent; prostaglandin derivative; blepharoconjunctivitis; bradycardia; cataract; cataract extraction; coronavirus disease 2019; cultural factor; drug substitution; drug withdrawal; editorial; glaucoma; glaucomatous optic neuropathy; health care access; health care delivery; health equity; human; internet access; interpersonal communication; intraocular pressure; language ability; ophthalmologist; patient attitude; patient satisfaction; Pennsylvania; physician attitude; practice guideline; priority journal; social status; telemedicine; videoconferencing; visual field; visual field defect; visual impairment; visual system examination

Prevalence of refractive error and visual impairment among rural dwellers in mashonaland Central Province, Zimbabwe - Tagoh, S.; Kyei, S.; Kwarteng, M.A.; Aboagye, E. (Journal of Current Ophthalmology, 2020)
Purpose: To determine the prevalence of refractive error and visual impairment in a rural population of Zimbabwe. Methods: This community-based, cross-sectional study used a multi-stage sampling to select the participants from households in four communities within three rural districts in Mashonaland Central Province. Participants' demographic data were collated, and their presenting visual acuity (VA) was measured using the logMAR E chart. Clinical refraction was preceded by an anterior segment and posterior segment eye examinations. Visual impairment was defined as presenting VA worse than 6/12 (0.3 logMAR) in the better eye. Descriptive statistics were presented as frequencies. Results: A total of 519 participants were involved in this study. Their ages ranged from 5 to 100 years (mean age = 50.94; standard deviation ± 21.12 years). Out of the 519 participants, 233 (44.9%) were male, and 286 (55.1%) were female. The prevalence of visual impairment was 56.8% (95% confidence interval [CI]: 55.7-67.2), and blindness was 13.1% (95% CI: 11.2-17.6). The prevalence of near visual impairment based on presenting near VA (N = 408) was 78.6% (95% CI: 78.1-85.4). The two most common causes of visual impairment were uncorrected refractive errors (UREs) (54.2%) and cataract (24.8%). The most common cause of blindness was cataract (41.2%). Hypermetropia (56.9%) was the most common refractive error. Conclusions: A high burden of visual impairment due to UREs and cataracts was observed among the rural dwellers of Zimbabwe. Public health education, access to refractive error services, and cataract surgery are necessary to mitigate this high burden of visual impairment.
Keywords: adolescent; adult; aged; anterior eye segment; article; blindness; cataract; child; controlled study; cornea opacity; cross-sectional study; disease burden; disease severity; eye examination; female; glaucoma; health care access; health education; human; hypermetropia; major clinical study; male; myopia; posterior eye segment; prevalence; refraction error; rural population; visual acuity; visual impairment; Zimbabwe

Racial and Sex-based Disparities in Health Care Utilization: Eye Inflammation as a Paradigm - Chauhan, K.; Rosenbaum, J. (Arthritis and Rheumatology, 2020)
Background/Purpose: Disparities in health care utilization based on sex, race, education, or income affect outcomes in rheumatologic care. We have used ocular inflammatory and infectious disease, which complicates many rheumatic diseases, to study some of these disparities. These eye conditions, significantly increase disease burden, especially in people greater than 65 years of age and disproportionately affect females and racial minorities. However, there is lack of national level data in the US regarding influence of age, sex and race on utilization of medical care for inflammatory and infectious eye disease in people > 65 years. We have conducted an epidemiologic study using the Medicare database to analyze these trends and the influence of age, sex and race. Methods: We have used Medicare data available through National Vision and Eye Health Surveillance System (VEHSS). Medicare data are collected from research identifiable files obtained through the Center for Medicare and Medicaid Services (CMS) and include all fee for service beneficiaries. VEHSS uses ICD-10 codes to identify ocular disorders and organizes them into two level categorization, which are category and subgroup. Each code is categorized in one subgroup and multiple subgroups are combined to form a category. Inflammatory and infectious eye disease category includes subgroups of ocular inflammatory conditions, lacrimal system and orbital inflammation, keratitis, conjunctivitis, eyelid inflammation and infection and endophthalmitis. Utilization for the inflammatory and infectious eye disease caterogory, is stratified by age, sex and race. We have measured trends of utilization for the category and for the individual subgroups for the years 2014-2017. We have identified the effect of stratification on utilization; by race, sex, age alone; combining race and sex; age and sex; and the combination of race, sex and age. Results: There were 29,971,000, 30,027,208, 30,423,400 and 30,238,300 million Medicare beneficiaries enrolled for the years 2014 to 2017 respectively. There was a decrease in utilization for inflammatory and infectious eye diseases category and subgroups from the year, 2014 to 2015 followed by a steady increase from 2015-2017 (Figure 1). This trend remains, when utilization is stratified by sex, race and age. Asians and Hispanics have higher utilization for the inflammatory and infectious eye diseases category, and for the individual subgroups, for both males and females (Figure 2). This higher utilization remains, when further stratified by age. Females have higher utilization across all races. This holds true when utilization is stratified by race; an Asian female has higher utilization than an Asian male (Figure 3). And remains steady when we further stratify by age groups. An Asian female of age group: 65-84 has higher utilization than an Asian male of the same age group; for all the years of the study 2014 to 2017. Conclusion: Females, Asians and Hispanics have higher Medicare utilization for inflammatory and infectious eye diseases. These results may be due to higher disease prevalence or service utilization in these subgropus. Racial and sex-based disparitiies should be considered when making health care policy decisions.
Keywords: aged; Asian; blepharitis; communicable disease; conference abstract; conjunctivitis; controlled study; disease burden; endophthalmitis; female; groups by age; health care policy; health care utilization; health survey; human; ICD-10; inflammatory disease; keratitis; lacrimal apparatus; male; medicaid; medical care; medicare; prevalence; race; rheumatic disease; vision

Patient characteristics and comorbidities in patients with MS with commercial insurance or Medicare Advantage in a large health plan - Sharma, A.; Dai, D.; Phillips, A.; Lobo, C. (Journal of Managed Care and Specialty Pharmacy, 2020)
BACKGROUND: Published evidence comparing patient characteristics of commercially-insured versus Medicare enrollees with multiple sclerosis (MS) is lacking. Such knowledge may be important in optimizing disease management and outcomes. OBJECTIVE: To conduct a retrospective database analysis of patients with MS with commercial insurance or Medicare in a large health plan to better understand patient characteristics and comorbidities. METHODS: This observational cohort study used administrative claims data from January 1, 2015 through October 31, 2019. Eligibility criteria were: ≥ 3 MS-related inpatient/outpatient (ICD-10-CM: G35), or MS disease-modifying drug (DMD) claims within a one-year period (1st claim = index date); a large health plan with commercial fully-insured and Medicare Advantage members with medical and pharmacy benefits ≥ 12 months before and after index; and age ≥ 18. Patients with inflammatory bowel disease receiving natalizumab, enrolled in a compassionate care program, or hospice care were excluded. RESULTS: A total of 5000 patients met eligibility criteria. Mean (SD) age was 52.6 (12.9) years, 75.2% were female, 53.3% had commercial insurance, and 46.7% had Medicare (59.2% of whom were < 65 years old [i.e., Social Security Disability Insurance SSDI]). Patients with Medicare were older (Medicare SSDI 53.3 [8.0] years, ≥65 Medicare 70.8 [5.2] years vs. commercial 45.7 [10.2] years), lived in more rural locations (Medicare SSDI 43.5%, ≥65 Medicare 47.7% vs. commercial 35.1%), and had greater overall comorbidity burden (Charlson Comorbidity Index; Medicare SSDI 1.17 [1.64], ≥ 65 Medicare 1.65 [1.95] vs. commercial 0.53 [1.02]; all P < 0.0001). MS-specific symptoms (i.e., malaise, fatigue, depression/anxiety, spasms, fibromyalgia, convulsions) were more common among Medicare SSDI beneficiaries (all P < 0.0001), whereas age-related and other comorbidities (i.e., hypertension, hyperlipidemia, dyspepsia, osteoarthritis, osteoporosis, glaucoma, thyroid disorders, diabetes, cerebrovascular disease, and cancer) were more common among ≥ 65 Medicare beneficiaries (all P < 0.0001). Many patients with MS had multiple comorbidities (overall median 4), particularly those with Medicare SSDI (median 6) and ≥ 65 Medicare (median 7). CONCLUSIONS: Patient characteristics and comorbidities differed between patients with MS with commercial insurance and patients with Medicare. Multiple comorbidities are highly prevalent among patients with MS and should be considered in the context of clinical decision making to ensure comprehensive MS management.
Keywords: natalizumab; adult; anxiety; cancer patient; cerebrovascular disease; Charlson Comorbidity Index; clinical decision making; cohort analysis; conference abstract; controlled study; convulsion; depression; diabetes mellitus; drug therapy; dyspepsia; eligibility criteria; fatigue; female; fibromyalgia; glaucoma; hospice care; hospital patient; human; hyperlipidemia; hypertension; ICD-10-CM; inflammatory bowel disease; insurance; major clinical study; malaise; male; malignant neoplasm; medicare; multiple sclerosis; muscle spasm; osteoarthritis; osteoporosis; outpatient; retrospective study; social security; thyroid disease

Prospective multicenter observational cohort study to assess the burden of herpes zoster disease in the eye: Baseline results of initial patients - Pizzi, L.T.; Leiby, B.; Chu, D.S.; Gower, E.W.; Ailani, H.; Shovlin, J.; Prioli, K.M.; Shukla, S.; Patterson, B.J.; Rausch, D.A.; Buck, P.O.; Murchison, A.P. (Open Forum Infectious Diseases, 2020)
Background. Herpes Zoster Ophthalmicus (HZO) affects 10-20% of adults with herpes zoster; ≥ 50% of these cases manifest as serious ocular diseases. This 1-year prospective observational cohort study aims to determine patient-reported HZO symptoms as well as economic and quality of life burden among 300 HZO patients from 6 major US ophthalmology practices. Here, we report baseline data from 13 initial enrollees. Methods. Inclusion criteria were: participants ≥ 18 years, diagnosis of clinically active HZO, English or Spanish speaking, be willing and able to respond to study assessments, not be enrolled in a concurrent interventional HZO trial. Information are collected via 1) a clinical assessment form completed by the practice (baseline) and 2) patient questionnaires (baseline, 3, 6, and 12 months) on symptoms, medications, healthcare use, vision function, depression, and work productivity impact. Baseline results are presented for patients recruited during the first 6 months of enrollment from the first 4 sites to go live: diagnoses, and patient-reported symptoms and outcomes (eight-item Patient Health Questionnaire [PHQ-8] for depressive symptoms, National Eye Institute 25-item Visual Function Questionnaire [NEI-VFQ-25] for vision-related quality of life, and Zoster Brief Pain Inventory [ZBPI] for pain). Results. The mean age of participants is 71 years; 11 are female and 9 are retired. Seven participants are college graduates or hold other degrees. All have health insurance coverage, with most (10) having primary insurance through Medicare. HZO diagnoses (Table 1) were: keratitis (4), iridocyclitis (4), conjunctivitis (1), other HZO diagnosis (3), other ocular diagnosis (6). Patient-reported symptoms (Table 2) were: pain above the eye, sensitivity to light, redness, feeling of sand/grit in the eye (9 each). The mean overall PHQ-8 and NEI-VFQ-25 scores were 5.9 (Standard Deviation [SD]:4.5) and 74.6 (SD:13.9), respectively; the mean ZBPI score for worst pain severity was 3.3 (SD:3.8) (Table 3). Conclusion: This study represents the first large scale effort to quantify HZO burden. Findings will inform development of a formal patient-reported symptom scale for use in research and clinical practice.
Keywords: aged; Brief Pain Inventory; clinical assessment; clinical practice; cohort analysis; conference abstract; conjunctivitis; controlled study; depression; female; health care utilization; health insurance; herpes zoster ophthalmicus; human; iridocyclitis; keratitis; major clinical study; multicenter study; National Eye Institute Visual Function Questionnaire; ophthalmology; pain severity; Patient Health Questionnaire 8; productivity; prospective study; quality of life; questionnaire; speech

Effect of medically lowering intraocular pressure in glaucoma suspects with high myopia (GSHM study): Study protocol for a randomized controlled trial - Lin, F.B.; Da Chen, S.; Song, Y.H.; Wang, W.; Jin, L.; Liu, B.Q.; Liu, Y.H.; Chen, M.L.; Gao, K.; Friedman, D.S.; Jonas, J.B.; Aung, T.; et al. (Trials, 2020)
Background: Currently, whether and when intraocular pressure (IOP)-lowering medication should be used in glaucoma suspects with high myopia (GSHM) remains unknown. Glaucoma suspects are visual field (VF) defects that cannot be explained by myopic macular changes or other retinal and neurologic conditions. Glaucoma progression is defined by VF deterioration. Here we describe the rationale, design, and methodology of a randomized controlled trial (RCT) designed to evaluate the effects of medically lowering IOP in GSHM (GSHM study). Methods: The GSHM study is an open-label, single-center, RCT for GSHM. Overall, 264 newly diagnosed participants, aged 35 to 65 years, will be recruited at the Zhongshan Ophthalmic Center, Sun Yat-sen University, between 2020 and 2021. Participants will be randomly divided into two arms at a 1:1 ratio. Participants in the intervention arm will receive IOP-lowering medication, while participants in the control arm will be followed up without treatment for 36 months or until they reach the end point. Only one eye per participant will be eligible for the study. If both eyes are eligible, the eye with the worse VF will be recruited. The primary outcome is the incidence of glaucoma suspect progression by VF testing over 36 months. The secondary outcomes include the incidence of changes in the optic nerve head morphology including the retinal nerve fiber layer, and retinal ganglion cell-inner plexiform layer loss, progression of myopic maculopathy, visual function loss, and change in the quality of life. Statistical analyses will include baseline characteristics comparison between the intervention and control groups using a two-sample t-test and Wilcoxon rank sum test; generalized linear models with Poisson regression for the primary outcome; Kaplan-Meier curve and log-rank test for the incidence of the secondary outcome; and longitudinal analyses to assess trends in outcomes across time. Discussion: To the best of our knowledge, the GSHM study is the first RCT to investigate the impact of medically lowering IOP in GSHM. The results will have implications for the clinical management of GSHM. Trial registration: ClinicalTrials.gov NCT04296916. Registered on 4 March 2020
Keywords: NCT04296916; Cirrus 5000 HDOCT; optical coherence tomography device; Goldmann applanation tonometer; KR800; Ocular 90D Slit Lamp Lenses; optical coherence tomography device; refractometer; spectral domain optical coherence tomography device; bimatoprost; brimonidine; brimonidine plus timolol; brinzolamide; brinzolamide plus timolol; eye drops; latanoprost; latanoprost plus timolol; tafluprost; timolol; travoprost; adult; aged; article; best corrected visual acuity; central corneal thickness; China; controlled study; disease course; drug substitution; drug withdrawal; false negative result; false positive result; female; gonioscopy; high myopia; human; image quality; incidence; intraocular pressure; longitudinal study; medication compliance; oculoplethysmography; open angle glaucoma; ophthalmoscopy; optical coherence tomography; patient compliance; perimetry; physical examination; quality of life; randomized controlled trial; retina ganglion cell; retina maculopathy; retinal inner plexiform layer; retinal nerve fiber layer; slit lamp microscopy; spectral domain optical coherence tomography; survival rate; treatment outcome; AT900; Cirrus 5000 HDOCT; DRI-OCT Triton; KR800; Ocular 90D Slit Lamp Lenses

Cornea thinning in two cases of ICE syndrome - Harvey, M.M.; Schmitz, J.W. (BMJ Case Reports, 2020)
We present two patients with a new finding of symmetrical corneal thinning early in the clinical course of iridocorneal endothelial syndrome. Patient 1 was evaluated for uncontrolled angle closure glaucoma of the left eye (OS) status post laser peripheral iridotomy (LPI). After placement of an Ahmed glaucomatous valve and trabeculectomy with mitomycin C were performed, the patient was diagnosed with Chandler syndrome. The patient's pachymetry at the time of diagnosis revealed stable central corneal thickness (CCT) of 481 μm of the right eye (OD) (baseline 494 μm) and central cornea thinning with CCT of 407 μm OS (baseline 486 μm). Patient 2 was evaluated for ocular hypertension and Chandler syndrome OS was diagnosed. The patient had a good short-term response to LPI and ocular hypotensive medications. This patient was also found to have thinning of his affected cornea with CCT 523 μm OD and 476 μm OS.
Keywords: Ahmed valve; Humphrey perimeter; brimonidine plus timolol; dorzolamide; dorzolamide plus timolol; latanoprost; mitomycin; adult; article; case report; central corneal thickness; clinical article; closed angle glaucoma; confocal microscopy; cornea disease; cornea thinning; drug response; follow up; gonioscopy; human; intraocular hypertension; intraocular pressure; iridocorneal endothelial syndrome; iridotomy; laser peripheral iridotomy; laser surgery; male; middle aged; optical coherence tomography; pachymetry; patient compliance; priority journal; slit lamp microscopy; trabeculectomy; treatment response; combigan; cosopt; trusopt; xalatan

Improvement in inner retinal function in glaucoma with nicotinamide (vitamin B3) supplementation: A crossover randomized clinical trial - Hui, F.; Tang, J.; Williams, P.A.; McGuinness, M.B.; Hadoux, X.; Casson, R.J.; Coote, M.; Trounce, I.A.; Martin, K.R.; van Wijngaarden, P.; Crowston, J.G. (Clinical and Experimental Ophthalmology, 2020)
Importance: Retinal ganglion cells endure significant metabolic stress in glaucoma but maintain capacity to recover function. Nicotinamide, a precursor of NAD+, is low in serum of glaucoma patients and its supplementation provides robust protection of retinal ganglion cells in preclinical models. However, the potential of nicotinamide in human glaucoma is unknown. Background: To examine the effects of nicotinamide on inner retinal function in glaucoma, in participants receiving concurrent glaucoma therapy. Design: Crossover, double-masked, randomized clinical trial. Participants recruited from two tertiary care centres. Participants: Fifty-seven participants, diagnosed and treated for glaucoma. Methods: Participants received oral placebo or nicotinamide and reviewed six-weekly. Participants commenced 6 weeks of 1.5 g/day then 6 weeks of 3.0 g/day followed by crossover without washout. Visual function measured using electroretinography and perimetry. Main outcome measures: Change in inner retinal function, determined by photopic negative response (PhNR) parameters: saturated PhNR amplitude (Vmax), ratio of PhNR/b-wave amplitude (Vmax ratio). Results: PhNR Vmax improved beyond 95% coefficient of repeatability in 23% of participants following nicotinamide vs 9% on placebo. Overall, Vmax improved by 14.8% [95% CI: 2.8%, 26.9%], (P =.02) on nicotinamide and 5.2% [−4.2%, 14.6%], (P =.27) on placebo. Vmax ratio improved by 12.6% [5.0%, 20.2%], (P =.002) following nicotinamide, 3.6% [−3.4%, 10.5%], (P =.30) on placebo. A trend for improved visual field mean deviation was observed with 27% improving ≥1 dB on nicotinamide and fewer deteriorating (4%) compared to placebo (P =.02). Conclusions: Nicotinamide supplementation can improve inner retinal function in glaucoma. Further studies underway to elucidate the effects of long-term nicotinamide supplementation.
Keywords: 12617000809336; NCT00580931; NCT03061474; insolar; nicotinamide; placebo; aged; article; B wave; closed angle glaucoma; constipation; controlled study; crossover procedure; double blind procedure; drug effect; drug megadose; drug tolerability; drug withdrawal; electroretinography; evening dosage; female; gastrointestinal symptom; glaucoma; headache; human; inner retina; loose feces; low tension glaucoma; major clinical study; male; morning dosage; multicenter study; nausea; open angle glaucoma; patient compliance; perimetry; photopic vision; pigment dispersion glaucoma; prospective study; pseudoexfoliation; randomized controlled trial; retina ganglion cell; retinal nerve fiber layer thickness; visual field; vitamin supplementation; insolar

Device development: Mapping the regulatory strategy to better navigate electronic drug delivery device development for patient safety & security - Mallek, A.; Gremillet, H.; Chandra, A. (Drug Development and Delivery, 2020)
Keywords: computer; drug delivery device; electronic device; electronic drug delivery device; certification; clinical trial (topic); computer security; digitalization; drug administration; drug industry; glaucoma; health care; health care access; home care; human; language ability; manufacturing industry; medical documentation; note; patient attitude; patient compliance; patient safety; product development; quality of life; risk management; software; software validation; therapy effect; validation process; viscosity; workflow

Ophthalmic genetics in South America - Daich Varela, M.; Moya, R.; Schlottmann, P.G.; Hufnagel, R.B.; Arberas, C.; Fernández, F.M.; Inga, M.E.; Lores, J.; Pachajoa, H.; Prada, C.E.; Sallum, J.M.F. (American Journal of Medical Genetics, Part C: Seminars in Medical Genetics, 2020)
South America comprises of heterogeneous topographies, populations, and health care systems. Therefore, it is not surprising to see differences among the countries regarding expertise, education, and practices of ophthalmic genetics for patients with rare eye diseases. Nevertheless, common challenges such as limited genetics training in medical schools and among ophthalmologists, scarcity of diagnostic tools for phenotyping, and expensive genetic testing not covered by the public healthcare systems, are seen in all of them. Here, we provide a detailed report of the current status of ophthalmic genetics, described by the personal views of local ophthalmologists from Brazil, Colombia, Argentina, and Chile. By reporting our strengths and weaknesses as a region, we intend to highlight the need for guidelines on how to manage these patients aligned with public health policies. Our region contributes to research worldwide, with thousands of well diagnosed patients from a number of unique and genetically diverse populations. The constant expansion of ophthalmic genetics and molecular diagnostics requires us to join forces to collaborate across South America and with other countries to improve access to next-generation diagnostics and ultimately improve patient care.
Keywords: age related macular degeneration; anophthalmia; Argentina; article; autofluorescence imaging; Brazil; Chile; choroideremia; chromosome analysis; Colombia; comparative genomic hybridization; congenital cataract; congenital glaucoma; cornea dystrophy; electrophysiological procedures; eye photography; Fabry disease; fluorescence in situ hybridization; gelatinous drop-like corneal dystrophy; gene; genetic counseling; genetic heterogeneity; genetic variability; genetics; health care access; health care organization; health care policy; health care system; high throughput sequencing; human; karyotyping; Leber congenital amaurosis; microarray analysis; microphthalmia; molecular diagnosis; multiplex ligation dependent probe amplification; NMNAT1 gene; ocular albinism; ophthalmic genetics; optical coherence tomography; perimetry; practice guideline; priority journal; retina detachment; retina dystrophy; retinitis pigmentosa; retinoschisis; Sanger sequencing; spectral domain optical coherence tomography; Stargardt disease; support group

Inpatient Adherence to Topical Glaucoma Medications before and after an Educational Intervention - Mammo, D.A.; Strampe, M.; Naravane, A.; Mallory, P.W.; Boysen, J.; Wright, M.M. (Ophthalmology Glaucoma, 2020)
Purpose: To assess the inpatient adherence rate and factors associated with adherence to topical glaucoma medications (TGMs) at a single academic institution throughout hospitalization before and after an educational intervention. Design: Nonrandomized, comparative, retrospective study. Participants: Inpatients 18 years of age and older admitted to a single academic hospital from January 2014 through June 2019 with a diagnosis of glaucoma who also received TGMs. Methods: The medication administration record during admission was examined closely to determine if the TGMs were reconciled and administered correctly before and after an educational intervention with inpatient providers. A simple intervention reached various health care providers through an educational e-mail, communication in a weekly newsletter, and a morning report presentation. Adherence was defined as administration of more than 75% of recommended doses during the inpatient stay. Other collected variables included length of stay and primary diagnosis on admission. Main Outcome Measures: Adherence rate to inpatient administration of TGMs. Results: One hundred eighty-four patients (n = 142 before intervention; n = 42 after intervention) were included. The preintervention group had a total of 275 TGMs, of which 207 (75.3%) were administered in accordance with the adherence definition of this study. After the intervention phase, 49 of 56 (87.5%) TGMs were administered with appropriate adherence (P = 0.047). Adherence was associated significantly with a known outpatient medication regimen (P = 0.006) and correct admission reconciliation (P < 0.001). Conclusions: When glaucoma patients requiring topical treatment are admitted, approximately one quarter of patients seem to not receive their medications appropriately. In this study, a simple educational intervention was able to improve adherence. To prevent daily fluctuations in intraocular pressure for vulnerable glaucoma patients, inpatient adherence to appropriate medication administration should be stressed continuously. While in the care of health care providers, inpatients should be afforded at least the opportunity to maintain adequate adherence, just as is carried out for other medications related to other chronic medical conditions.
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; muscarinic receptor blocking agent; prostaglandin; adult; aged; comparative study; conference paper; controlled study; e-mail; female; glaucoma; hospital admission; hospital patient; hospitalization; human; interpersonal communication; length of stay; major clinical study; male; medication compliance; outcome assessment; patient compliance; patient education; priority journal; retrospective study; risk factor; total quality management

Corticosteroid refractory sarcoidosis - Goldman, C.; Judson, M.A. (Respiratory Medicine, 2020)
A sarcoidosis patient may be refractory to corticosteroid therapy. This may be because corticosteroids are ineffective in relieving the sarcoidosis patient's symptoms/dysfunction or because the clinician has determined that the risks of corticosteroids outweigh their benefits. Interestingly, when corticosteroids truly fail to improve a sarcoidosis patient's condition, it is very rarely because of failure of the drug as an anti-granulomatous agent; rather, it is usually because the patient's symptoms were unrelated to active sarcoid granulomas. In this manuscript, we review the causes of corticosteroid refractory sarcoidosis. The clinician should consider these causes when confronted with a sarcoidosis patient who is either not responding to corticosteroids, developing corticosteroid side-effects, or is at significant risk of developing such side-effects. We believe that determining the cause of corticosteroid refractory sarcoidosis may aid the clinicians in optimizing the care of sarcoidosis patients and clinical researchers in appropriately stratifying patients for clinical trials.
Keywords: corticosteroid; acne; adrenal insufficiency; article; body weight disorder; body weight gain; cataract; cataractogenesis; clinician; cognitive defect; corticosteroid induced osteoporosis; corticosteroid therapy; Cushingoid syndrome; delirium; depression; diabetes mellitus; edema; eye toxicity; fragility fracture; glaucoma; human; hyperglycemia; hypertension; infection; mania; medication compliance; mood change; mood disorder; opportunistic infection; osteoporosis; patient compliance; priority journal; psychosis; sarcoidosis

The Effect of Patient Education and Telemedicine Reminders on Adherence to Eye Drops for Glaucoma - Lai, Y.; Wu, Y.; Chai, C.; Yen, C.-C.; Ho, Y.; Eng, T.C.; Jain, P.; Koh, V. (Ophthalmology Glaucoma, 2020)
Purpose: To determine the improvement in patient adherence to topical ocular hypotensive therapy by introducing a personalized illustrated medication reference chart and telereminder. Design: Prospective randomized controlled clinical trial. Participants: Fifty-nine patients with glaucoma who were using at least 3 or more eye drops were recruited from the ophthalmology clinic at the National University Hospital of Singapore. Methods: Participants were randomized into 3 groups: control, reference chart only, and reference chart with telereminder. They completed a survey on demographics, barriers to glaucoma medication adherence, and self-adherence (measured by the Morisky adherence scale) before and 6 weeks after intervention. Logistic regression analysis was performed on the barriers that contribute to nonadherence and paired t tests were conducted for the preimplementation and postimplementation effects of intervention on adherence score. Main Outcome Measures: Changes in mean adherence score based on the Morisky adherence scale before and after intervention in participants from all 3 groups. Results: In our study, 71% of participants who were nonadherent to medications had multiple barriers to adherence, with lack of self-efficacy and forgetfulness being the most common factors. Only the reference chart with telereminder group showed a statistically significant increase in mean adherence score, from 7.18 to 7.69 (P = 0.047). Conclusions: Adherence to medication in chronic diseases like glaucoma is an important healthcare issue to address. Most of these patients have poor adherence because of multiple factors, and hence interventions aimed at improving adherence should be multifaceted to target these barriers.
Keywords: antiglaucoma agent; bimatoprost; brimonidine; brinzolamide; eye drops; levofloxacin; prednisolone acetate; adult; aged; article; cognition; communication skill; controlled study; demography; doctor patient relationship; female; follow up; forgetfulness; glaucoma; health survey; human; major clinical study; male; medication compliance; Morisky Medication Adherence Scale; patient compliance; patient education; personalized medicine; priority journal; prospective study; randomized controlled trial; reminder system; self concept; Singapore; telemedicine; treatment duration; university hospital; alphagan; azopt; cravit; lumigan; predforte

Selective laser trabeculoplasty in patients with angle recession glaucoma: A small case series - AlObaida, I.; Aljasim, L.A. (American Journal of Ophthalmology Case Reports, 2020)
Purpose: To describe the results of selective laser trabeculoplasty (SLT) in eyes with angle recession glaucoma (ARG). To our knowledge, this is the first report of SLT being used as treatment modality for angle recession glaucoma. Argon laser trabeculoplasty (ALT) was used for ARG but showed a little therapeutic effect. Observations: Retrospective case series of 4 eyes of 4 patients with history of non-penetrating injury to the eye resulted in angle recession glaucoma. All eyes underwent SLT. Post-treatment, the best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of glaucoma medications, additional need for intervention, and complications were recorded. Success of treatment was defined as an IOP reduction of 20% or reduction in medications and maintaining target IOP without further intervention during follow up period of more than 3 months. Mean patient age was 44 years (SD = 9) and 2 out of 4 were females. SLT treatment resulted in decreased IOP from 21 to 12 mmHg in one patient and from 26 to 20 mmHg with reduced medication burden in another patient and reduced medication burden in the third patient who stopped glaucoma medication with no significant change in IOP (from 10 to 14 mmHg) at last follow up visit at 45 months. Two SLT sessions failed in one patient who underwent tube surgery. In the 3 patients with successful treatment, IOP remained controlled for the duration of follow up ranging from 4 to 45 months. Conclusions and Importance: Predicting IOP outcomes after SLT is difficult in patients with ARG. Success was noted early in the post-treatment period and was maintained for years. Repeating SLT in a case of early failure didn't change the result and is not recommended. A larger study is required to confirm the safety and effectiveness of SLT for ARG.
Keywords: ophthalmic argon laser; posterior chamber lens; betaxolol; brinzolamide plus timolol; latanoprost; pilocarpine; adult; angle recession glaucoma; article; blunt trauma; brain concussion; case report; case study; clinical article; disease burden; epithelium lesion; extracapsular cataract extraction; eye injury; female; follow up; glaucoma; gonioscopy; human; hyphema; intraocular pressure; laser surgery; male; medical record review; medication compliance; middle aged; patient compliance; reduction (chemistry); retina hemorrhage; retrospective study; selective laser trabeculoplasty; trabeculectomy; trabeculoplasty; treatment failure; treatment refusal; visual field defect

Early versus late switch: How long should we extend the anti-vascular endothelial growth factor therapy in unresponsive diabetic macular edema patients? - Hernández Martínez, A.; Pereira Delgado, E.; Silva Silva, G.; Castellanos Mateos, L.; Lorente Pascual, J.; Lainez Villa, J.; García Vicente, P.; Almeida-González, C.-V. (European Journal of Ophthalmology, 2020)
Purpose: To compare the results of early versus late switch to the dexamethasone intravitreal implant Ozurdex® in patients with diabetic macular edema who had a poor response to vascular endothelial growth factor inhibitors. Methods: Retrospective and single-center study conducted, in a real setting, on consecutive diabetic macular edema patients who were switch to an intravitreal dexamethasone implant after a poor response to anti-vascular endothelial growth factor treatment. Study sample was divided into two groups: (1) early-switch group, included those eyes who received three anti-vascular endothelial growth factor injections before switch and (2) late-switch group, included those eyes that received six or more anti-vascular endothelial growth factor injections before switch. The primary end-point was the difference in mean change in best-corrected visual acuity and in central subfoveal thickness. Results: A total of 69 (31 early-switch group and 38 late-switch group) eyes were included. In the early-switch group, median (25–75 quartile range) best-corrected visual acuity significantly increase from 0.2 (0.2–0.5) at baseline to 0.4 (0.3 –0.7) at month 24 (p = 0.0043). Whereas, in the late-switch group, best-corrected visual acuity did not increase (p = 0.8602). Central subfoveal thickness was significantly reduced in both early- and late-switch groups, p = 0.0002 and 0.0038, respectively. The proportion of eyes obtaining a central subfoveal thickness reduction ⩾ 10% was significantly greater in the early-switch group than in the late-switch group (71.0% vs 47.4%, respectively, p = 0.0498). Three (9.7%) and 10 (26.3%) eyes have developed ocular hypertension during the study in the early- and late-switch groups, respectively, p = 0.0816. Conclusion: Early switch to Ozurdex in patients who did not adequately respond to anti-vascular endothelial growth factor therapy provided better functional and anatomical outcomes.
Keywords: optical coherence tomography device; dexamethasone; vasculotropin antibody; adult; article; best corrected visual acuity; clinical outcome; diabetic macular edema; female; fluorescence angiography; human; intraocular pressure; macular volume; major clinical study; male; middle aged; ophthalmoscopy; optical coherence tomography; patient compliance; phacoemulsification; priority journal; refraction error; retrospective study; subfoveal choroidal thickness; visual analog scale; vitrectomy

Safety and Efficacy of Scleral Lenses for Keratoconus - Fuller, D.G.; Wang, Y. (Optometry and vision science : official publication of the American Academy of Optometry, 2020)
SIGNIFICANCE: This study affirms the long-term safety and efficacy of scleral contact lens use in patients with keratoconus. PURPOSE: This study aimed to evaluate the safety and efficacy of contemporary scleral contact lenses in the visual rehabilitation of the keratoconic population. METHODS: A retrospective study of keratoconic subjects examined between 2013 and 2018 was conducted. Subjects were included regardless of age, sex, pre-existing morbidity, or scleral lens design. Only eyes fit successfully with scleral contact lenses for ≥1 year were included. Exclusion criteria were prior corneal surgery, dystrophy, degeneration, and trauma. RESULTS: A total of 157 eyes of 86 subjects met the study criteria. The mean Keratoconus Severity Score at initial fitting was 3.6 ± 1.0. Lenses were gas-permeable and nonfenestrated, with a mean overall diameter of 15.8 ± 0.6 mm and 70.1% toric scleral periphery. Physiological adverse events occurred in 9.6% of eyes, including microbial keratitis (0.6%), phlyctenulosis (0.6%), corneal abrasion (1.3%), contact lens-induced acute red eye (1.3%), corneal infiltrative events (1.3%), pingueculitis (1.3%), and hydrops (3.2%). Lens-related adverse events were documented in 55.4% of eyes. Adverse events related to surface issues included poor wetting in 1.9%, handling in 3.8%, reservoir fogging in 7.0%, lens intolerance in 7.6%, deposit in 8.9%, and broken lenses in 26.1% of eyes. The most common management strategies involved refits (54.0% of interventions), patient reeducation (29.5%), medical treatment (5.5%), surgical referral (6.8%), adjustment to wear time (2.5%), surface treatment (1.2%), and lens replacement (0.6%). Best-corrected distance logMAR visual acuity improved significantly from a mean of 0.50 in spectacles to a mean of 0.08 in scleral lenses (P < .0001). During the study period, 14.6% of eyes lost best-corrected scleral lens visual acuity, all from keratoconus progression. CONCLUSIONS: Consistent with other groups, our study demonstrates excellent safety and efficacy of scleral contact lenses in subjects with keratoconus.
Keywords: adolescent; adult; contact lens; device safety; eye refraction; female; human; keratoconus; male; middle aged; pathophysiology; patient compliance; physiology; prosthetic fitting; retrospective study; sclera; treatment outcome; visual acuity; young adult

IoMT (Internet of Medical Things): Reducing Cost while Improving Patient Care - Arora, S. (IEEE Pulse, 2020)
Keywords: medical device; carbon dioxide; article; coronavirus disease 2019; electroencephalogram; glaucoma; health care utilization; heart rate; hospital readmission; hospital waste; hospitalization; human; Internet; Internet of medical things; intraocular pressure; medical technology; patient care; patient monitoring; physician; quality of life; quarantine; resuscitation; social network; telemedicine; telemonitoring; videorecording; waste management

COVID 19—An eye on the virus - Cho, P.; Boost, M. (Contact Lens and Anterior Eye, 2020)
Keywords: contact lens; face mask; orthokeratology lens; spectacles; sunglasses; surgical mask; hand sanitizer; aerosol; body temperature measurement; China; conjunctiva epithelium; conjunctivitis; consultation; coronavirus disease 2019; disease severity; editorial; general practitioner; glaucoma; hand washing; health care access; health care personnel; human; hypoxia; immune response; incubation time; infection risk; lacrimal duct; myopia; nasal tissue; ophthalmologist; optometrist; optometry; pandemic; pediatric hospital; priority journal; quarantine; risk reduction; social distance; treatment withdrawal; United States; viral contamination; viral eye infection; virus transmission; virus virulence

Intereye Symmetry of 24-Hour Intraocular Pressure-related Patterns in Untreated Glaucoma Patients Using a Contact Lens Sensor - Mansouri, K.; Gillmann, K. (Journal of Glaucoma, 2020)
Purpose:Scarce data are available on the symmetry of 24-hour intraocular pressure (IOP) variations between fellow eyes of glaucoma patients, and such evidence could have profound consequences on the interpretation of monocular therapeutic trials. The objective is to evaluate the intereye correlation of continuously measured circadian IOP-related patterns in untreated glaucoma patients.Methods:In this single-center prospective study, a total of 29 untreated patients with open-angle glaucoma underwent bilateral ambulatory 24-hour monitoring of IOP-related patterns using a contact lens sensor (CLS; SENSIMED Triggerfish). IOP was measured before and after CLS monitoring using Goldmann applanation tonometry. Intereye agreement of 24-hour patterns was calculated using Spearman correlation (r) of raw data and after cosinor rhythmometry modeling.Results:Complete bilateral CLS data could be obtained in 20 patients (mean age: 55.5±15.7 y; 51.7% women). On average, intereye correlation was r=0.76±0.19 (range: 0.16 to 0.95) and r=0.77±0.15 (range: 0.49 to 0.91), after excluding 8 patients with lower quality recordings. Cosine rhythmometry modeling showed mean acrophases occurring at 4:21±2:20 am in left eyes and 3:39±1:50 am in right eyes (r=0.48; P=0.034). Mean acrophase amplitude was 110.9±51.9 for left eyes and 107.8±46.2 for right eyes (r=0.79; P<0.001). No serious adverse events related to CLS monitoring were recorded. Transient conjunctival hyperemia (13 patients) and blurred vision (11 patients) were the most frequent adverse events.Conclusions:In this group of untreated glaucoma patients, there was good intereye agreement for circadian IOP-related patterns using the CLS. These results show a higher degree of intereye symmetry, in terms of IOP peak timings and amplitudes, than previously reported with standard tonometry.
Keywords: NCT02231515; automated perimeter; biosensor; contact lens; contact lens sensor; Goldmann applanation tonometer; octopus; ophthalmic camera; optical coherence tomography device; slit lamp; Triggerfish; acrophase amplitude; adult; aged; ambulatory monitoring; analytical parameters; article; blurred vision; circadian rhythm; conjunctival hyperemia; controlled study; correlation analysis; cosinor rhythmometry modeling; female; gonioscopy; human; intraocular pressure; major clinical study; male; open angle glaucoma; optical coherence tomography; priority journal; prospective study; statistical model; tonometry; Octopus; Pentacam; Spectralis OCT; Triggerfish

Bilateral Secondary Angle Closure during Daratumumab Infusion: A Case Report and Review of the Literature - Edwards, R.G.; Vanderhoof, S.; Palestine, A.; Seibold, L.K. (Journal of Glaucoma, 2020)
Daratumumab is an anti-CD38 monoclonal antibody approved for use in multiple myeloma in 2015 and under investigation for use in light-chain amyloidosis. We report a case of a patient with amyloidosis who developed bilateral, acute secondary angle closure during an infusion of daratumumab. Ultrasound biomicroscopy obtained 3 days after the onset of her symptoms demonstrated the cause to be bilateral choroidal effusions. Taken together with several previous case reports, the evidence suggests that, like topiramate, daratumumab is associated with the idiosyncratic reaction of choroidal effusions, resulting in a spectrum of clinical outcomes from myopic shift to acute angle closure. The treating oncologist and eye care provider should be aware of these adverse outcomes in any patient undergoing treatment with this medication, as swift recognition and intervention may be vision-saving.
Keywords: slit lamp; ultrasound biomicroscope; aciclovir; brimonidine; cotrimoxazole; daratumumab; dexamethasone; diphenhydramine; famotidine; hydrocortisone; methylprednisolone; montelukast; ondansetron; paracetamol; prednisolone; adult; amyloidosis; anterior eye chamber; article; autologous bone marrow transplantation; biomicroscopy; case report; chemosis; choroidal effusion; ciliary body; clinical article; drug infusion; evening dosage; eye disease; eye pain; female; gonioscopy; headache; human; infection; intraocular hypertension; intraocular pressure; middle aged; patient compliance; penicillin allergy; priority journal; secondary angle closure; virus infection

Fixed-combination topical anti-hypertensive ophthalmic agents - Machen, L.; Razeghinejad, R.; Myers, J.S. (Expert Opinion on Pharmacotherapy, 2020)
Introduction: Fixed-combination glaucoma medications have altered the paradigm of ocular hypertension and glaucoma treatment and are in widespread use today. A comprehensive review of fixed-combination medications will help educate and inform providers for optimal patient care. Areas covered: In this review, the authors describe the composition, mechanism of action, efficacy, side effects, and safety profile of fixed-combination agents for the treatment of ocular hypertension and glaucoma as well as comparisons between the most frequently prescribed medications. Expert opinion: Fixed-combination therapeutics provide an effective and efficient means of lowering intraocular pressure with comparable side effects and outcomes to constituent parts with lower patient exposure to preservatives and improvement in compliance.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; bimatoprost plus timolol; brimonidine; brimonidine plus brinzolamide; brimonidine plus dorzolamide plus timolol; brimonidine plus timolol; brinzolamide plus timolol; carbonate dehydratase inhibitor; carteolol; carteolol plus latanoprost; carteolol plus pilocarpine; dorzolamide; dorzolamide plus timolol; krytantek ofteno; latanoprost; latanoprost plus netarsudil; latanoprost plus timolol; latanoprostene bunod; mikeluna; netarsudil; pilocarpine; pilocarpine plus timolol; prostaglandin derivative; tafluprost plus timolol; tapticom; tim brim dor; timolol; timolol plus travoprost; travoprost; unclassified drug; allergic conjunctivitis; application site pain; asthma; blurred vision; bradycardia; bronchospasm; burn; burning sensation; cardiovascular disease; cataract; chemical composition; chronic obstructive lung disease; clinical trial (topic); comparative study; conjunctival hemorrhage; conjunctival hyperemia; conjunctivitis; depression; dizziness; drug efficacy; drug mechanism; drug safety; drug tolerability; dry eye; dysgeusia; eye discharge; eye discomfort; eye irritation; eye pain; foreign body; glaucoma; headache; heart block; human; hyperemia; hypertrichosis; hypotension; intraocular hypertension; intraocular pressure; lung disease; meta analysis (topic); multicenter study (topic); nausea; outcome assessment; patient care; patient compliance; phase 2 clinical trial (topic); phase 3 clinical trial (topic); photophobia; pruritus; punctate keratitis; randomized controlled trial (topic); review; side effect; taste disorder; topical treatment; visual disorder; visual field defect; xerostomia; azarga; combigan; cosopt; duotrav; fotil; ganfort; krytantek ofteno; mikeluna; rocklatan

Patients’ perception of glaucoma diagnosis practice: Results from a survey of glaucoma patients in North India - Sood, D.; Sood, I.; Sood, S.; Kumar, D.; Sood, R.; Sood, N.N. (International Ophthalmology, 2020)
Purpose: This study assesses the practice patterns of diagnosing ophthalmologists, as reported by glaucoma patients attending specialty glaucoma clinics in urban and rural areas of North India, for a second opinion. Methods: Prospective cross-sectional study using a structured interview-based survey was conducted from 1 November 2011 to 31 October 2012 on patients attending two specialty glaucoma care facilities in North India. Both clinics were in North India; however, one was rural (Kaithal) and one was urban (Delhi). Patients were asked through descriptions of machines and processes, regarding practice patterns of their glaucoma diagnosing ophthalmologists. The interview was conducted by ophthalmic assistants in tune with the vernacular of the region, in a language understood by the interviewee. Results: A total of 1506 patients consented to participate in the survey. The majority of patients reported undergoing tests for intraocular pressure measurement; however, 56–60% of these tests were carried out by the non-contact tonometer. More than 90% of patients reported no knowledge regarding the type and severity of the glaucoma they suffered from, and even less reported undergoing gonioscopy (3.6% Karnal and 16% Delhi). 84–86% patients who underwent perimetry reported undergoing at least some digital imaging of the optic disc. Conclusions: Better counselling of, and communication with, the patient would help increase their awareness regarding their condition and the care required. This has the potential to enable better compliance with and adherence to treatment. Standardized training of ophthalmologists to improve clinical diagnosis of glaucoma would also go a long way.
Keywords: non contact tonometer; article; clinical practice; cross-sectional study; diagnostic procedure; digital imaging; disease severity; disease surveillance; glaucoma; gonioscopy; human; India; intraocular pressure; ophthalmologist; optic disk; patient attitude; patient compliance; perimetry; pressure measurement; prospective study; structured interview

Recent trends in vision impairment certifications in England and Wales - Rahman, F.; Zekite, A.; Bunce, C.; Jayaram, H.; Flanagan, D. (Eye (Basingstoke), 2020)
Background: The Certificate of Visual Impairment (CVI) provides essential data for preventable sight loss indicators as part of the Public Health Outcomes Framework (PHOF) published annually by the Department of Health. Trends in CVI certification rates can provide information on the effectiveness of current services and treatments and may be used to guide allocation of resources, and is the only such indicator within ophthalmology. This study aimed to compare recent trends in new vision impairment certifications in 2017/18 against prior baseline data in England and document trends in new certifications in Wales. Methods: PHOF data from 2010/11 and 2017/18 were examined with respect to preventable sight loss indicators: age-related macular degeneration (AMD) (Indicator E12a), glaucoma (Indicator E12b), diabetic eye disease (Indicator E12c) as well as the total numbers of certifications (Indicator E12d). Results: In 2017/18, the rate of new CVI certifications was 41 per 100,000 population which has reduced from 43/100,000 in 2010/11 in England. Certifications for AMD reduced from 132/100,000 in 2010/11 to 107/100,000 in 2017–18. Certifications for glaucoma have remained stable at 13/100,000 in 2017/8. Certifications for diabetic eye disease have declined from 4/100,000 in 2010/11 to 3/ 100,000 in 2017/18. The number of vision impaired individuals that each Clinical Commissioning Group (CCG) has to support varies from 8 to 82 per 100,000 population. Conclusions: There has been a significant decrease in the rate of all CVI certifications particularly from AMD and diabetic retinopathy. However, maintaining this will require changes in the way care is delivered as the elderly population, which is at greatest risk of preventable sight loss, is projected to increase by 50% over the next 20 years. Inherited retinal diseases are now the leading cause of sight loss in the working age population. CVI data demonstrate the need for CCGs to tailor their investment in ophthalmic services to the needs of their specific patient populations. It is important that all ophthalmologists continue to provide accurate CVI data in order to help support the future equitable allocation of adequate resources to reduce avoidable vision loss.
Keywords: age related macular degeneration; aging; article; certification; diabetic macular edema; diabetic retinopathy; education; England; ethnicity; geographic distribution; glaucoma; health care access; health care delivery; health service; home monitoring; human; lifestyle; multidisciplinary team; patient education; pediatrics; public health; social status; visual acuity; visual impairment; Wales

Efficacy and Safety of Suprachoroidal CLS-TA for Macular Edema Secondary to Noninfectious Uveitis: Phase 3 Randomized Trial - Yeh, S.; Khurana, R.N.; Shah, M.; Henry, C.R.; Wang, R.C.; Kissner, J.M.; Ciulla, T.A.; Noronha, G. (Ophthalmology, 2020)
Purpose: Injection of pharmacotherapy into the suprachoroidal space, between the sclera and choroid, is an alternative delivery technique developed with the rationale of providing higher drug concentrations to posterior ocular structures compared with other intraocular and periocular injection procedures. This study was conducted to evaluate the safety and efficacy of suprachoroidally injected triamcinolone acetonide formulation (CLS-TA), a suspension of triamcinolone acetonide, in improving vision among patients with noninfectious uveitis complicated by macular edema (ME). Design: Phase 3 masked, randomized trial. Participants: One hundred sixty patients with ME secondary to noninfectious uveitis. Patients were required to have a best-corrected visual acuity (BCVA) of 5 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letters (Snellen equivalent, 20/800) and 70 or fewer ETDRS letters read (Snellen equivalent, 20/40) in the study eye. Methods: Patients were randomized 3:2 to suprachoroidally injected CLS-TA or sham treatment, with administrations at day 0 and week 12. Main Outcome Measures: The primary end point was improvement from baseline of 15 or more ETDRS letters in BCVA at week 24. The secondary end point was reduction from baseline in central subfield thickness (CST) at week 24. Results: In the CLS-TA arm, 47% of patients gained 15 or more ETDRS letters in BCVA versus 16% in the control arm (P < 0.001), meeting the primary end point. Mean reductions in CST from baseline were 153 μm versus 18 μm (P < 0.001). No serious adverse events (AEs) related to treatment were reported. Corticosteroid-associated AEs of elevated intraocular pressure occurred in 11.5% and 15.6% of the CLS-TA and control groups, respectively. Cataract AE rates were comparable (7.3% and 6.3%, respectively). Conclusions: Patients in the CLS-TA study arm experienced clinically significant improvement in vision relative to the sham procedure, demonstrating the efficacy of suprachoroidal injection of CLS-TA for the treatment of ME in a vision-threatening disorder.
Keywords: NCT02595398; corticosteroid; triamcinolone acetonide; adult; best corrected visual acuity; cataract; choroidal thickness; compression fracture; conference paper; controlled study; drug administration route; drug efficacy; drug safety; drug withdrawal; eye pain; female; glaucoma; human; intermediate uveitis; intraocular hypertension; intraocular pressure; iridocyclitis; macular edema; major clinical study; male; middle aged; multicenter study; patient compliance; phase 3 clinical trial; priority journal; randomized controlled trial; retina macula cystoid edema; sclera; sialoadenitis; side effect; spine fracture; suprachoroidal drug administration; suspension; uveitis; vision; vitreous body detachment

The Impact of the Support, Educate, Empower Personalized Glaucoma Coaching Pilot Study on Glaucoma Medication Adherence - Newman-Casey, P.A.; Niziol, L.M.; Lee, P.P.; Musch, D.C.; Resnicow, K.; Heisler, M. (Ophthalmology Glaucoma, 2020)
Purpose: To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among glaucoma patients with low adherence. Design: Uncontrolled intervention study with a pre–post design. Participants: Glaucoma patients ≥ age 40, taking ≥1 medication, who self-reported poor adherence were recruited from the University of Michigan Kellogg Eye Center. Adherence was monitored electronically for a 3-month baseline period; participants with median adherence of ≤80% were enrolled in the SEE program. Methods: Participants’ adherence was monitored electronically (AdhereTech, New York, NY) during the 7-month program. Adherence was calculated as the percentage of doses taken on time of those prescribed. The SEE program included (1) automated medication reminders, (2) 3 in-person counseling sessions with a glaucoma coach who had training in motivational interviewing (MI), and (3) 5 phone calls with the same coach for between-session support. The coach used a web-based tool to generate an education plan tailored to the patient's glaucoma diagnosis, test results, and ophthalmologist's recommendations (www.glaucomaeyeguide.org). The tool guided an MI-based conversation between coach and patient to identify barriers to adherence and possible solutions. Descriptive statistics were used to summarize baseline patient characteristics, and differences between those who did and did not complete the SEE program were tested with 2-sample t tests, chi-square tests, and Fisher exact tests. Adherence was compared before and after the SEE program with paired t tests. Main Outcome Measure: Change in electronically monitored medication adherence. Results: A total of 48 participants were enrolled. The participants were 54% male, 46% white, and on average 64 years of age (standard deviation [SD], 10.8 years), with an average worse-eye mean deviation (MD) of –7.9 dB (SD, 8.8 dB). Those completing the SEE program (n = 39) did not differ significantly from those who dropped out (n = 9) on gender, race, age, MD, or baseline adherence. Medication adherence improved from 59.9% at baseline to 81.3% (P < 0.0001) after completing the SEE program. Ninety-five percent of participants showed an improvement in adherence (mean relative improvement, 21.4%; SD, 16.5%; range, –3.2% to 74.4%; median, 20.1%). Fifty-nine percent of participants showed adherence of >80% on completing the SEE program. Conclusions: The SEE program participants showed clinically meaningful, statistically significant improvement in glaucoma medication adherence.
Keywords: adult; Caucasian; clinical article; clinical effectiveness; conference paper; counseling; female; gender; glaucoma; groups by age; health care planning; health center; health education; health program; human; male; motivational interviewing; ophthalmologist; patient compliance; patient monitoring; personalized medicine; pilot study; prescription; pretest posttest design; priority journal; race; self report

Predicting Glaucoma before Onset Using Deep Learning - Thakur, A.; Goldbaum, M.; Yousefi, S. (Ophthalmology Glaucoma, 2020)
Purpose: To assess the accuracy of deep learning models to predict glaucoma development from fundus photographs several years before disease onset. Design: Algorithm development for predicting glaucoma using data from a prospective longitudinal study. Participants: A total of 66 721 fundus photographs from 3272 eyes of 1636 subjects who participated in the Ocular Hypertension Treatment Study (OHTS) were included. Main Outcome Measures: Accuracy and area under the curve (AUC). Methods: Fundus photographs and visual fields were carefully examined by 2 independent readers from the optic disc and visual field reading centers of the OHTS. When an abnormality was detected by the readers, the subject was recalled for retesting to confirm the abnormality and for further confirmation by an end point committee. By using 66 721 fundus photographs, deep learning models were trained and validated using 85% of the fundus photographs and further retested (validated) on the remaining (held-out) 15% of the fundus photographs. Results: The AUC of the deep learning model in predicting glaucoma development 4 to 7 years before disease onset was 0.77 (95% confidence interval [CI], 0.75–0.79). The accuracy of the model in predicting glaucoma development approximately 1 to 3 years before disease onset was 0.88 (95% CI, 0.86–0.91). The accuracy of the model in detecting glaucoma after onset was 0.95 (95% CI, 0.94–0.96). Conclusions: Deep learning models can predict glaucoma development before disease onset with reasonable accuracy. Eyes with visual field abnormality but not glaucomatous optic neuropathy had a higher tendency to be missed by deep learning algorithms.
Keywords: area under the curve; article; controlled study; deep learning; diagnostic test accuracy study; disease exacerbation; eye disease assessment; eye fundus; eye photography; glaucoma; health care access; human; image analysis; image artifact; multicenter study; optic disk; priority journal; prospective study; risk factor; visual field

Association of Visual Acuity Improvement with Uncorrected Refractive Error in Patients New to Low Vision Clinics - Guo, X.; Swenor, B.K.; Goldstein, J.E. (JAMA Ophthalmology, 2020)
Importance: There is substantial socioeconomic and individual burden from uncorrected refractive error (URE) and chronic ocular disease. Understanding the association of visual acuity (VA) reduction with URE and the adults most likely to benefit from refraction may help support clinical decision-making in ophthalmologic care and maximize patient outcomes. Objectives: To assess the magnitude of VA improvement associated with URE among adults under ophthalmic care who obtain low vision rehabilitation (LVR) services and identify the characteristics of the patients who are most likely to experience improvement. Design, Setting, and Participants: This retrospective case series assessed patients 20 years or older who were new to the LVR clinics from August 1, 2013, to December 31, 2015, and who had habitual VA between 20/40 and counting fingers (not including) and underwent refraction. Data analysis was performed from April 4, 2018, to December 20, 2019. Exposures: Patient demographics and clinical data, including habitual and refraction VA, refraction, and disease diagnosis. Habitual VA was categorized as mild (VA worse than 20/40 and at least 20/60), moderate (VA worse than 20/60 and better than 20/200), severe (VA 20/200 or worse and better than 20/500), and profound (VA 20/500 or worse) vision impairment (VI). Main Outcomes and Measures: At least 2-line VA improvement and any VA improvement (≥1-line) by refraction. Results: Among the 2923 patients new to LVR clinics, 1773 (mean [SD] age, 70 [18.2] years; 1069 [60.3%] female) were included in these analyses. The mean habitual VA was 20/100 (mean [SD], 0.67 [0.36] logMAR). At least 2-line improvement was observed in 493 patients (27.8%), and any VA improvement was seen in 1023 patients (57.7%). At least 2-line improvement was observed in 54 patients (34.8%) with corneal disorders and was more likely seen among patients aged 40 to <65 years compared with those aged 20 to <40 years (odds ratio [OR], 1.57; 95% CI, 1.02-2.41), African American patients compared with white patients (OR, 1.41; 95% CI, 1.08-1.85), or patients with moderate VI compared with mild VI (OR, 1.36; 95% CI, 1.07-1.72). Conclusions and Relevance: The findings suggest that URE is prevalent among patients with ocular disease and accessing LVR and that refractive evaluation should be considered for patients with ocular disease and reduced VA, especially working-age adults aged 40 to <65 years, African American patients, and those with moderate VI.
Keywords: adult; African American; age related macular degeneration; aged; ambulatory care; article; clinical decision making; controlled study; cornea disease; demography; diabetic retinopathy; eye care; eye disease; female; glaucoma; groups by age; human; low vision rehabilitation; major clinical study; male; measurement; outcome assessment; priority journal; refraction error; retina disease; retrospective study; treatment outcome; uncorrected refractive error; visual acuity

Increasing Engagement of African American Patients with Glaucoma during Medical Encounters: Creation of a Pre-visit Video - Sleath, B.; Davis, S.A.; Carpenter, D.M.; Robin, A.L.; Muir, K.W.; Lee, C.; Garcia, N.; Budenz, D.L. (Optometry and vision science : official publication of the American Academy of Optometry, 2020)
SIGNIFICANCE: The developed video can be accessed by African American patients with glaucoma from across the United States on YouTube to learn why it is important to ask eye care providers any questions they might have about glaucoma and/or its treatment. PURPOSE: Our objective was to develop an educational video for African Americans with glaucoma to watch before their ophthalmology office visits to help motivate them to be actively involved in their care. METHODS: The Social Cognitive Theory guided the development of the video. We conducted three focus groups with African American patients with glaucoma and three focus groups with providers who care for African American patients with glaucoma. The research team reviewed the transcripts of the focus groups and then developed a plan for video production. RESULTS: The themes that both patients and providers felt should be covered in the video to motivate patient question-asking included the following: what is glaucoma, glaucoma treatment, glaucoma testing, and treatment adherence. Based on focus group results, the resulting video had one male African American physician and four African American patients covering the themes that emerged. CONCLUSIONS: Ophthalmologists and African Americans with glaucoma gave us excellent insight into developing videos to increase patient involvement during their visits.
Keywords: African American; aged; ambulatory care; doctor patient relationship; ethnology; female; glaucoma; human; information processing; interpersonal communication; male; middle aged; ophthalmologist; patient education; patient participation; procedures; United States; videorecording

Comparison of male and female patients in Louisiana medical Marijuana dispensaries - Allen, H.R.; Boudreaux, D.; Keller, J.N. (Journal of Clinical Medicine, 2020)
Relatively little is known in terms of patient demographics, indications, previous cannabis use, or the forms and dosages of medical marijuana (MM) dispensed for patients at MM dispensaries. Even less is known in terms of how male and female patients may differ in each of these aspects. The goal of the current study was to examine each of these variables using a retrospective analysis of deidentified patient data from MM dispensaries in Louisiana. Deidentified data were analyzed from web-based pharmacist–patient consultations at MM dispensaries throughout Louisiana. Data were collected during the first 6 months following the initiation of the MM dispensing program in Louisiana. A total of 1195 MM patients (598 male/597 female) were included in the analyses. The average age of the sample was 51.9 years (±14.8) and it was composed primarily of white patients (86.7%). Males and females were nearly identical in terms of average age, race, previous cannabis use, indication profile, and MM recommendations. Differences between males and females were observed in terms of opioid use, history of psychosis, presence of more than one indication, and the duration of previous cannabis use. Our data indicate that, in MM dispensaries of the Deep South state, there are numerous similarities—and some potentially important differences—between male and female MM patients. The importance of these differences, and the importance of continued data collection/analysis, for improving MM dispensing are discussed.
Keywords: cannabidiol; cannabis; opiate; tetrahydrocannabinol derivative; vegetable oil; adult; ambulatory care; article; autism; cannabis use; comparative study; consultation; diseases; drug cost; epilepsy; female; glaucoma; human; Human immunodeficiency virus infection; intractable pain; Louisiana; major clinical study; male; middle aged; multiple sclerosis; muscle spasm; muscular dystrophy; Parkinson disease; pharmacist; pharmacy (shop); psychosis; retrospective study; seizure; self report

Perioperative Management of Diabetic Macular Edema - Leung, E.H.; Leung, J.H. (International Ophthalmology Clinics, 2020)
Keywords: bevacizumab; dexamethasone; glucagon like peptide 1; hemoglobin A1c; nonsteroid antiinflammatory agent; ranibizumab; triamcinolone; vasculotropin; article; cardiovascular disease; cataract extraction; central foveal thickness; choroidal thickness; clinical evaluation; diabetes mellitus; diabetic macular edema; diabetic retinopathy; fluid retention; glucose blood level; glycemic control; half life time; hazard ratio; human; incidence; inflammation; intraocular pressure; macular thickness; non insulin dependent diabetes mellitus; open angle glaucoma; patient compliance; perioperative period; priority journal; proliferative diabetic retinopathy; retina vein occlusion; retinopathy; risk factor; sample size; uveitis; visual acuity; vitreous body; wound healing

Proceedings of the RAMI Student Section Meeting (Irish Journal of Medical Science, 2020)
The proceedings contain 51 papers. The topics discussed include: the human paralaminar nucleus and the HPA axis: salience in major depressive disorder; the association between monocyte subset numbers and significant disease on coronary angiography; the provision of a specialized turner syndrome pediatric clinic in a regional pediatric department; investigating the duration and indications of antimicrobial prescriptions: a clinical audit; efficacy and adverse events with the use of tranexamic acid in the hip fracture population in a university teaching hospital; a virtual HIV clinic at a tertiary referral center: a feasibility study; analyzing the apoptotic signature of activated lamina cribrosa fibroblasts in glaucoma; the relationship between healthcare utilization and mental health in young people; a longitudinal cohort study; and the mental health referral pathway from general practitioners to the emergency department at beaumont hospital.
Keywords: antiinfective agent; tranexamic acid; apoptosis; child; clinical audit; cohort analysis; conference review; coronary angiography; drug therapy; emergency ward; feasibility study; fibroblast; general practitioner; glaucoma; health care utilization; hip fracture; human; Human immunodeficiency virus; hypothalamus hypophysis adrenal system; major depression; mental health; monocyte; nonhuman; pediatric hospital; pediatric ward; prescription; tertiary care center; Turner syndrome; university hospital

Understanding Barriers to Glaucoma Treatment Adherence among Participants in South India - Killeen, O.J.; Pillai, M.R.; Udayakumar, B.; Shroff, S.; Vimalanathan, M.; Cho, J.; Newman-Casey, P.A. (Ophthalmic Epidemiology, 2020)
Purpose: Data on glaucoma treatment barriers in South India is limited; improved knowledge of barriers could advance disease self-management. We aimed to understand glaucoma treatment barriers in South India. Methods: Glaucoma patients ≥18 taking ≥1 medication at the Aravind Eye Hospital were screened with a validated medication adherence tool. Patients who self-reported poor adherence and/or were >3 months late for follow-up completed semi-structured interviews on treatment barriers. Interviews were audio-recorded, transcribed, translated and back-translated to ensure accuracy. Researchers used grounded theory to code the transcripts and identify themes using NVivo 11.0. Demographic and clinical characteristics were abstracted from the medical record. Results: 70/167 (42%) had poor self-reported adherence to drops. The 45 interviewed were 62 ± 12 years and took 1.6 ± 0.7 drops. Forty-two (93%) were non-adherent to medication and 21 (47%) were late for follow-up. Top barriers to medication adherence were difficulty obtaining drops (20, 44%), being busy (18, 40%), and the expense (17, 38%). Top barriers to appointment follow-up were distance to the hospital (21, 47%), expense (20, 44%), and no escort (15, 33%). Other important barriers included mistrust in the health system, poor knowledge of glaucoma and family needs. Conclusions: Previously, 6% of glaucoma patients in South India self-reported poor medication adherence; the 42% identified in this study is in line with glaucoma medication adherence rates globally. Complex factors caused high rates of non-adherence. Societal-level interventions that address systemic barriers and counselling that supports patients’ and families’ motivation for behaviour change should be implemented.
Keywords: antiglaucoma agent; eye drops; adult; article; attitude to health; clinical article; drug cost; female; follow up; glaucoma; grounded theory; human; India; male; medication compliance; middle aged; patient compliance; priority journal; self report; semi structured interview; social responsibility; social status; traffic and transport

Personalized approaches for the management of glaucoma - Balendra, S.I.; Zollet, P.; Cisa Asinari Di Gresy E Casasca, G.; Cordeiro, M.F. (Expert Review of Precision Medicine and Drug Development, 2020)
Introduction: Personalized medicine is the future goal across all specialties. Accurate prediction of optimal treatment beneficial and adverse effects could transform patient management. This is of particular importance in chronic conditions, where a ‘trial and error’ approach over months and years can contribute to significant morbidity. Glaucoma is a chronic irreversible progressive optic neuropathy, a leading cause of blindness worldwide. An ideal personalized approach in glaucoma clinic would be to answer the inevitable question in a patient’s first visit: ‘Which treatment option will work best for me so that I won’t go blind?’ Areas covered: This review will give an overview of the knowledge we have acquired to achieve this goal, particularly discussing using patient’s individual risk factors, their genetic profile, and different treatment modalities, including therapy compliance, to personalize care. Expert opinion: Pharmacogenomics and genetic profiling are the most tangible ways in which glaucoma management can be personalized. Future challenges will include developing realistic animal models to reflect the underlying genetic patterns in glaucoma to investigate their interaction with different treatments.
Keywords: glaucoma drainage implant; beta adrenergic receptor blocking agent; neurotrophin; prostaglandin; steroid; Alzheimer disease; apoptosis; drug response; endoplasmic reticulum stress; Flammer syndrome; genetic predisposition; genetic profile; glaucoma; glaucoma surgery; glaucomatous optic neuropathy; human; hypotension; intraocular hypertension; intraocular pressure; migraine; morbidity; neuroprotection; open angle glaucoma; patient care; patient compliance; patient counseling; personalized medicine; pharmacogenetics; pharmacogenomics; prediction; prognosis; pseudoexfoliation; review; risk factor; topical treatment; trabecular meshwork; trabeculectomy; vasospasm

Improving eye drop adherence: a simple technique using a cable tie - Huang, S.; Andrew, N. (Acta Ophthalmologica, 2020)
Keywords: electrical cord; eye drop delivery aid; eye drops; daily life activity; drug self administration; eye care professional; glaucoma; human; letter; medication compliance; patient compliance; priority journal

Beyond intraocular pressure: Optimizing patient-reported outcomes in glaucoma - Fenwick, E.K.; Man, R.E.; Aung, T.; Ramulu, P.; Lamoureux, E.L. (Progress in Retinal and Eye Research, 2020)
Glaucoma, an irreversible blinding condition affecting 3–4% adults aged above 40 years worldwide, is set to increase with a rapidly aging global population. Raised intraocular pressure (IOP) is a major risk factor for glaucoma where the treatment paradigm is focused on managing IOP using medications, laser, or surgery regimens. However, notwithstanding IOP and other clinical parameters, patient-reported outcomes, including daily functioning, emotional well-being, symptoms, mobility, and social life, remain the foremost concerns for people being treated for glaucoma. These outcomes are measured using objective patient-centered outcome measures (PCOMs) and subjective patient-reported outcome measures (PROMs). Studies using PCOMs have shown that people with glaucoma have several mobility, navigational and coordination challenges; reading and face recognition deficits; and are slower in adapting to multiple real-world situations when compared to healthy controls. Similarly, studies have consistently demonstrated, using PROMs, that glaucoma substantially and negatively impacts on peoples’ self-reported visual functioning, mobility, independence, emotional well-being, self-image, and confidence in healthcare, compared to healthy individuals, particularly in those with late-stage disease undergoing a heavy treatment regimen. The patient-centred effectiveness of current glaucoma treatment paradigms is equivocal due to a lack of well-designed randomized controlled trials; short post-treatment follow-up periods; an inappropriate selection or availability of PROMs; and/or an insensitivity of currently available PROMs to monitor changes especially in patients with newly diagnosed early-stage glaucoma. We provide a comprehensive, albeit non-systematic, critique of the psychometric properties, limitations, and recent advances of currently available glaucoma-specific PCOMs and PROMs. Finally, we propose that item banking and computerized adaptive testing methods can address the multiple limitations of paper-pencil PROMs; customize their administration; and have the potential to improve healthcare outcomes for people with glaucoma.
Keywords: ophthalmic argon laser; antiglaucoma agent; computerized adaptive testing; coordination; drug efficacy; drug tolerability; facial recognition; follow up; glaucoma; glaucoma surgery; human; intraocular pressure; medication compliance; minimally invasive surgery; patient compliance; patient satisfaction; patient-reported outcome; priority journal; quality of life; reading; review; symptom; trabeculoplasty; watchful waiting

Cost-Utility Analysis of Glaucoma Medication Adherence - Newman-Casey, P.A.; Salman, M.; Lee, P.P.; Gatwood, J.D. (Ophthalmology, 2020)
Purpose: The majority of patients with glaucoma do not take their medications as prescribed. Estimates of the cost-utility value of adherence to prescribed glaucoma medication are vital to implement potentially effective interventions. Design: Cost-utility analysis using Monte Carlo microsimulations incorporating a series of Markov cycles (10 000 iterations per strategy). Participants: Patients with glaucoma aged ≥40 years with a full lifetime horizon (up to 60 years). Methods: The analysis estimated glaucomatous progression on the basis of data from the United Kingdom Glaucoma Treatment Study. Participants with glaucoma entered the model at age 40 years with a mean deviation in the better-seeing eye of −1.4±−1.9 decibels (dB) and −4.3±−3.4 dB in the worse-seeing eye. Participants whose glaucoma worsened each year accumulate −0.8 dB loss compared with −0.1 dB loss for those who remained stable. Data from the Glaucoma Laser Trial and the Tube versus Trabeculectomy Studies were used to assign probabilities of worsening disease among treated patients. Claims data estimating rates of glaucoma medication adherence over 4 years were used to assign probability of adherence. Those with poor adherence were modeled as having outcomes similar to the placebo arm of the clinical trials. As patients’ mean deviation deteriorated, they transitioned between health states from mild (≥−6 dB), to moderate (<−6 to ≥−12 dB), to severe glaucoma (<−12 to ≥23 dB), to unilateral (<−20 dB) and bilateral blindness. At each health state, patients incurred the costs of treatment and established health utilities; ultimately, societal costs of low vision and blindness were included. Main Outcome Measures: Cost and quality-adjusted life year (QALY) of glaucoma medication adherence. Results: Beginning at an initial glaucoma diagnosis at age 40 years, patients proceeded to single-eye blindness as early as 19 years among those who were nonadherent and 23 years for those remaining adherent. Total healthcare costs for adherent patients averaged $62 782 (standard deviation [SD], 34 107), and those for nonadherent patients averaged $52 722 (SD, 38 868). Nonadherent patients had a mean loss of 0.34 QALYs, resulting in a cost-effectiveness ratio of $29 600 per QALY gained. Conclusion: At a conservative willingness to pay of $50 000/QALY, there is room to expand services to improve patient adherence.
Keywords: latanoprost; placebo; adult; aged; conference paper; cost utility analysis; female; glaucoma; health care cost; health status; human; lifespan; low vision; major clinical study; male; medication compliance; middle aged; patient compliance; prescription; priority journal; quality adjusted life year; trabeculectomy; unilateral blindness; xalatan

Register your interest - Gillies, M. (Clinical and Experimental Ophthalmology, 2020)
Keywords: ranibizumab; vasculotropin inhibitor; Australia; blindness; cataract extraction; clinical practice; comorbidity; diabetic macular edema; disease registry; drug approval; editorial; electronic medical record; Europe; glaucoma; health care cost; health care utilization; health economics; human; intraocular pressure; medication compliance; patient care; patient safety; randomized controlled trial (topic); reimbursement; visual impairment; wet macular degeneration

Societal and Economic Impact of Poor Glaucoma Medication Adherence - Aptel, F.; Toren, A. (Ophthalmology, 2020)
Keywords: antiglaucoma agent; blindness; cost effectiveness analysis; economic aspect; editorial; eye care professional; glaucoma; health care system; human; medication compliance; patient compliance; priority journal; quality adjusted life year; social aspect

PSS6 DIRECT COSTS EXPERIENCED BY THOSE IN A PATIENT NAVIGATOR PROGRAM VERSUS USUAL CARE: RESULTS FROM THE PHILADELPHIA TELEMEDICINE GLAUCOMA DETECTION AND FOLLOW-UP EYE CARE STUDY (PTGD) - Yuan, J.; Prioli, K.M.; Hark, L.; Abersone, I.; Myers, J.S.; Katz, L.J.; Pizzi, L.T. (Value in Health, 2020)
Objectives: Glaucoma is the second leading cause of irreversible blindness in the US and is often asymptomatic and underdiagnosed. Recent studies have explored interventions to improve early glaucoma detection, but data regarding their economic burden remains limited. We present direct medical costs experienced by those in a patient navigator intervention as compared to usual care in the Philadelphia Telemedicine Glaucoma Detection and Follow-Up Eye Care Study (PTGD), a two-part primary care-based intervention designed to detect glaucoma via telemedicine screening and use a patient navigator to improve adherence to recommended follow-up glaucoma eye care visits. Methods: In Part 1 of the study, a telemedicine eye examination was performed to screen for glaucoma. If glaucoma was detected, participants received a confirmatory ophthalmologist examination. In Part 2, those with confirmed glaucoma were randomized to usual care (UC) or enhanced intervention (EI). In EI, a patient navigator assessed barriers to recommended follow-up visit adherence, helped schedule visits, and provided reminder telephone calls. Direct costs (examinations, procedures, and medications) were estimated from practice billing codes and prevailing Medicare reimbursement rates. Number of follow-up visits and per-participant direct costs during Part 2 were compared between groups via Wilcoxon rank-sum tests. Results: Participants in EI had significantly greater adherence to recommended follow-up visits than those in UC (mean 2.2 vs. 1.0 visits/participant, p<0.0001). Examination costs were higher in EI vs. UC ($152.90/participant vs. $82.60/participant respectively, p<0.0001). Similarly, procedure costs were higher in EI vs. UC ($43.80/participant vs. $23.50/participant respectively, p<0.0001). Costs of newly prescribed eye medications were lower in EI vs. UC ($21.75/participant vs. $28.84/participant respectively, p=0.0003), whereas costs of current eye medications were higher in EI vs. UC ($59.93/participant vs. $48.35/participant, p=0.0103). Conclusions: Primary care-based screenings represent a novel means of early glaucoma detection. Though EI experienced greater per-participant direct costs, this group showed improved adherence to follow-up care.
Keywords: adult; clinical assessment; conference abstract; controlled study; coronavirus disease 2019; eye care; eye examination; female; follow up; glaucoma; human; low drug dose; male; medicare; ophthalmologist; Pennsylvania; primary medical care; randomized controlled trial; rank sum test; reimbursement; telemedicine; telephone

The differences between patient and optometrist experiences of contact lens hygiene education from the perspective of a Scottish university teaching hospital - Hind, J.; Williams, O.; Oladiwura, D.; Macdonald, E. (Contact Lens and Anterior Eye, 2020)
Background: Contact lens related keratitis is a frequent presentation to acute ophthalmology services. Patients often do not recall being counselled regarding the safe use of contact lenses therefore fail to comply with guidance. This study aimed to identify the content and format of advice given to patients with contact lens keratitis concerning appropriate hygiene practices, determine their compliance with this and finally characterise optometrist practices regarding contact lens advice provided to patients. Methods: All adult patients presenting with contact lens related keratitis to the acute ophthalmology clinic were asked to complete a survey. Information was collected on lens type, format of advice received and compliance. Community optometrists were asked to complete an electronic survey on their contact lens review practices and routine patient education. Results: All patients surveyed recalled counselling on initiation of contact lenses; however 12% (6/50) were given no advice on return visits. This advice was in written format for 20% (10/50) of patients on initiation increasing to 32% (16/50) on renewal. Many patients slept (22%), showered (44%) or swam (36%) in lenses. 92% cleaned their contact lenses appropriately, but cases were washed infrequently (19% of cases cleaned < monthly) or with tap water (27%). All optometrists surveyed claimed to provide advice to patients in either written or verbal format for new and returning contact lens users. 49% (16/33) of optometrists gave written advice to patients on initial contact lens fitting, but only 1/33 continued with written advice for repeat customers. Conclusion: This study identified that although most patients were informed of appropriate hygiene requirements, compliance was poor. Optometrists regularly provide verbal advice but do not routinely offer written support and there is a mismatch between patient recollection and self-reported optometrist practice. It is suggested that patient education needs greater emphasis and both verbal and written information should be regularly provided on initial review and follow up assessments.
Keywords: bath; contact lens; tap water; adult; article; cleaning; counseling; experience; female; human; hygiene; keratitis; major clinical study; male; optometrist; patient compliance; patient education; priority journal; Scotland; sleep; swimming; university hospital

Visual impairment and unmet eye care needs among a Syrian adult refugee population in a Canadian city - Bin Yameen, T.A.; Abadeh, A.; Slomovic, J.; Lichter, M. (Canadian Journal of Ophthalmology, 2020)
Objective: To assess the prevalence of visual impairment and unmet eye care needs of the Syrian adult refugee population in Canada. Design: Cross-sectional descriptive study. Participants: Enrolment was offered to all Syrian refugees 18 years or older, with 248 patients enrolled. Methods: Five clinics were organized from July 2016 to November 2017 in Toronto, Ontario. A vision screening and dilated retinal examination was performed on all participants. Prevalence of visual impairment and nonrefractive pathologies as well as information on sociodemographics and subjective visual acuity were obtained. Results: The mean age of participants was 36 years (interquartile range, 30–35) and 53% were females. The prevalence of reported uncorrected vision problems was 22.2% for distance vision, 6.5% for near vision, and 5.6% for both distance and near vision, including loss of vision. Compared with the Canadian population, Syrian adult refugees were 19.04 times more likely to report uncorrected vision problems (34.4% vs 1.8%, p < 0.01). The presenting visual acuity in the better-seeing eye was 20/50 or worse in 19.4%. Pinhole improved this to 12.5% (95% confidence interval [CI], 8.7%–17.3%). Compared with the Canadian population (0.95%), Syrian adult refugees were 13 times more likely to have 20/50 vision or worse (p < 0.01). The most common finding was refractive error in 46.0% (95% CI, 39.6%–52.4%) followed by nonrefractive error in 30.2% (95% CI, 24.9%–36.2%). Conclusions: This is the first study to assess ocular health in a refugee population in Canada. Syrian adult refugees have a high prevalence of visual impairment, even when living within a system of universal health care.
Keywords: spectacles; adult; age related macular degeneration; article; Canada; Canadian; cataract; cross-sectional study; descriptive research; diabetic retinopathy; eye care; eye examination; eye injury; female; glaucoma; health care access; health care need; human; hypermetropia; major clinical study; male; myopia; presbyopia; refraction error; refugee; retinitis pigmentosa; Syrian; vision test; visual acuity; visual impairment; young adult

Intraocular pressure reduction with once-a-day application of a new prostaglandin eye drop: a pilot placebo-controlled study in 12 patients - Caruso, C.; Pacente, L.; Troiano, P.; Ostacolo, C.; D’Andrea, L.; Bartollino, S.; Costagliola, C. (International Ophthalmology, 2020)
Purpose: To assess the ocular hypotensive effect of 15-keto fluprostenol, the oxidized metabolite of travoprost, on glaucoma patients, through a randomized double-masked placebo-controlled study. Methods: Twelve patients with ocular normal tension glaucoma (NTG) (intraocular pressure [IOP] < 22 mmHg) were enrolled. In order to ensure patient compliance to treatment, all study subjects were hospitalized. In each patient, the eye to be submitted to the treatments was randomly chosen. After hospital admission (day 1), those patients received for 5 days at 8 P.M. either one drop of 15-keto fluprostenol (35 μg/ml) or one drop of placebo. IOP evaluation was performed within 8 A.M. and 8 P.M. for 6 days. Furthermore, we performed a determination of cardiovascular parameters before and after the treatments. Results: Starting with the first IOP measurement after the first treatment (8 A.M. on day 2), IOP was reduced of about 14% in the eyes treated 15-keto fluprostenol, in comparison with baseline IOP values of 15-keto fluprostenol-treated patients. The IOP reduction in the 15-keto fluprostenol-treated group was significantly compared to placebo group (p < 0.05) starting from day 3 till day 6 of the study. Except for mild hyperemia in one 15-keto fluprostenol-treated eye, no other side effects were observed or reported by the enrolled patients. Conclusions: The travoprost metabolite 15-keto fluprostenol was effective in decrease IOP and maintained IOP reduction along 5 days of treatment. The 15-keto fluprostenol can be developed as a good candidate for once-a-day NTG patients’ treatment.
Keywords: eye drops; fluprostenol; placebo; adult; aged; article; cardiovascular parameters; clinical article; controlled study; evening dosage; female; hospital admission; hospitalization; human; hyperemia; intraocular pressure; low tension glaucoma; male; patient compliance; pilot study; randomized controlled trial; therapy effect; treatment duration

Clinical utility of genetic testing in 201 preschool children with inherited eye disorders - Lenassi, E.; Clayton-Smith, J.; Douzgou, S.; Ramsden, S.C.; Ingram, S.; Hall, G.; Hardcastle, C.L.; Fletcher, T.A.; Taylor, R.L.; Ellingford, J.M.; Newman, W.D.; Fenerty, C.; et al. (Genetics in Medicine, 2020)
Purpose: A key property to consider in all genetic tests is clinical utility, the ability of the test to influence patient management and health outcomes. Here we assess the current clinical utility of genetic testing in diverse pediatric inherited eye disorders (IEDs). Methods: Two hundred one unrelated children (0–5 years old) with IEDs were ascertained through the database of the North West Genomic Laboratory Hub, Manchester, UK. The cohort was collected over a 7-year period (2011–2018) and included 74 children with bilateral cataracts, 8 with bilateral ectopia lentis, 28 with bilateral anterior segment dysgenesis, 32 with albinism, and 59 with inherited retinal disorders. All participants underwent panel-based genetic testing. Results: The diagnostic yield of genetic testing for the cohort was 64% (ranging from 39% to 91% depending on the condition). The test result led to altered management (including preventing additional investigations or resulting in the introduction of personalized surveillance measures) in 33% of probands (75% for ectopia lentis, 50% for cataracts, 33% for inherited retinal disorders, 7% for anterior segment dysgenesis, 3% for albinism). Conclusion: Genetic testing helped identify an etiological diagnosis in the majority of preschool children with IEDs. This prevented additional unnecessary testing and provided the opportunity for anticipatory guidance in significant subsets of patients.
Keywords: albinism; anticipatory guidance; article; bilateral ocular anterior segment dysgenesis; cataract; child; childhood disease; cohort analysis; diagnostic value; disease surveillance; ectopia lentis; eye disease; female; genetic disorder; genetic screening; glaucoma; health care utilization; human; infant; major clinical study; male; newborn; personalized medicine; retina disease; retrospective study

Rates and determinants of eyecare utilization and eyeglass affordability among individuals with visual impairment in a multi-ethnic population-based study in singapore - Gupta, P.; Majithia, S.; Fenwick, E.K.; Gan, A.T.L.; Tham, Y.-C.; Poh, S.; Thakur, S.; Sabanayagam, C.; Wong, T.Y.; Cheng, C.-Y.; Lamoureux, E.L. (Translational Vision Science and Technology, 2020)
Purpose: The purpose of this study was to determine the rates of, and factors associated with, eyecare utilization and spectacle affordability among Singaporeans with vision impairment (VI). Methods: We included adults with VI from their second visit of the Singapore Epidemiology of Eye Disease Study. Data on eyecare utilization and spectacle affordability were collected. Low eyecare utilization was defined as no eye check ever or eye checks not even once per year in reference to at least once per year. Difficulty affording glasses was defined as glasses being rated as expensive in reference to not expensive. Results: There were 985 adults (14.5%; 415 Malays, 260 Indian, and 310 Chinese; mean age [SD]: 69.5 [10.2] years; 55.4% women) with VI who answered the above questions, were included. Of these, 624 (63.4%) wore glasses. The rates of low eyecare utilization and difficulty affording eyeglasses were 31% and 63%, respectively. Compared to Chinese (23.8%) and Indians (18.8%), Malays (57.4%) had the highest rates of low eyecare utilization (P < 0.001), and most difficulty affording eyeglasses (47.2% vs. 26.1% and 26.6% in Chinese and Indians, respectively; P < 0.001). Younger age, low socioeconomic status, absence of diabetes, absence of self-reported eye conditions, and poor vision were independently associated with low eyecare utilization, whereas older age and female sex was associated with difficulty affording glasses. Conclusions: In this multi-ethnic population with VI, almost one-third had low eyecare utilization and nearly two-thirds reported difficulty affording eyeglasses. Translational Relevance: This will inform strategies, such as tailored eyecare utilization awareness campaigns and awareness of available subsidy schemes for at-risk Singapore-ans, such as Malays.
Keywords: adult; age related macular degeneration; aged; article; best corrected visual acuity; cross-sectional study; diabetes mellitus; ethnic group; eye care professional; eye examination; female; follow up; glaucoma; health care utilization; health insurance; human; intraocular pressure; low vision; major clinical study; male; mass screening; population research; prevalence; public health; quality of life; questionnaire; risk factor; Singapore; socioeconomics; United States; visual acuity; visual impairment

Treatment of Open-Angle Glaucoma and Ocular Hypertension with Preservative-Free Tafluprost/Timolol Fixed-Dose Combination Therapy: The VISIONARY Study - Oddone, F.; Tanga, L.; Kóthy, P.; Holló, G.; Faschinger, C.; Chen, E.; Holló, G.; Nemeth, G.; Bator, G.; Tsorbatzoglou, A.; Acs, T.; Ferencz, M.; et al. (Advances in Therapy, 2020)
Introduction: A non-interventional, multicenter, European, prospective evaluation of the effectiveness, tolerability, and safety of a topical preservative-free tafluprost (0.0015%) and timolol (0.5%) fixed-dose combination (PF tafluprost/timolol FC) in adults with open-angle glaucoma (OAG) and ocular hypertension (OHT) demonstrating insufficient response to topical beta-receptor blockers or prostaglandin analogue (PGA) monotherapy. Methods: Mean intraocular pressure (IOP) change from baseline was measured at study visits following a switch to PF tafluprost/timolol FC. Primary endpoint was absolute mean IOP change at month 6. Change from baseline concerning ocular signs and symptoms was also explored. Results: Analyses included 577 patients (59.6% female). Mean age (SD) was 67.8 (11.67) years. Mean (SD) IOP reduction from baseline was significant at all study visits; 5.4 (3.76) mmHg (23.7%) at week 4, 5.9 (3.90) mmHg (25.6%) at week 12, and 5.7 (4.11) mmHg (24.9%) at month 6 (p < 0.0001 for all visits). At month 6, 69.2%, 53.6%, 40.0%, and 25.8% were responders based on ≥ 20%, ≥ 25%, ≥ 30%, and ≥ 35% cutoff values for mean IOP, respectively. Significant reductions were observed concerning corneal fluorescein staining (p < 0.0001), dry eye symptoms, irritation, itching, and foreign body sensation (p < 0.001 for each parameter). Conjunctival hyperemia was significantly reduced at all study visits (p < 0.0001 at each visit). Overall, 69 treatment-related adverse events (AEs) were reported, one of which was serious (status asthmaticus). Most AEs were mild to moderate in severity, and the majority had resolved or were resolving at the end of the study period. Conclusion: In clinical practice, PF tafluprost/timolol FC provided statistically and clinically significant IOP reductions in patients with OAG and OHT insufficiently controlled on or intolerant to PGA or beta-receptor blocker monotherapy. The full IOP reduction appeared at week 4 and was maintained over the 6-month study period. Key symptoms of ocular surface health improved. Trial Registration: European Union electronic Register of Post-Authorisation Studies (EU PAS) register number, EUPAS22204.
Keywords: bimatoprost; latanoprost; tafluprost; tafluprost plus timolol; travoprost; adult; aged; article; asthma; asthmatic state; atrioventricular block; best corrected visual acuity; blepharitis; blurred vision; bradycardia; clinical practice; conjunctival hyperemia; conjunctivitis; controlled study; disease severity; dizziness; drug contraindication; drug efficacy; drug safety; drug tolerability; dry eye; evening dosage; eye discharge; eye discomfort; eye irritation; eye pain; eyelash; eyelid edema; eyelid erythema; eyelid pruritus; fatigue; female; foreign body; headache; heart palpitation; human; hyperpigmentation; hypersensitivity; intraocular hypertension; intraocular pressure; keratitis; lacrimation disorder; major clinical study; male; monotherapy; morning dosage; multicenter study; observational study; open angle glaucoma; patient assessment; patient compliance; prospective study; rash; thorax pain; treatment duration

The Association between Medication Adherence and Visual Field Progression in the Collaborative Initial Glaucoma Treatment Study - Newman-Casey, P.A.; Niziol, L.M.; Gillespie, B.W.; Janz, N.K.; Lichter, P.R.; Musch, D.C. (Ophthalmology, 2020)
Purpose: To evaluate the relationship between medication adherence and visual field progression in participants randomized to the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS). Design: The CIGTS was a randomized, multicenter clinical trial comparing initial treatment with topical medications to trabeculectomy for 607 participants with newly diagnosed glaucoma. Participants: Three hundred seven participants randomized to the medication arm of the CIGTS. Methods: Participants were followed up at 6-month intervals for up to 10 years. Self-reported medication adherence and visual fields were measured. Medication adherence was assessed by telephone from responses to the question, “Did you happen to miss any dose of your medication yesterday?” The impact of medication adherence on mean deviation (MD) over time was assessed with a linear mixed regression model adjusting for the effects of baseline MD and age, cataract extraction, interactions, and time (through year 8, excluding time after crossover to surgery). Medication adherence was modeled as a cumulative sum of the number of prior visits where a missed dose of medication was reported. Main Outcome Measure: Mean deviation over time. Results: Three hundred seven subjects (306 with adherence data) were randomized to treatment with topical medications and followed up for an average of 7.3 years (standard deviation, 2.3 years). One hundred forty-two subjects (46%) reported never missing a dose of medication over all available follow-up, 112 patients (37%) reported missing medication at up to one third of visits, 31 patients (10%) reported missing medication at one third to two thirds of visits, and 21 patients (7%) reported missing medication at more than two thirds of visits. Worse medication adherence was associated with loss of MD over time (P = 0.005). For subjects who reported never missing a dose of medication, the average predicted MD loss over 8 years was 0.62 dB, consistent with age-related loss (95% confidence interval [CI], 0.17–1.06; P = 0.007); subjects who reported missing medication doses at one third of visits had a loss of 1.42 dB (95% CI, 0.86–1.98; P < 0.0001); and subjects who reported missing medication doses at two thirds of visits showed a loss of 2.23 dB (95% CI, 1.19–3.26; P < 0.0001). Conclusions: This longitudinal assessment demonstrated a statistically and clinically significant association between medication nonadherence and glaucomatous vision loss.
Keywords: NCT00000149; antiglaucoma agent; adult; age; aged; cataract extraction; clinical evaluation; conference paper; disease exacerbation; female; follow up; human; longitudinal study; major clinical study; male; medication compliance; multicenter study (topic); open angle glaucoma; patient compliance; priority journal; randomized controlled trial (topic); self report; telephone interview; time; topical treatment; trabeculectomy; treatment refusal; visual field; visual impairment

Glaucoma Care of Prison Inmates at an Academic Hospital - Kanu, L.N.; Jang, I.; Oh, D.J.; Tiwana, M.S.; Mehta, A.A.; Dikopf, M.S.; Vajaranant, T.S.; Aref, A.A.; Edward, D.P. (JAMA Ophthalmology, 2020)
Importance: Glaucoma care for prison inmates is underrepresented in the literature even though managing the treatment of such patients may provide unique challenges. Objectives: To evaluate the glaucoma profile of prison inmates treated at an academic ophthalmology center and to report on the medical and surgical management and follow-up metrics. Design, Setting, and Participants: This retrospective cohort study assessed data from 82 incarcerated patients treated at the glaucoma clinic, an academic referral center at the University of Illinois at Chicago, between January 2013 and December 2017. Main Outcomes and Measures: Diagnosis, glaucoma severity, medical and surgical interventions, and patient-reported medication adherence were recorded for each visit. Recommended and actual follow-up times were recorded and compared. Data analyses were conducted from January 2013 to December 2018. Results: In total, 82 patients (161 eyes) had 375 visits during the study period. All patients were male and ranged from 20 to 75 years of age (mean [SD] age, 50.8 [11.9] years). Most participants were black patients (65 [79.3%]). The most common diagnoses were primary open-angle glaucoma (POAG; 53 eyes [32.9%]) and POAG suspect (52 eyes [32.3%]). Glaucoma severity ranged from mild (25 of 77 eyes [32.5%]) to advanced (41 of 77 eyes [53.2%]). Overall, 59 patients (73.2%) were treated medically with up to 4 topical agents (40.0%). Of those treated, 70.0% of patients (95% CI, 57.7%-81.2%) reported medication nonadherence during at least 1 visit. Medication nonadherence was more common among those taking 4 different topical medications (21 of 24 [87.5%]) compared with others taking fewer medications (20 of 35 [57.1%]), for a difference of 30.4% (95% CI, 7.0%-53.6%; P =.02), and among those with advanced disease (22 of 26 [84.6%]) compared with glaucoma suspect (6 of 13 [46.2%]), for a difference of 38.4% (95% CI, 9.3%-67.5%; P =.02). Nineteen office procedures, including laser peripheral iridotomy and laser trabeculoplasty, were performed on 14 eyes. Seventeen incisional glaucoma procedures were performed on 15 eyes, including glaucoma drainage device implant (11 procedures [64.7%]) and trabeculectomy (3 procedures [17.6%]). Only 26.6% of return office visits (95% CI, 21.3%-32.3%) occurred within the recommended follow-up time frame. Furthermore, 93 patients (34.8%; 95% CI, 28.2%-40.0%) were seen more than 1 month after the recommended follow-up. Conclusions and Relevance: Despite incarceration in prison, where medication administration and appointment attendance are theoretically controlled, the results of this study suggested that substantial medication and follow-up nonadherence exists among inmates.
Keywords: cyclophotocoagulation laser; glaucoma drainage implant; acetazolamide; antiglaucoma agent; methazolamide; topical agent; adult; aged; article; cataract extraction; cohort analysis; disease severity; follow up; human; iridotomy; laser surgery; low tension glaucoma; major clinical study; male; medication compliance; open angle glaucoma; patient compliance; primary glaucoma; priority journal; prisoner; retrospective study; trabeculectomy; trabeculoplasty

Development and internal validation of a multimorbidity index that predicts healthcare utilisation using the Canadian Longitudinal Study on Aging - Wang, Z.; Boulanger, L.; Berger, D.; Gaudreau, P.; Marrie, R.A.; Potter, B.; Wister, A.; Wolfson, C.; Lefebvre, G.; Sylvestre, M.-P.; Keezer, M. (BMJ Open, 2020)
Objectives We aimed to develop and internally validate a measure of multimorbidity burden using data from the Canadian Longitudinal Study on Aging (CLSA). Design Data from 40 264 CLSA participants (52% men) aged 45-85 years (a mean of 63 years) were analysed. We used logistic regression models to predict overnight hospitalisation in the last 12 months in the development dataset (random two-thirds of the total) and used these to construct 10 multimorbidity indices (5 models, each treated with and without an age interaction term). Thirty-five chronic conditions were considered for inclusion in these models, in addition to age and sex. We assessed predictive and convergent validity for these 10 different multimorbidity indices in the validation dataset (remaining one-third of the total). Results The absolute count of chronic conditions plus an interaction with age, displayed strong calibration properties, outperforming other candidate indices. Discrimination was modest for all of the indices that we internally validated, with C-statistics ranging from 0.66 to 0.68. The indices showed weak correlations (ie, convergent validity) with satisfaction with life, functional disability and mental health (absolute Pearson's correlation coefficients ranging from 0.11 to 0.30) but generally moderate correlations with self-rated general health (0.32-0.45). Conclusions We investigated alternative methods to measure the multimorbidity burden of individuals, tailored to the CLSA. Our findings show that an absolute count of conditions, along with an age interaction term, has the strongest calibration for overnight hospitalisation in the last 12 months. The utility of an age interaction term in measuring multimorbidity burden may be applicable to the study of chronic disease in cohorts other than the CLSA.
Keywords: adult; age distribution; aged; aging; allergy; angina pectoris; anxiety disorder; article; asthma; cataract; cerebrovascular accident; chronic obstructive lung disease; cohort analysis; controlled study; convergent validity; correlational study; current smoker; daily life activity; diabetes mellitus; digestive system ulcer; disease burden; enteropathy; epilepsy; female; glaucoma; health care utilization; heart disease; heart infarction; human; hypertension; hyperthyroidism; hypothyroidism; internal validity; kidney disease; longitudinal study; macular degeneration; major clinical study; male; mental health; migraine; mood disorder; multiple chronic conditions; multiple sclerosis; osteoporosis; Parkinson disease; patient satisfaction; peripheral vascular disease; rheumatoid arthritis; Satisfaction with Life Scale; skin cancer; transient ischemic attack

Dexamethasone Implant Produces Better Outcomes than Oral Acetazolamide in Patients with Cystoid Macular Edema Secondary to Retinitis Pigmentosa - Veritti, D.; Sarao, V.; De Nadai, K.; Chizzolini, M.; Parmeggiani, F.; Perissin, L.; Lanzetta, P. (Journal of Ocular Pharmacology and Therapeutics, 2020)
Purpose: To compare the clinical outcome of intravitreal dexamethasone implant versus oral acetazolamide in patients with cystoid macular edema (CME) secondary to retinitis pigmentosa (RP). Design: Multicenter, prospective, propensity-score-matched, comparative study. Methods: Eyes with RP and CME were treated either with intravitreal dexamethasone implant or with oral acetazolamide (500 mg/day). Patients were evaluated monthly and followed up for 12 months. Primary outcome measures were changes in central retinal thickness and best corrected visual acuity (BCVA). Adverse events were recorded. Results: Propensity score matching resulted in 2 groups of 30 eyes each. All patients completed 12 months of follow-up. Mean central retinal thickness decreased from 535 μm at baseline to 208 μm at month 12 in the dexamethasone implant group and from 519 to 339 μm in the oral acetazolamide group (P < 0.001, Student's t-test). Mean BCVA average change from baseline during the study (area-under-the-curve approach) was -0.084 logarithm of the minimum angle of resolution (logMAR) (+4.2 letters) in the dexamethasone implant group and -0.032 (+1.6 letters) in the oral acetazolamide group (P < 0.05, Mann-Whitney U test). Patients in the dexamethasone implant group required on average 1.7 treatments during 1 year of therapy. Conclusions: In this study, intravitreal dexamethasone implant produced better anatomic and functional improvements over oral acetazolamide in patients affected by CME secondary to RP. Larger, randomized clinical trials with longer follow-up are warranted to confirm these data.
Keywords: drug implant; acetazolamide; dexamethasone; adult; article; best corrected visual acuity; cataract; cataract extraction; central retinal thickness; clinical article; clinical outcome; comparative effectiveness; drug dosage form comparison; female; follow up; human; intraocular hypertension; male; medication compliance; multicenter study; patient compliance; propensity score; prospective study; retina macula cystoid edema; retinitis pigmentosa; ozurdex

The relationship between patient proximity to postoperative follow-up care and long-term glaucoma surgery outcomes - Funk, I.; Strelow, B.; Van Buren, E.; Lin, F.; Fleischman, D. (Journal of the American Geriatrics Society, 2020)
Background: Surgical glaucoma interventions such as trabeculectomy and tube shunt implantations require frequent follow-up to assess for function, evolution, and complications. Current guidelines attribute long-term surgical success to strict follow-up adherence but lack recommendations considering potential patient barriers to follow-up care. Methods: Retrospective longitudinal chart review of non-institutionalized adult glaucoma patients with trabeculectomy or drainage device implantations from April 4, 2014 to December 31, 2018. Straight-line distances from patients' residences to the UNC-Chapel Hill Kittner Eye Center were measured to create radii of incidence of postoperative complications measured by: number of corrective surgeries, visual fields, and visual acuity. Straight-line distance from residence to nearest interstate access categorized patients' rurality. Canceled appointments were noted. Means were compared via two-tailed Student's t-test and logistical regression analyses were performed to determine odds ratios (OR). Results: 203 patients met inclusion criteria. 6-months postoperatively, patients residing >50 miles from the Kittner Eye Center had significantly more cancellations (t(143) = 3.39, p < .001, MD = 1.050, p < .001 95% CI 0.44-1.66), higher rates of loss to follow-up (t(143) = 2.78, p < .01, MD = 23%, p < 0.01, 95% CI 0.071-0.389) and more worsened visual fields (t(143) = 2.14, p < .05, MD = 0.20, p < .05, 95% CI 0.021-0.380) than patients ≤25 miles from clinic. Significantly more patients >20 miles from interstate access were lost to follow-up compared to those ≤10 miles away (p < .001). Regression revealed that patients >50 away were 3.92 times more likely to be lost to follow up (OR 3.92 95% CI 1.46-10.44), and had increased OR of having worsened postoperative visual fields (OR 2.64 95% CI 1.14-4.49). Conclusions: Greater distance from clinic and interstate access is associated with higher rates of loss to follow-up and worsened visual field outcomes. Rural patients may be at higher risk for negative outcomes due to a paucity of convenient ophthalmic care. Glaucoma specialists should consider patients' distance from clinic when choosing a surgical intervention that requires frequent postoperative evaluations. .
Keywords: adult; complication; conference abstract; controlled study; female; follow up; glaucoma surgery; human; implantation; incidence; major clinical study; male; medical record review; plastic surgery; postoperative complication; retrospective study; surgery; trabeculectomy; visual acuity; visual field

Intra-articular facet joint steroid injection–related adverse events encountered during 11,980 procedures - Kim, B.R.; Lee, J.W.; Lee, E.; Kang, Y.; Ahn, J.M.; Kang, H.S. (European Radiology, 2020)
Objectives: To analyze the incidence and characteristics of intra-articular facet joint injection (FJI)–related adverse events requiring hospitalization and emergency room visits. Methods: From January 2007 to December 2017, a total of 11,980 FJI procedures in 6066 patients (mean age 66.8 years, range 15–97 years, M:F = 2004:4062) were performed in our department. Of these, we retrospectively reviewed 489 cases in 432 patients who were hospitalized or visited the emergency room within a month of FJI. FJI-related adverse events were classified as procedure-related complications, drug-related systemic events, or uncertain etiology events, on the basis of consensus of two spine radiologists. This is a descriptive study without statistical analysis. Results: There were 101 FJI-related adverse event cases in 99 patients (mean age 71.8 years, range 39–97 years, M:F = 39:60). The overall incidence of FJI-related adverse events was 0.84% (101/11,980) per case and 1.63% (99/6066) per patient. The incidence of procedure-related complications and drug-related systemic adverse events was 0.07% (8/11,980) and 0.15% (18/11,980), respectively; the rate of uncertain etiology events was 0.63% (75/11,980). All eight procedure-related complication cases involved major complications. There are seven cases of infectious spondylitis and one was progression of systemic aspergillosis to the spine. One patient died of an uncontrolled infection with infective endocarditis, and two patients experienced partial recovery with neurological sequelae. Conclusions: The overall incidence of FJI-related adverse events is low, and procedure-related major complications are rare without dural puncture or epidural hematoma. Nevertheless, infection can occur, resulting in serious outcomes. Key Points: • The incidence of FJI-related adverse events requiring hospitalization or ER visit was 0.84%. • The incidence of major procedure-related complications was 0.07%. • All major complications were associated with infection and there were no cases of epidural hematoma.
Keywords: Integris Allura Xper FD 20; antibiotic agent; antifungal agent; iohexol; rivaroxaban; ropiva; ropivacaine; steroid; tamceton; triamcinolone acetonide; adolescent; adult; adverse event; aged; antibiotic therapy; antifungal therapy; arthrography; article; atrial fibrillation; backache; bacteremia; bacterial endocarditis; bone infection; compression fracture; consensus; depression; descriptive research; disease exacerbation; dizziness; emergency ward; epidural abscess; epidural hematoma; erosive gastritis; facet joint injection; female; fungal endophthalmitis; gastric ulcer bleeding; gastrointestinal symptom; glaucoma; health care utilization; heart failure; hematoma; hospitalization; human; hyperglycemia; hypertension; incidence; infectious arthritis; injection; injection site reaction; invasive aspergillosis; leg pain; limb weakness; lower limb; lung aspergillosis; major clinical study; male; mental disease; musculoskeletal radiologist; nausea and vomiting; nuclear magnetic resonance imaging; paraspinal muscle; pneumonia; priority journal; procedural pain; procedural site reaction; psoas abscess; retrospective study; spine; spine fracture; spine radiography; spondylitis; systemic mycosis; urticaria; vertebra body; vertigo; very elderly; iohexol; ropiva; tamceton; xarelto; Integris Allura Xper FD 20

Comment on: Trends in Retina Specialist Imaging Utilization From 2012 to 2016 in the United States Medicare Fee-for-Service Population - Pontikos, N.; Wagner, S.K.; Balaskas, K.; Faes, L.; Kortuem, K.; Fasler, K.; Keane, P.A. (American Journal of Ophthalmology, 2020)
Keywords: cataract; clinical practice; European; glaucoma; health care utilization; human; letter; medical fee; medical specialist; medicare; national health service; optical coherence tomography; patient care; population research; priority journal; retina examination; trend study; United States

Work tool-related eye injuries: Helsinki Ocular Trauma Study - Sahraravand, A.; Haavisto, A.-K.; Puska, P.; Leivo, T. (International Ophthalmology, 2020)
Purpose: To quantify and characterize the epidemiology, treatments, long-term outcome, and use of resources for work tool-related eye injuries and their severity. Methods: We included all new patients with a work tool-related eye injury treated at the Helsinki University Eye Hospital in 1 year. The data were from hospital records, examinations, and patient questionnaires. The follow-ups were at 3 months and 6 years. Results: Work tools caused 3% (37/1151) of all eye injuries. The mean age was 37 and 84% were men. Most injuries (84%) occurred at work (17) or at home (15). There were 14 minor injuries, 12 contusions, 9 open globe injuries (OGI), and 2 eyelid wounds. The annual incidence of work tool-related eye injuries was 2.4/100,000 and hospitalization 0.6/100,000. At 6-year follow-up, we re-examined 18 patients and 17 were interviewed by phone. Four patients were blinded. We recorded 690 sick leave days and 43 major operations. No traumatic glaucoma was diagnosed. Fifteen patients needed lifelong follow-up. Permanent impairment occurred in 30% (11) of work tool-related eye injuries, from whom, nine were caused by manual tools. Work tools comprised 10% of the permanently impaired, but 2.5% of the non-permanently impaired cases among all eye injuries (1151). Conclusion: The proportional difference between the permanently impaired and the non-permanently impaired was higher in work tool-related eye injuries than other causes reported in previous Helsinki Ocular Trauma Studies. High-risk injuries were mainly caused by manual tools and nails and resulted in OGI.
Keywords: brush; electrical cord; general device; hammer; knife; knob; pliers; plunger; rake; screw; screwdriver; steel wire; tent pole; wrench; accident prevention; adult; article; clinical article; controlled study; contusion; eye injury; eyelid disease; female; follow up; health care utilization; high risk patient; hospitalization; human; incidence; injury severity; male; occupational accident; outcome assessment; telephone interview; tool use; work tool related eye injury

Smartphone-assisted glaucoma screening in patients with type 2 diabetes: A pilot study - Bilong, Y.; Domngang, C.N.; Nwanlih, G.G.; Katte, J.-C.; Afetane, T.E.; Kagmeni, G.; Mbanya, J.C.; Kumar, N.; Sharma, A.; Sobngwi, E. (Medical Hypothesis, Discovery, and Innovation in Ophthalmology, 2020)
We aimed to determine true and false positives of glaucoma screening, relying solely on photos of the retina, taken with a smartphone. We performed a descriptive and analytical study on patients with type 2 diabetes at the National Obesity Centre, Yaoundé, Cameroon. Participating patients had retinal photography sessions using an iPhone 5s (iOS 10.3.3; Apple, Cupertino, CA) coupled to the Make in India Retinal Camera (MIIRetCam; MIIRetCam Inc., Coimbatore, TN, India). Obtained pictures of the retina were stored and transferred via the internet to an ophthalmologist to assess glaucoma. Selected patients were then invited to undergo a conventional ophthalmological examination to confirm the diagnosis. A total of 395 patients were screened, 39 (including 20 women) were diagnosed with suspicion of glaucoma based on retinal photos, a prevalence rate of 9.87%. The following signs were found; Cup/Disc ratio (C/D) ≥0.5 in 64.1% (25/39), asymmetric C/D >0.2 in 35.9% (14/39), papillary haemorrhage in 10.2% (4/39) and retinal nerve fibre deficiency in 2.5% (1/39). Only 14 of 39 patients with suspicion of glaucoma were examined, giving a lost-to-follow-up rate of 64.1%. Chronic open-angle glaucoma was confirmed in 8 patients (true positives) and absent in 6 patients (false positives). The prevalence of smartphone-detected glaucoma and lost-to-follow-up rates were high. So we need to improve this type of screening, with additional tests like transpalpebral applanation tonometer and the smartphone Frequency Doubling Technique visual field combined with better education of patients to increase their adherence to follow-up.
Keywords: iOS 10.3.3; ophthalmic camera; smartphone; article; best corrected visual acuity; female; follow up; glaucoma; human; intraocular pressure; major clinical study; male; non insulin dependent diabetes mellitus; ophthalmologist; optical coherence tomography; pachymetry; pilot study; tonometry; virus genome; visual acuity; visual field; visual system examination; iOS 10.3.3

A Canadian Cost-Utility Analysis of 2 Trabecular Microbypass Stents at Time of Cataract Surgery in Patients with Mild to Moderate Open-Angle Glaucoma - Ahmed, I.I.K.; Podbielski, D.W.; Patel, V.; Falvey, H.; Murray, J.; Botteman, M.; Goeree, R. (Ophthalmology Glaucoma, 2020)
Purpose: To assess, from the Canadian public payer perspective, the cost-utility of implanting iStent Inject trabecular bypass stent (TBS) devices in conjunction with cataract surgery versus cataract surgery alone in patients with open-angle glaucoma (OAG) and visually significant cataract. Design: Cost-utility analysis using efficacy and safety results of pivotal randomized clinical trial. Participants: Modeled cohort of patients with OAG (83.1% with mild disease, 16.9% with moderate disease) and visually significant cataract. Methods: Open-angle glaucoma treatment costs and effects were projected over a 15-year time horizon using a Markov model with Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, severe or blind) and death as health states. Patients in the mild or moderate OAG health states received implantation of iStent Inject during cataract surgery versus cataract surgery alone. On worsening of visual field defect and optic disc damage, patients could receive selective laser trabeculoplasty and trabeculectomy. We measured treatment effect as reduction in intraocular pressure (IOP) and mean medication use and estimated transition probabilities based on efficacy-adjusted visual field mean deviation decline per month. Healthcare resource utilization and utility scores were obtained from the literature. Cost inputs (2017 Canadian dollars [C$]) were derived using the Ontario Health Insurance Plan, expert opinion, medication claims datasets, and Ontario Drug Benefit Formulary medication consumption costs. We conducted deterministic and probabilistic sensitivity analyses to examine the impact of alternative model input values on results. Main Outcome Measures: Incremental cost per quality-adjusted life year (QALY) gained. Results: Compared with cataract surgery alone, TBS plus cataract surgery showed a 99% probability of being more effective (+0.023 QALYs; 95% confidence interval [CI], 0.004 to 0.044) and a 73.7% probability of being cost-saving (net cost, –C$389.00; 95% CI, –C$1712.00 to C$850.70). In 95% of all simulations, TBS plus cataract surgery showed a cost per QALY of C$62 366 or less. Results were robust in additional sensitivity and scenario analyses. Conclusions: iStent Inject TBS implantation during cataract surgery seems to be cost effective for reducing IOP in patients with mild to moderate OAG versus cataract surgery alone.
Keywords: glaucoma drainage implant; bimatoprost; brimonidine; brimonidine plus brinzolamide; brimonidine plus timolol; brinzolamide; brinzolamide plus timolol; dorzolamide; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; levobunolol; timolol; timolol plus travoprost; travoprost; vistitan; aged; Canada; cataract; cataract extraction; clinical effectiveness; cohort analysis; conference paper; cost control; cost utility analysis; cross-sectional study; death; device safety; disease exacerbation; disease severity; drug use; eye injury; health care utilization; health insurance; human; implantation; medical expert; open angle glaucoma; optic disk; priority journal; probability; quality adjusted life year; scoring system; sensitivity analysis; simulation; trabeculectomy; trabeculoplasty; visual field defect; alphagan; azarga; azopt; betagan; combigan; cosopt; duotrav; lumigan; simbrinza; trusopt; vistitan; xalacom; xalatan; iStent

Glaucoma screening: Where are we and where do we need to go? - Tan, N.Y.Q.; Friedman, D.S.; Stalmans, I.; Ahmed, I.I.K.; Sng, C.C.A. (Current Opinion in Ophthalmology, 2020)
Purpose of review Current recommendations for glaucoma screening are decidedly neutral. No studies have yet documented improved long-term outcomes for individuals who undergo glaucoma screening versus those who do not. Given the long duration that would be required to detect a benefit, future studies that may answer this question definitively are unlikely. Nevertheless, advances in artificial intelligence and telemedicine will lead to more effective screening at lower cost. With these new technologies, additional research is needed to determine the costs and benefits of screening for glaucoma. Recent findings Using optic disc photographs and/or optical coherence tomography, deep learning systems appear capable of diagnosing glaucoma more accurately than human graders. Eliminating the need for expert graders along with better technologies for remote imaging of the ocular fundus will allow for less expensive screening, which could enable screening of individuals with otherwise limited healthcare access. In India and China, where most glaucoma remains undiagnosed, glaucoma screening was recently found to be cost-effective. Summary Recent advances in artificial intelligence and telemedicine have the potential to increase the accuracy, reduce the costs, and extend the reach of screening. Further research into implementing these technologies in glaucoma screening is required.
Keywords: artificial intelligence; China; clinical effectiveness; cost benefit analysis; deep learning; diagnostic procedure; eye fundus; glaucoma; health care access; human; India; medical technology; optical coherence tomography; priority journal; review; screening test; telemedicine

Assessing health care burden in glaucoma patients with and without physical or mental comorbidities - Serbin, M.; Devine, B.; Campbell, J.; Basu, A. (Journal of Managed Care and Specialty Pharmacy, 2020)
BACKGROUND: Glaucoma is a collection of eye diseases that damage the eye's optic nerve resulting in vision loss and blindness. Treatment for glaucoma is primarily pharmacologic; however, studies have shown patients have difficulty adhering to topical regimens. The reasons for potentially poor adherence are numerous, including influence from a myriad of either physical or mental comorbid conditions faced by many glaucoma patients. Neither adherence nor associated outcomes have been estimated in these 2 groups of glaucoma patients. OBJECTIVES: To (a) characterize glaucoma patients with and without select physical or mental comorbidities and (b) estimate differences between the 2 groups for 3 types of outcomes: health care resource use (HCRU; office-based/outpatient-based provider visits, emergency room visits, inpatient stays, home health provider days, prescription fills); health care expenditures; and health-related quality of life (HRQoL) as measured by the physical and mental component scores of the Short Form-12. METHODS: We used first-year data from each glaucoma patient's 2-year panel survey in the Medical Expenditure Panel Survey (MEPS) database, 2003-2014. Two groups were created using ICD-9-CM codes collected by MEPS to compare glaucoma patients with and without at least 1 selected physical or mental comorbid condition. Between-group comparisons in the outcomes of interest (HCRU, expenditure, HRQoL) were estimated using multivariable regression analyses while adjusting for socio-demographic and clinical characteristics at baseline. RESULTS: We identified 2,928 unique glaucoma patients during the 11 years of collected data, including 1,539 (53%) who had at least 1 physical or mental comorbid condition of interest. Comparing those with at least 1 select physical or mental comorbidity to those without (n=1,389), unadjusted HCRU and expenditures were greater in patients with a physical or mental comorbidity (all P<0.05). After adjustment, significant associations with increased HCRU remained for office-based provider visits and home health provider days (each P<0.01). Average total expenditures were $12,324 in those with comorbidities and $8,590 for those without. HRQoL (unadjusted and adjusted) was lower in those with a physical or mental comorbid condition (all P<0.05). CONCLUSIONS: Some differences in HCRU and expenditures were accounted for by differences in baseline characteristics between those with and those without 1 or more physical or mental comorbid conditions, but differences remained after adjustment. Results suggest that glaucoma patients with physical and mental comorbidities may experience greater HCRU and associated expenditures, and lower HRQoL, when compared with glaucoma patients without these comorbidities With this knowledge, future work may include estimating the effect of the number of these comorbid conditions on each of the 3 types of outcomes.
Keywords: prescription drug; adolescent; adult; aged; article; child; comorbidity; controlled study; cross-sectional study; disease burden; emergency ward; female; glaucoma; health care; health care cost; health care utilization; human; ICD-9-CM; major clinical study; male; prescription; quality of life; Short Form 12

Compliance to follow-up care after urban diabetic retinopathy tele-screening - Boucher, M.C.; Ouazani Chahdi, H.; El Yamani, M.E.M. (Canadian Journal of Ophthalmology, 2020)
Background: Although many diabetic retinopathy (DR) tele-screening projects have shown effectiveness for DR, timely follow-up care after screening is essential to achieve the expected visual benefits of screening. Objective: To better understand the possible factors of non-compliance to follow-up care in diabetics after tele-screening for DR. Method: This cross-sectional retrospective descriptive study analyses the data of 148 diabetics referred to follow-up care following screening of 1185 diabetics through an urban community-based DR Teleophthalmology Project aimed at Type 2 diabetes. A telephone survey was conducted to assess the screening program appreciation and the sociodemographic characteristics of that population. Results: This study achieved a 91,9% (n=136) compliance rate to follow-up care. Female sex, type 2 diabetes, lower general and DR education, telephone unreachability, age less than 60 years, knowledge of a visually impaired acquaintance and more severe DR were more prevalent in non-compliant patients. Age, ethnicity, economic status, level of precariousness, distance from home to the screening/examination sites, and previous adherence to the DR screening guidelines were similar in both compliants and noncompliants. A high satisfaction score (4,8/5, n=96) to the tele-screening program was measured. Conclusion: This study is applicable to other screening programs and suggests that an increase in the number of recall letters and a greater flexibility in the organization of follow-up care appointments as well as the addition of multilingual members to the recalling team may have further improved compliance to follow-up care. It measures a high level of satisfaction provided by this model of urban teleophthalmology screening.
Keywords: adult; article; blood vessel occlusion; cross-sectional study; demography; diabetic retinopathy; disease duration; economic status; ethnicity; female; follow up; glaucoma; human; insulin dependent diabetes mellitus; macular edema; major clinical study; male; non insulin dependent diabetes mellitus; nonproliferative diabetic retinopathy; patient education; practice guideline; retrospective study; screening; telephone interview; urban area; urban population; visual acuity

Rationale and Design of the Hamburg City Health Study - Jagodzinski, A.; Johansen, C.; Koch-Gromus, U.; Aarabi, G.; Adam, G.; Anders, S.; Augustin, M.; der Kellen, R.B.; Beikler, T.; Behrendt, C.-A.; Betz, C.S.; Bokemeyer, C.; et al. (European Journal of Epidemiology, 2020)
The Hamburg City Health Study (HCHS) is a large, prospective, long-term, population-based cohort study and a unique research platform and network to obtain substantial knowledge about several important risk and prognostic factors in major chronic diseases. A random sample of 45,000 participants between 45 and 74 years of age from the general population of Hamburg, Germany, are taking part in an extensive baseline assessment at one dedicated study center. Participants undergo 13 validated and 5 novel examinations primarily targeting major organ system function and structures including extensive imaging examinations. The protocol includes validate self-reports via questionnaires regarding lifestyle and environmental conditions, dietary habits, physical condition and activity, sexual dysfunction, professional life, psychosocial context and burden, quality of life, digital media use, occupational, medical and family history as well as healthcare utilization. The assessment is completed by genomic and proteomic characterization. Beyond the identification of classical risk factors for major chronic diseases and survivorship, the core intention is to gather valid prevalence and incidence, and to develop complex models predicting health outcomes based on a multitude of examination data, imaging, biomarker, psychosocial and behavioral assessments. Participants at risk for coronary artery disease, atrial fibrillation, heart failure, stroke and dementia are invited for a visit to conduct an additional MRI examination of either heart or brain. Endpoint assessment of the overall sample will be completed through repeated follow-up examinations and surveys as well as related individual routine data from involved health and pension insurances. The study is targeting the complex relationship between biologic and psychosocial risk and resilience factors, chronic disease, health care use, survivorship and health as well as favorable and bad prognosis within a unique, large-scale long-term assessment with the perspective of further examinations after 6 years in a representative European metropolitan population.
Keywords: biological marker; genomic DNA; protein; untranslated RNA; adult; aged; aortic aneurysm; aortic valve disease; article; asthma; atrial fibrillation; bone metastasis; cardiovascular magnetic resonance; cerebrovascular accident; cerebrovascular disease; chronic disease; chronic kidney failure; chronic obstructive lung disease; chronic wound; clinical outcome; cohort analysis; comparative study; controlled study; coronary artery disease; coronary risk; dementia; dental caries; depression; dermatitis; dietary intake; environmental exposure; epigenetics; eye disease; family history; feeding behavior; female; follow up; fundus hypertonicus; genomics; Germany; glaucoma; health care utilization; health insurance; heart failure; heart infarction; human; hypercholesterolemia; hypertension; incidence; lifestyle; lung disease; macular degeneration; major clinical study; male; medical history; mental disease; middle aged; migraine; mitral valve disease; musculoskeletal disease; neuroimaging; nuclear magnetic resonance imaging; oropharynx cancer; osteoporosis; papillomavirus infection; pension; periodontal disease; peripheral occlusive artery disease; physical activity; population research; prevalence; professionalism; prognosis; prospective study; prostate cancer; proteomics; psoriasis; psychosocial care; psychosomatic disorder; quality of life; retina tumor; retinal vascular disease; risk factor; self report; sexual dysfunction; skin cancer; skin disease; social media; social status; survivorship; thrombosis; valvular heart disease

This issue of Acta - Stefánsson, E. (Acta Ophthalmologica, 2020)
Keywords: bioinformatics; cataract; color vision; Descemet membrane endothelial keratoplasty; diabetic retinopathy; editorial; gene expression; glaucoma; health care access; human; molecular pathology; open angle glaucoma; ophthalmology; optic nerve; priority journal; publication; retina vein occlusion; retinoblastoma; strabismus; trabecular meshwork; uveitis; visual acuity

Economic Burden of Non-Infectious Inflammatory Eye Disease (NIIED) in a Commercially-Insured Population in the United States - Albini, T.A.; Rice, J.B.; White, A.G.; Johnson, M.; Reiff, J.; Lima, A.F.; Bartels-Peculis, L.; Ciepielewska, G.; Nelson, W.W. (Ocular Immunology and Inflammation, 2020)
Purpose: To assess the economic burden of non-infectious inﬂammatory eyedisease (NIIED) in a commercially-insured population in the United States Methods: Adult patients with a NIIED diagnosis between 2006 and 2015 were selected from a de-identified, privately insured claims database and were matched 1:1 to a non-NIIED control. Ophthalmologic complications, direct healthcare resource use and costs, and indirect work loss (from the payer perspective) were calculated for a 12-month period and compared across the 2 cohorts. Results: Among the 14 876 matched pairs, NIIED patients were significantly more likely than controls to experience ocular complications, including glaucoma and cataracts (p < 0.001). NIIED patients had significantly higher healthcare resource utilization and costs compared with matched controls (relative difference 40%, p < 0.001). NIIED patients missed 12.2 days of work ($2925 annual work-loss costs), 46% more than non-NIIED patients (p < 0.001). Conclusion: NIIED imposes a significant clinical and economic burden, suggesting an unmet need for expanded access to alternative treatment options.
Keywords: adult; article; blindness; cataract; cohort analysis; controlled study; economic aspect; eye disease; eye inflammation; female; glaucoma; health care cost; health care utilization; human; macular degeneration; major clinical study; male; medically uninsured; middle aged; non infectious inflammatory eye disease; retina detachment; unemployment; United States; visual disorder

Epidemiology of multimorbidity in Iran: An investigation of a large pharmacy claims database - Ebrahimoghli, R.; Janati, A.; Sadeghi-Bazargani, H.; Hamishehkar, H.; Ghaffari, S.; Sanaat, Z.; Farahbakhsh, M.; Farhoudi, M.; Khalili-Azimi, A. (Pharmacoepidemiology and Drug Safety, 2020)
Purpose: Multimorbidity (MM) (presence of more than one chronic condition within a same patient) imposes a heavy burden on patients and health care systems. In contrast to high-income countries, the epidemiology of this phenomenon is unclear in low- and middle-income countries, particularly among Iranian population. Methods: This was a retrospective cohort study using Iranian Health Insurance Organization claims database. A framework was developed for identifying a set of 18 chronic conditions from the pharmacy claims data in Iran. All 2013 outpatient utilizers (aged 18 years or older) were included. Data were analyzed according to number of chronic conditions, gender, and age. The association between MM and utilizations of health services was examined for 2013 to 2016. Results: In total, 481 733 people were included. Cardiovascular diseases (including hypertension) (19.1%), depression/anxiety/sleep disorders (13.7%), and acid-related disorders (10.3%) were the three most prevalent conditions. MM was present in 21.1%. Although prevalence of MM is higher in older age groups and was present in 40% of individuals aged 65 and older, the absolute number of multimorbid patients was higher in those younger than 65 years (66 271 vs 35 386). MM was more prevalent among women (22.1%) compared with men (19.5). After multivariate adjustment for age group and sex, each additional chronic condition was associated with an increase of 2.23 physician visits, 2.86 drugs dispensed, 2.32 laboratory tests, and 1.6 medical imaging. Conclusions: Our findings challenge the current single-disease–based assumption implicit in Iranian health care system. To take account of MM, complementary strategies should be designed and implement in health care system.
Keywords: methotrexate; prescription drug; acid related disorder; adult; aged; anxiety disorder; article; billing and claims; bipolar disorder; bone disease; cancer chemotherapy; cancer pain; cardiovascular disease; chronic obstructive lung disease; cohort analysis; consultation; controlled study; cross-sectional study; dementia; depression; diabetes mellitus; diagnostic imaging; enteritis; Ewing sarcoma; female; glaucoma; gout; groups by age; health care system; health care utilization; health insurance; health service; human; hyperlipidemia; hypertension; hyperuricemia; inflammatory disease; iron deficiency anemia; laboratory test; major clinical study; male; malignant neoplasm; middle aged; migraine; multiple chronic conditions; osteoporosis; outpatient care; Parkinson disease; pharmacy (shop); prevalence; priority journal; psoriasis; respiratory tract disease; retrospective study; rheumatoid arthritis; schizophrenia; sex difference; sleep disorder; thyroid disease; very elderly; young adult

Using GRADE methodology to assess innovation of new medicinal products in Italy - Fortinguerra, F.; Tafuri, G.; Trotta, F.; Addis, A. (British Journal of Clinical Pharmacology, 2020)
Aim: In April 2017 the Italian Medicine Agency (AIFA) developed new criteria to grant any new medicinal product with an innovative designation. The aim of this study is to describe this new model and how it works. Methods: A retrospective descriptive analysis was performed on the results of the assessment process of innovativeness of new medicinal products (or therapeutic indications) based on the AIFA's new innovation criteria (therapeutic need, added therapeutic value and quality of clinical evidence through GRADE methodology) carried out between April 2017 and February 2019 and made publicly available on the AIFA website starting from January 2018. Results: A total of 37 full reports (22 for oncological indications) explaining the rationale for the AIFA's decision is made publicly available on the agency's website. A total of 12 therapeutic indications (5 oncological) were evaluated as fully innovative, 13 indications (11 oncological) were evaluated as conditionally innovative, while 12 indications (6 oncological) as non-innovative. Conclusion: The new AIFA innovation criteria resulted in a much more flexible and transparent model to define and assess what constitutes a therapeutic innovation. In particular, the choice of AIFA to use the GRADE methodology to evaluate the quality of clinical evidence within a process of drug innovativeness assessment is essential for the early identification of the discrepancy between the need for patients of a rapid access to innovative therapies and the available clinical data needed to make decisions on drug innovativeness.
Keywords: adalimumab; alectinib; atezolizumab; avelumab; avibactam plus ceftazidime; baricitinib; bezlotoxumab; canakinumab; cenegermin; daratumumab; dinutuximab; dupilumab; emicizumab; glecaprevir plus pibrentasvir; ibrutinib; inotuzumab ozogamicin; kisquali; lenalidomide; letermovir; midostaurin; new drug; niraparib; nivolumab; nusinersen; obeticholic acid; ocrelizumab; palbociclib; regorafenib; ribociclib; sofosbuvir plus velpatasvir plus voxilaprevir; telotristat ethyl; abdominal infection; acute lymphoblastic leukemia; acute myeloid leukemia; adult; advanced cancer; article; atopic dermatitis; bleeding; carcinoid syndrome; chronic hepatitis C; chronic lymphatic leukemia; Clostridium difficile infection; cornea ulcer; cytomegalovirus infection; decision making; descriptive research; diarrhea; drug indication; drug industry; experimental therapy; familial Mediterranean fever; GRADE approach; Gram negative infection; head and neck squamous cell carcinoma; health care access; hospital acquired pneumonia; human; human epidermal growth factor receptor 2 negative breast cancer; hyperimmunoglobulinemia D and periodic fever syndrome; infection prevention; iridocyclitis; Italy; liver cell carcinoma; mast cell leukemia; merkel cell carcinoma; metastasis; metastatic breast cancer; monotherapy; multiple myeloma; multiple sclerosis; neuroblastoma; neurotrophic keratopathy; non small cell lung cancer; ovary carcinoma; peritoneum cancer; primary biliary cirrhosis; primary tumor; priority journal; prophylaxis; pyelonephritis; recurrent disease; recurrent infection; refractory multiple myeloma; retrospective study; rheumatoid arthritis; spinal muscular atrophy; systemic mastocytosis; tumor necrosis factor receptor associated periodic syndrome; urinary tract infection; uterine tube carcinoma; ventilator associated pneumonia; alecensa; bavencio; besponsa; darzalex; dupixent; hemlibra; humira; ibrance

Adherence with medical therapy for primary open-angle glaucoma in Kenya – a pilot study - Murdoch, I.; Nyakundi, D.; Baker, H.; Dulku, S.; Kiage, D. (Patient Preference and Adherence, 2020)
Background/Objectives: Adherence is a major challenge in topical glaucoma therapy, particularly in an African context. We report a pilot study assessing adherence independently for the first time in an African context. Subjects/Methods: Participants with newly diagnosed open-angle glaucoma received a weighed bottle of Lumigan 0.01% with counselling on therapy. The bottles were returned monthly for renewal and weighed on return to estimate drops taken during the period. Data collection was for one year with a short compliance questionnaire. Results: 11 patients participated. 5 (45%) failed to complete one full year of topical therapy. The overall mean number of drops per eye per day was 1.74 (SD 0.69) for the 6 with one year of monthly returned bottles and controlled IOPs at each visit. Self-perception of compliance in these patients was good. Conclusion: The signs of poor adherence based on both self-report (previous literature), and in this small-scale study of an objective measure suggest medication may not be the first-line treatment of choice in this environment. Our report does, however, raise the possibility that those patients who return for repeat prescriptions and review are indeed adhering to their treatment regimens.
Keywords: bimatoprost; eye drops; article; clinical article; clinical assessment; counseling; human; intraocular pressure; Kenya; medication compliance; open angle glaucoma; outcome assessment; patient compliance; pilot study; prescription; questionnaire; self concept; self report

Current knowledge and attitudes concerning cost-effectiveness in glaucoma pharmacotherapy: A glaucoma specialists focus group study - Feldman, R.M.; Cioffi, G.A.; Liebmann, J.M.; Weinreb, R.N. (Clinical Ophthalmology, 2020)
Background: Rising healthcare costs motivate continued cost-reduction efforts. To help lower costs associated with open-angle glaucoma (OAG), a prevalent, progressive disease with substantial direct and indirect costs, clinicians need to understand the cost-effectiveness of intraocular pressure (IOP)-lowering pharmacotherapies. There is little published information on clinicians’ knowledge and attitudes about cost-effectiveness in glaucoma treatment. Purpose: This pilot focus group study aimed to explore clinician attitudes and perspectives around the costs and cost drivers of glaucoma therapy; the implementation of cost-effectiveness decisions; the clinical utility of cost-effectiveness studies; and the cost-effectiveness of available treatments. Methods: Six US glaucoma specialists participated in two separate teleconferencing sessions (three participants each), managed by an independent, skilled moderator (also a glaucoma specialist) using a discussion guide. Participants reviewed recent publications (n=25) on health economics outcomes research in glaucoma prior to the sessions. Results: Participants demonstrated a clear understanding of the economic burden of glaucoma therapy and identified medications, diagnostics, office visits, and treatment changes as key cost drivers. They considered cost-effectiveness an appropriate component of treatment decision-making but identified the need for additional data to inform these decisions. Participants indicated that there were only a few recent studies on health economics outcomes in glaucoma which evaluate parameters important to patient care, such as quality of life and medication adherence, and that longitudinal data were scant. In addition to efficacy, participants felt patient adherence and side-effect profile should be included in economic evaluations of glaucoma pharmacotherapy. Recently approved medications were evaluated in this context. Conclusion: Clinicians deem treatment decisions based on cost-effectiveness data as clinically appropriate. Newer IOP-lowering therapies with potentially greater efficacy and favorable side-effect and adherence profiles may help optimize cost-effectiveness. Future studies should include: clinicians’ perspectives; lack of commercial bias; analysis of long-term outcomes/costs; more comprehensive parameters; real-world (including quality-of-life) data; and a robust Markov model.
Keywords: article; clinical decision making; cost effectiveness analysis; disease burden; economic evaluation; glaucoma; health care cost; health care planning; health care utilization; health personnel attitude; human; longitudinal study; patient care; pilot study; professional knowledge; protocol compliance; quality of life; teleconference

Investigation of Approval Trends and Benefits of New Fixed-Dose Combination Drugs in Japan - Kikuchi, C.; Ohno, M.; Izumo, T.; Takahashi, S.; Aoki, M.; Shimomura, H.; Kawano, Y.; Shimada, S.; Aoyama, T. (Therapeutic Innovation and Regulatory Science, 2020)
Background: New fixed-dose combination drugs (FDCs) had been developed in limited numbers in Japan. Since regulatory requirements were relaxed in 2005, 73 new FDCs have been approved by PMDA since 2006. In this study, we investigate trends in new FDCs and their benefits through a questionnaire survey provided to patients and pharmacists. Methods: The new FDCs were analyzed by therapeutic categories, first approval country and drug lag (DL). Questionnaire surveys were conducted on hypertension, bronchial asthma, and glaucoma in approximately 300 patients and 700 pharmacists in 66 hospitals to investigate the benefits of new FDCs. Results: The highest number of FDCs approved by the therapeutic category was 15 cardiovascular agents. The DL (median) was less than 1 year in several therapeutic categories including cardiovascular agents. The survey results showed that patient compliance improved in 30.8% of the bronchial asthma. Regarding the time and effort required to prescribe these drugs, 32.5% of pharmacists reported “slightly decreased” in bronchial asthma, while 32.0% reported “slightly increased” in hypertension. More than one-third (70.6%) responded “recommend” in bronchial asthma. Conclusion: The number of new FDCs markedly increased since 2006, and this presented new opportunities for the Japanese pharmaceutical industry. FDCs not only increase convenience to the patient but also improve patient compliance and the efficiency of pharmacist prescription processes. However, the rapid increase in new FDCs may cause confusion in the medical field, and new FDCs should be developed not only to improve convenience but also to consider the benefits they provide to patients, pharmacists, and physicians.
Keywords: agents acting on the peripheral nervous and neuromuscular systems; anti human immunodeficiency virus agent; antiallergic agent; antiasthmatic agent; antibiotic agent; antidiabetic agent; antiglaucoma agent; antihypertensive agent; antimalarial agent; antineoplastic agent; antivirus agent; biological product; cardiovascular agent; central nervous system agents; dermatological agent; drug; hormone; article; asthma; drug approval; drug combination; drug cost; drug industry; glaucoma; hypertension; Japan; medication compliance; patient; patient compliance; pharmacist; physician; priority journal; questionnaire

Treatment patterns and health care costs of lupus nephritis in a united states payer population - Bartels-Peculis, L.; Sharma, A.; Edwards, A.M.; Sanyal, A.; Connolly-Strong, E.; Nelson, W.W. (Open Access Rheumatology: Research and Reviews, 2020)
Objective: To describe the characteristics, treatment patterns, health care resource utilization (HCRU), and cost of care for members of a large United States (US) health insurance plan with lupus nephritis (LN). Methods: A retrospective observational study was conducted using a health insurance plan database to identify adult members with a diagnosis of LN. Medical and pharmacy claims were used to describe demographics, comorbidities, HCRU, and cost patterns over a 12-month follow-up period for each patient, between January 1, 2014, and December 31, 2016. All study variables were examined descriptively. Results: A total of 1039 patients were available for analysis (median age, 47 years; 83% female). The median Charlson Comorbidity Index (CCI) was 3.3. Less than half (41%) of patients received immunosuppressive therapies commonly used to treat LN. Evidence indi-cated that 58% of the study population were prescribed corticosteroid therapy, in most cases (73%) for more than 60 days. Adverse events known to be associated with corticosteroid therapy were recorded in 58% of patients. Guideline-recommended preventive therapy with hydroxychloroquine was prescribed for 54% of members with LN. Nearly half (47%) of members with LN did not see a nephrologist and more than one-third (36%) did not see a rheumatologist over 1 year of follow-up. Rates of all-cause hospitalization and emergency department (ED) use were 25% and 35%, respectively. The mean all-cause per-member-per-month (PMPM) medical cost for the study population was $2801, with LN-specific costs accounting for $1147 PMPM. Conclusion: Patients with LN who are insured through a large US health plan appeared to underutilize outpatient specialist services and guideline-recommended hydroxychloroquine therapy. Corticosteroid use and adverse events known to be associated with corticosteroids were common in this cohort.
Keywords: antilipemic agent; azathioprine; corticosteroid; cyclophosphamide; cyclosporine; hydroxychloroquine; hydroxymethylglutaryl coenzyme A reductase inhibitor; methylprednisolone; mycophenolate mofetil; mycophenolic acid; prednisone; rituximab; tacrolimus; adult; article; avascular necrosis; Charlson Comorbidity Index; controlled study; diabetes mellitus; digestive system ulcer; drug efficacy; drug safety; emergency ward; female; follow up; fracture; gastrointestinal hemorrhage; glaucoma; health care cost; health care planning; health care utilization; health insurance; heart infarction; hospitalization; human; immunosuppressive treatment; lupus erythematosus nephritis; major clinical study; male; middle aged; observational study; osteoporosis; patient compliance; population research; retrospective study; treatment planning; United States

Intraoperative optical coherence tomography guided ocular surgeries: Critical analysis of clinical role and future perspectives - Pujari, A.; Agarwal, D.; Chawla, R.; Kumar, A.; Sharma, N. (Clinical Ophthalmology, 2020)
Intraoperative imaging of ocular tissues for diagnostic and therapeutic applications has gained immense admiration in recent years. The real time cross-sectional imaging, as well as three and four dimensional reconstruction abilities of intraoperative optical coherence tomogra-phy (iOCT), has enhanced our knowledge on many fronts in surgical maneuvers. In this review, we discuss the iOCT discovered constructive knowledge in the cornea, cataract, refractive, glaucoma, pediatric ocular, and various retinal conditions. The practical utility with decision modifying aspects along the specified ocular tissues and with respect to specific ocular entities have been narrated. Moreover, limitations and future directions have also been emphasized to make ophthalmic care more comprehensive in the future.
Keywords: anterior eye segment; biometry; cataract; computer assisted surgery; cornea disease; corneal biopsy; deep anterior lamellar keratoplasty; Descemet stripping endothelial keratoplasty; epiretinal membrane; eye surgery; glaucoma; glaucoma surgery; health care access; health care need; human; image analysis; image reconstruction; intraoperative period; keratectomy; keratoconus; keratoplasty; myopia; optical coherence tomography; posterior eye segment; refraction error; refractive surgery; retina surgery; review; surgical approach; surgical technique; systematic review; trabeculotomy; vitrectomy

Neurodegenerative change of the visual analyzer in glaucoma - Egorov, E.A.; Alekseev, V.N.; Gazizova, I.R.; Martynova, E.B. (NeuroQuantology, 2020)
The aim of the research was to explore structural changes changes in the central departments of the visual analyzer for glaucoma. Materials and Methods: mortem examination was carried out in two people's death was not related to diseases of the central nervous system. Far-advanced glaucoma diagnosis was established and verified in life. There have been mortem, morphological and immunohistochemical studies, including a description of the material, morphometry of the optic nerve cells, optic chiasm, lateral geniculate body and visual cortex. Results: Macroscopic examination revealed severe atrophy of the second cranial nerve with the loss of a considerable number of axons and neurons in the lateral geniculate nucleus. Micrography showed the reduction of the cell layer’s thickness of the visual cortex, the puckering of the neurons’ radius and their nuclei’s radius. Examination also revealed grumose, granular cytoplasm, the presence of lipofuscin in vast numbers, which indicates an atrophic process. In either case, neurodegeneration processes were revealed in deceased patients, who suffered from POAG. All levels of the visual analyzer’s central division were involved in the degenerative process; however, the area of the visual cortex in the area of the calcarine fissure was most noticeable. It should be highlighted that in the optic nerve and IV-V layers cortical amyloid plaques were detected and calf. Conclusion: It was established as a result of autopsy that with POAG degenerative changes occur in the retina ganglion cells, fibers of the second cranial nerve, and the tissue of the visual analyzer’s pathways until visual cortex. This indicates a marked neurodegeneration character POAG, which is confirmed by the presence of the generally accepted criteria of neurodegenerative process as astrogliosis and the presence of beta-amyloid accumulation in the cortex and in the optic nerve. This pathology is similar to other neurodegenerative diseases such as Alzheimer's or Parkinson's.
Keywords: analyzer; microtome; rm 2125RT; Visual Analyzer; amyloid beta protein; beta secretase; glial fibrillary acidic protein; lipofuscin; neuron specific nuclear protein; von Willebrand factor; Alzheimer disease; ambulatory care; amyloid plaque; anatomicopathological; article; astrocyte; astrocytosis; autopsy; axon; brain cortex; calcarine sulcus; clinical article; confocal laser scanning microscopy; cytoplasm; degenerative disease; geniculate body; glaucoma; human; human cell; human tissue; immunohistochemistry; medicine; micrography; microscopy; morphological adaptation; morphometry; nerve cell; oligodendroglia; optic chiasm; optic nerve; optic nerve atrophy; optic nerve cell; Parkinson disease; peripheral nervous system; posthumous care; structure analysis; visual cortex; rm 2125RT

Ocular inserts of voriconazole-loaded proniosomal gels: Formulation, evaluation and microbiological studies - El-Emam, G.A.; Girgis, G.N.S.; El Sokkary, M.M.A.; El-Azeem Soliman, O.A.; Abd El Gawad, A.E.G.H. (International Journal of Nanomedicine, 2020)
Background: Voriconazole (VRC) is a triazole broad spectrum antifungal drug, used in the management of versatile fungal infections, particularly fungal keratitis. The obligatory use of niosomal delivery of VRC may reduce the frequency of dosing intervals resulting from its short biological half time and consequently improve patient compliance. Methods: VRC loaded proniosomes (VRC-PNs) were set by the coacervation technique and completely characterized. The developed formula was comprehensively assessed concerning in-vitro release behavior, kinetic investigation, and its conflict against refrigerated and room temperature conditions. A selected noisomal formula was incorporated into ocusert (VRCPNs Ocu) formulated by 1% w/w hydroxypropyl methyl cellulose HPMC and 0.1% w/w carbopol940. Eventually, in vitro antifungal activity against Candida albicans and Aspergillus nidulans was assessed by the cup diffusion method. Results: The optimized VRC-PNs (Pluronic F127: cholesterol weight ratio 1:1 w/w) exhibited the highest entrapment efficiency (87.4±2.55%) with a spherical shape, proper size in nano range and a suitable Zeta potential of 209.7±8.13 nm and −33.5±1.85 mV, respectively. Assurance of drug encapsulation in nanovesicles was accomplished by several means such as attenuated total reflection Fourier-transform infrared spectroscopy, differential scanning calorimetry in addition to powder X-ray diffraction investigations. It displayed a biphasic in vitro release pattern and after 6 months of storage at a refrigerated temperature, the optimized formula preserved its stability. VRC-PNs Ocu proved a very highly significant antifungal activity matched with the free drug or nanosuspension which was extra assured by comparing its mean inhibition zone with that of 5% natamycin market eye drops. Conclusion: In conclusion, VRC-PNs Ocu could be considered as a promising stable sustained release topical ocular nanoparticulate system for the management of fungal infections.
Keywords: cholesterol; gel; hydroxypropylmethylcellulose; proniosomal gel; unclassified drug; voriconazole; antifungal activity; article; Aspergillus nidulans; Candida albicans; controlled study; differential scanning calorimetry; drug delivery system; drug formulation; drug release; Fourier transform infrared spectroscopy; in vitro study; mycosis; nanoencapsulation; particle size; patient compliance; phase separation; physical chemistry; process optimization; room temperature; transmission electron microscopy; X ray diffraction; zeta potential

Patients’ experience of using eye drop guide device to aid self-administration of glaucoma medications - Sakiyalak, D.; Kobwanthanakun, S. (Clinical Ophthalmology, 2020)
Purpose: To determine the characteristics of the patients who preferred using the eye drop guide (EDG) regularly and their opinions toward the guide in order to select the patients for prescribing the EDG appropriately. Patients and Methods: Fifty-seven glaucoma patients who completed the primary study, “The effect of ‘eye drop guide’ on the success rate of eye drop self-instillation in glaucoma patients”, were included. Patients’ instillation techniques, routine instillation or using the EDG, were chosen independently. After 4–6 months, they were interviewed about the frequency of EDG use and their rating scores toward the guide in 4 aspects including aiming aids, contamination prevention, reduction of drop waste, and ease of use. The differences in opinion scores between each frequency group and the factors associated with the regularity of EDG use were statistically analyzed. Results: Of fifty-seven patients completing the interview, 19.3% used the EDG everyday, while 45.6% had never used the EDG. The nonusers rated significantly lower scores in all aspects (p-value < 0.005). From multivariate analysis, the factors associated with the preference not to use the EDG were administering in supine position (p-value < 0.001, adjusted OR 34.866, 95% CI 4.974–244.412) and more than one eye drop use (p-value = 0.048, adjusted OR 5.280, 95% CI 1.018–27.396). Conclusion: The EDG should be selectively prescribed for the particular patients who had one medication and performed instillation in sitting or standing position. Although the regular EDG users tended to have positive opinions on the EDG, their long-term compliance with the guide was underinvestigated. Keywords:.
Keywords: drug delivery device; eye drop guide; antiglaucoma agent; eye drops; polystyrene; aged; article; best corrected visual acuity; contamination prevention; drug instillation; drug self administration; female; glaucoma; human; long term care; major clinical study; male; medication compliance; patient compliance; patient preference; patient selection; personal experience; prescription; prevention; sitting; standing; supine position; telephone interview

Decreasing avoidable vision loss: Identifying antecedents of adherence - Morse, A.R.; Seiple, W.H. (Clinical Ophthalmology, 2020)
Adherence to medication treatment protocols and active participation by individuals in their medical care are important for all patients, but especially for those with chronic conditions such as vision loss. Adherence is crucial for decreasing avoidable vision loss. Failure to take medications as prescribed and keep scheduled appointments reduces treatment effectiveness, increases complications and results in poorer outcomes. Reasons for nonad-herence vary by diagnosis and include not understanding the importance of adherence, low health literacy, lack of adequate self-efficacy, low level of activation and behavioral issues including depression. Patients may lack information about their condition and its prognosis, available treatment alternatives, and other essential information such as how to monitor their eye condition, what to do if vision deteriorates and how to get needed community-based help. Each of these factors impedes patients’ ability to engage with their physician and participate in their own care. The ability of individuals with vision loss to actively and effectively manage their health care, ie, activation, has been understudied. When patients are involved with their own care, their care experience, and most importantly, their outcomes, are improved. Identifying antecedents of adherence may help provide disease-and patient-specific pathways to reduce avoidable vision loss.
Keywords: antiglaucoma agent; age related macular degeneration; alternative medicine; avoidable vision loss; depression; diabetic eye disease; glaucoma; health belief; health care; health literacy; human; interpersonal communication; medical information; medication compliance; note; patient compliance; patient participation; prognosis; self care; self concept; treatment failure; treatment outcome; visual impairment

Signs and symptoms of ocular surface disease: The reasons for patient dissatisfaction with glaucoma treatments - Stalmans, I.; Lemij, H.; Clarke, J.; Baudouin, C. (Clinical Ophthalmology, 2020)
Ocular Surface Disease (OSD) and hyperemia are the most common adverse events of topical ocular medications. While active compounds may cause allergic reactions or irritation, preservatives, which are intended to prevent bacterial growth, are toxic as well. Therefore, the most recent glaucoma medications no longer contain preservatives. Despite this, local tolerability may still impact treatment compliance and patient quality of life. We conducted an observational, multi-center, international, cross-sectional study in 793 treated and stabilized glaucoma patients to assess patient satisfaction and local tolerability of their treatment. The vast majority (93.7%) of patients was satisfied or very satisfied with their treatment in terms of tolerability and only 6.3% were dissatisfied. However, ophthalmologi-cal examination showed a high frequency of ocular signs: conjunctival hyperemia (32%), OSD (42.5%) and positive conjunctival fluorescein staining (10.3%). Additionally, patients reported symptoms upon instillation (31.4%) and between instillations (57.3%); 25.1% of patients were using tear substitutes. All signs and symptoms were significantly (p<0.001) associated with patient dissatisfaction. A logistic regression model indicated that dissatisfaction was higher in patients with symptoms upon instillation and in those using tear substitutes (OR: 3.03 and 4.63, respectively). The mean patient tolerability score to treatment was 82.7 ±16.1 on a 100-point visual analogue scale. In conclusion, even if patients may be highly satisfied with their current treatment, most of them present ocular signs and symptoms. A treatment change should be considered in case of clinical signs or patient-reported symptoms.
Keywords: artificial tear; eye drops; fluorescein; adult; aged; article; Belgium; blurred vision; conjunctival hyperemia; cross-sectional study; disease association; dry eye; epiphora; eye burning; eye examination; eye pain; eye redness; female; glaucoma; human; major clinical study; male; monotherapy; multicenter study; Netherlands; observational study; ocular pruritus; ocular surface disease; patient compliance; patient satisfaction; photophobia; physical disease by body function; prevalence; staining; tear break-up time; United Kingdom; visual analog scale

Impact of medication regimen simplification on medication adherence and clinical outcomes in patients with long-term medical conditions - Elnaem, M.H.; Irwan, N.A.; Abubakar, U.; Sulaiman, S.A.S.; Elrggal, M.E.; Cheema, E. (Patient Preference and Adherence, 2020)
Background: This study aims to identify interventions used to reduce medication regimen complexity and to assess their impact on medication adherence and clinical outcomes. Methods: A literature search was conducted using pre-defined search terms in three scientific databases, including ScienceDirect, ProQuest and MEDLINE. Original research articles published in English between 2009 and 2020 that assessed the impact of medication regimen simplification on medication adherence in patients with long-term medical conditions were eligible for inclusion. Review articles, meta-analysis studies and conference proceedings were excluded. Data charting was done in an iterative process using a studyspecific extraction form. Results: Of the 684 studies identified through initial searches, 17 studies were included in the review. Nine studies involved simplification of medication regimen related to HIV, while three studies focused on patients with diabetes with or without coronary artery disease. The remaining five studies included medications used among elderly patients or medications related to hypertension, psychiatric disorders, glaucoma and kidney diseases. Three medication regimen simplification strategies were identified; fixed-dose combination (n = 7), oncedaily dosing (n = 4) and the combination of both fixed-dose and once-daily dosing (n = 6). Overall, most of the regimen simplification strategies (14 out of 17) were found to be useful in improving medication adherence. There was no assessment of clinical outcomes in four out of 17 studies. Furthermore, more than half of the studies that assessed clinical outcomes did not show any additional impact on clinical outcomes. Conclusion: The findings suggest that there was an equal utilization of the three main approaches of regimen simplifications; fixed-dose combination, once-daily dosing and a combination of both. Overall, most of the regimen simplification strategies were found to be effective in improving medication adherence. However, the associated improvement in medication adherence did not extend to improvement in the clinical outcomes.
Keywords: angiotensin receptor antagonist; antiretrovirus agent; atazanavir plus ritonavir; corticosteroid; dipeptidyl carboxypeptidase inhibitor; efavirenz; emtricitabine; hydroxymethylglutaryl coenzyme A reductase inhibitor; insulin; lamivudine; proteinase inhibitor; rapamycin; RNA directed DNA polymerase inhibitor; tacrolimus; tenofovir; timolol; travoprost; antiretroviral therapy; chronic disease; clinical outcome; coronary artery disease; diabetes mellitus; dosage schedule comparison; drug dose regimen; glaucoma; human; Human immunodeficiency virus infection; hypertension; insulin treatment; intraocular hypertension; kidney disease; kidney transplantation; medication compliance; mental disease; mental patient; non insulin dependent diabetes mellitus; open angle glaucoma; patient compliance; review; systematic review

Panophthalmitis and orbital inflammation with cavernous sinus thrombosis following cataract surgery - Marinos, E.; McCall, D.; Tumuluri, K.; Rowe, N.; Do, H. (International Medical Case Reports Journal, 2020)
Background: Panophthalmitis is a severe inflammation of the globe that can result as a rare complication of ophthalmic surgery. In severe cases, it may also be associated with orbital inflammation and cavernous sinus thrombosis. Purpose: This case demonstrates a rare and life-threatening post-operative complication of cataract surgery. We also hope to highlight the importance of considering the relevant risk factors associated with developing potential infections after cataract surgery, including the use of corneal sutures, high-risk behaviours such as excessive eye-rubbing, and noncompliance with appointments and post-operative medications. Case Report: We report the case of a 35-year-old female with severe autism and developmental delay who developed panophthalmitis, orbital inflammation and cavernous sinus thrombosis 6 weeks post cataract surgery. The likely cause was corneal suture-related microbial keratitis, and the patient required enucleation due to sepsis. Conclusion: Post-surgical panophalmitis is a rapidly progressive disease that is not only sight-but life-threatening and demands urgent and intensive treatment. Consideration of early enucleation may be required to prevent deterioration in such patients.
Keywords: suture; abscess; adult; article; autism; case report; cataract; cataract extraction; cavernous sinus thrombosis; clinical article; developmental delay; eye enucleation; female; high risk behavior; human; infection risk; microbial keratitis; orbit inflammation; panophthalmitis; postoperative complication; rare disease; sepsis; treatment refusal

Icare home tonometer: A review of characteristics and clinical utility - Liu, J.; De Francesco, T.; Schlenker, M.; Ahmed, I.I. (Clinical Ophthalmology, 2020)
The Icare HOME (TA022, Icare Oy, Vanda, Finland) is rebound tonometer recently approved by the US Food and Drug Administration in March 2017 designed for selfmeasurement of intraocular pressure (IOP). IOP remains a major modifiable risk factor for glaucoma progression; however, IOP measurements typically occur through single office measurements on Goldmann applanation tonometry (GAT) and do not always reveal the complete picture of patient’s IOP patterns and daily fluctuations, which are important for accurate diagnosis and evaluation. Numerous studies have now compared the efficacy of the Icare HOME to that of GAT. The objective of this article is to review the existing literature surrounding the Icare HOME tonometer and its efficacy as a self-tonometer in comparison to GAT. The available literature has shown promising results in its accuracy of measuring IOP but suggests cautious usage in patients with central corneal thicknesses or IOP ranges that are outside of a certain range. This article will also provide details and example cases for when the Icare HOME may be most clinically useful.
Keywords: Goldmann applanation tonometer; intraocular pressure measuring device; TA022; tonometer; antiglaucoma agent; adult; aged; blood pressure monitoring; case report; clinical article; clinical effectiveness; clinical evaluation; clinical practice; clinical research; comparative study; correlation analysis; diagnostic accuracy; disease exacerbation; female; Food and Drug Administration; glaucoma; home; human; intraocular pressure; male; middle aged; optic nerve disease; optical coherence tomography; patient; patient compliance; patient referral; review; risk benefit analysis; risk factor; self examination; trabeculectomy; United States; visual field; visual field defect; TA022

Surgical grade and repeat laser peripheral iridotomy procedures with risk stratification and educational considerations - Riley, O.F.; Mamtora, S.; Carroll, E.; Luck, J. (Clinical Ophthalmology, 2020)
Background/Aims: Peripheral laser iridotomy (PLI) is a commonly performed procedure. While effective, repeat procedures (RPs) may be required for a variety of causes. We report the causes and rate of RP PLI and whether surgical grade is a risk factor. Methods: Two years of retrospective data from 282 patients who had undergone PLI at a single UK ophthalmology department were retrieved using an electronic medical record system (Medisoft, Leeds, UK). Results: A total of 253 patients underwent analysis with 20 requiring RPs. Our data identified a correlation between experience of the operating surgeon and an increase in RP rate, with statistical significance (p=0.036) observed between consultants and registrars. No other statistically significant risk factors were identified from our study. Prescriber preference for iopidine was observed. From our findings and the current literature, prognostic factors that appear to influence RP rate include surgical grade, patient compliance, Asian ethnicity, and anticoagulation. Conclusion: RP rate increases in PLI when a junior surgeon is performing the procedure, and thus cases with established prognostic factors for RPs should have senior input. Formal and standardized YAG-laser training should be implemented alongside risk stratification of patients to improve both trainee education and patient care.
Keywords: apraclonidine; adult; aged; anticoagulation; article; Asian; consultation; controlled study; drug preference; female; glaucoma; human; iridotomy; laser surgery; major clinical study; male; patient compliance; peripheral laser iridotomy; personal experience; prescription; prognosis; reoperation; retrospective study; risk assessment; risk factor; surgeon; surgical registrar; surgical training; United Kingdom

Visual impairment and mental health: Unmet needs and treatment options - Demmin, D.L.; Silverstein, S.M. (Clinical Ophthalmology, 2020)
Purpose: An estimated 2.2 billion people are visually impaired worldwide. Given that age-related vision loss is a primary cause of vision impairment, this number is projected to rise with increases in average lifespan. Vision loss often results in significant disability and is associated with a substantial economic burden, reduced quality-of-life, concurrent medical issues, and mental health problems. In this review, the mental health needs of people with vision impairment are examined. Patients and methods: A review of recent literature on mental health outcomes and current treatments in people with visual impairment was conducted. Results: Considerable data indicate that rates of depression and anxiety are elevated among people with visual impairments. Moreover, individuals of lower socioeconomic status may be at increased risk for vision impairment and subsequent mental health problems. Existing psychosocial interventions for improving mental health in people with visual impairment show some promise, but are limited by low adherence and lack generalizability. Conclusion: In order to improve outcomes, a better understanding of the mechanisms linking visual impairment and poor mental health is needed. It will also be essential to develop more effective interventions and expand access to services to improve the detection and treatment of mental health problems in this population.
Keywords: adult; anxiety; article; cataract; cognition; depression; diabetic retinopathy; disability; economic aspect; female; glaucoma; health care access; health care need; health service; human; macular degeneration; male; mental health; prevalence; quality of life; social psychology; social status; socioeconomics; visual acuity; visual impairment

Challenges contributing to loss to follow-up as experienced by glaucoma patients in the Vhembe district of Limpopo Province, South Africa - Tshivhase, S.; Khoza, L.B. (Open Public Health Journal, 2020)
Background: Glaucoma is a group of chronic diseases of the optic nerve that, if not managed effectively, could lead to blindness of many people worldwide. Non-adherence to medical treatments typically lead to burdensome consequences such as progressive visual loss and disabilities. Fortunately, literature reveals that with timed appropriate treatment, such blindness can be prevented. Thus, patients’ adherence to follow-up plays an important role in maintaining vision. However, glaucoma patients in Vhembe District still miss their follow-up appointments. Objective: This study sought to explore factors contributing to loss to follow-up as experienced by glaucoma patients in South Africa. Methods: Qualitative, explorative, and descriptive research designs, using qualitative methodology, were adopted. The population consisted of glaucoma patients who had been on antiglaucoma medications for three years and above. The purposive sampling method was used to select 18 participants for the study. Data were collected using a semi-structured interview using an interview guide. Participants were between the ages of 24 and 80 years. Tesch’s eight steps of qualitative data analysis were used. Measures to ensure trustworthiness and ethical issues were observed. Results: The study findings revealed that some of the patients did not understand glaucoma disease and the importance of follow-up. Financial constraints, traditional/religious belief, shortage of medications, and negative staff attitude were the most cited barriers contributing to loss to follow-up. Conclusion: Follow up adherence amongst glaucoma patients was negatively influenced by low disease knowledge. Therefore an improvement in patient education, transportation services, and clinic efficiency may strengthen follow-up visits.
Keywords: article; communication skill; community care; follow up; glaucoma; health care delivery; health care facility; health care personnel; health care policy; health education; hospital personnel; human; intraocular pressure; medication compliance; optical coherence tomography; patient compliance; priority journal; quality of life; questionnaire; semi structured interview; social support; visual acuity; visual field

The latest drugs in development that reduce intraocular pressure in ocular hypertension and glaucoma - Jayanetti, V.; Sandhu, S.; Lusthaus, J.A. (Journal of Experimental Pharmacology, 2020)
Glaucoma causes irreversible vision loss, with elevated intraocular pressure (IOP) being the only known modifiable risk factor. There are a variety of medical and interventional options for lowering IOP; however, despite these treatments, glaucoma continues to be a leading cause of visual impairment. Further research continues to strive for treatment options with improved side effect profiles, additional IOP-lowering effects, and ease of use. This review provides a brief summary of current IOP-lowering therapies and then outlines pipeline ocular hypotensive agents, their mechanisms of action, benefits, and side effect profiles. Advancements are seen within currently used eye drop classes such as prostaglandin analogues, Rho kinase inhibitors and nitric oxide donors, whilst there are also new drug classes, such as tyrosine protein kinase activators. Most developing drugs are topical drop formulations, with a number already having entered Phase III trials. Alternative drug delivery methods are also in development and will be briefly discussed. Pharmacological and drug delivery developments continue to provide glaucoma patients and clinicians with new options and the promise of better outcomes, particularly in terms of improved tolerance and reduced frequency of dosing.
Keywords: ophthalmological implant; ama 0076; antihypertensive agent; bamosiran; bimatoprost; cotosudil; de 126; fm 101; itri e 212; latanoprostene bunod; ncx 470; netarsudil; nyxol; omidenepag; omidenepag isopropyl; ono 9056; phentolamine; php 201; pilocarpine; prostaglandin derivative; razuprotafib; ripasudil; rki 983; sepetaprost; snj 1656; syl 040012; tak 639; unclassified drug; y 39983; antihypertensive activity; aqueous humor; aqueous humor outflow; article; central corneal thickness; conjunctival hyperemia; cornea disease; drug tolerability; drug tolerance; glaucoma; human; hyperemia; intraocular hypertension; intraocular pressure; iritis; macular edema; outcome assessment; patient compliance; priority journal; quality of life; risk assessment; risk factor; Schlemm canal; trabecular meshwork; akb 9778; ama 0076; de 117; de 126; fm 101; h 1337; h 1337; itri e 212; ncx 470; nyxol; ono 9056; php 201; rhopressa; rki 983; snj 1656; syl 040012; tak 639; vyzulta; y 39983

A Systematic Review of Economic Studies Evaluating Ophthalmic Drugs: An Analysis of the Health-state Utilities - Ribeiro, I.; Batel Marques, F.; Mendes, D.; Alves, C. (Ophthalmic Epidemiology, 2020)
Purpose: To characterize the techniques used to derive health-state utilities (HSU) in the cost-utility studies (CUS) of ophthalmic drugs. Methods: A systematic review was conducted in Pubmed/Embase until October 2019. CUS evaluating ophthalmic drugs were included. Therapeutic area, technique to derive HSU and sources of HSU were extracted. It was assessed if the HSU and the other parameters of CUS were collected from the same population. The techniques to derive HSU used in the CUS were compared to the techniques recommended by the country-specific economic evaluation guidelines. Results: Seventy CUS were included. Forty-three (61.4%) used direct techniques to derive HSU, 19 (27.1%) used indirect, 1 (1.4%) used direct and indirect and the remaining (n = 7; 10.0%) used other or unknown techniques. Twelve (17.1%) CUS collected the HSU and the other parameters from the same population: nine (12.9%) retrieved utility data from experimental studies, two (2.9%) from observational and one (1.4%) from other sources. Forty-eight (68.6%) CUS collected the HSU and the other parameters from different populations: eight (11.4%) retrieved utility data from experimental studies, 33 (47.1%) from observational, one (1.4%) from both experimental and observational and six (8.6%) from other sources. It was not possible to identify the population from whom data were obtained in 10 (14.3%) CUS. Eleven (15.7%) CUS followed the recommendations of guidelines, 21 (30.0%) did not follow and for 38 (54.3%), it was not possible to assess. Conclusion: Choosing different techniques to derive HSU may result in different results, which can preclude the comparison between cost-utility studies.
Keywords: agents acting on the eye; age related macular degeneration; allergic conjunctivitis; cost utility analysis; diabetic macular edema; eye disease; glaucoma; health care utilization; health economics; human; practice guideline; priority journal; review; systematic review; uveitis

Glaucoma medications: Issues with adherence in a tertiary hospital in Nigeria - Onwubiko, S.N.; Nwachukwu, N.Z.; Eze, B.I. (Family Medicine and Primary Care Review, 2020)
Background. Patient adherence with glaucoma medical therapy remains a global challenge. Objectives. To determine the prevalence of non-adherence and identify the determinants and deterrents to glaucoma medications in Enugu, southeast Nigeria. Material and methods. This study adopted a cross-sectional, descriptive, hospital-based survey involving 114 glaucoma patients on topical medications. They were recruited from the ophthalmic clinic of the University of Nigeria Teaching Hospital, Enugu. Information on their socio-demographic characteristics, clinical profile and issues of adherence with glaucoma medications were collected using a pre-tested, close-ended, interviewer–administered questionnaire. The data collected was analysed using SPSS version 21. Bivariate analysis was done to identify the associations of different factors of adherence with glaucoma medications. The level of significance was set at p < 0.05. Results. The participants were comprised of 58 males (50.9%) and 56 females (49.1%), with a mean age of 60.0 ± 14.8 years. Most were mainly on two or less glaucoma medications (92 (80.7%)) and were diagnosed with glaucoma for less than 5 years (73 (64.0%)). 42 (36.8%) participants were non-adherent with their glaucoma medications. Assisted administration of glaucoma medication was the most important determinant of non-adherence to medication. Gender, good/fair vision, distance from the pharmacy, knowledge of the disease and educational status also contributed. Cost was the major deterrent (59 (51.7%)) to adherence with glaucoma medications. Conclusions. The prevalence of non-adherence with medications among glaucoma patients in Enugu was high. Assisted drug administration was the most significant determinant, while the cost of drugs was a major deterrent to non-adherence with glaucoma medica-tion.
Keywords: adolescent; adult; aged; article; child; cross-sectional study; disease duration; educational status; female; glaucoma; health care cost; health care facility; health insurance; human; human experiment; male; medication compliance; middle aged; Nigeria; patient compliance; pharmacy (shop); prevalence; questionnaire; risk factor; tertiary care center; treatment refusal; very elderly

Abiraterone in patients with recurrent epithelial ovarian cancer: principal results of the phase II Cancer of the Ovary Abiraterone (CORAL) trial (CRUK – A16037) - Banerjee, S.; Tovey, H.; Bowen, R.; Folkerd, E.; Kilburn, L.; McLachlan, J.; Hall, M.; Tunariu, N.; Attygalle, A.; Lima, J.P.D.S.N.; Perry, S.; Chatfield, P.; et al. (Therapeutic Advances in Medical Oncology, 2020)
Background: Recurrent epithelial ovarian cancer (EOC) remains difficult to treat, with an urgent need for more therapy options. Androgens bind to the androgen receptor (AR), commonly expressed in EOC. CYP17 inhibitor abiraterone irreversibly inhibits androgen biosynthesis. The Cancer of the Ovary Abiraterone (CORAL) trial was designed to evaluate the clinical activity of abiraterone in EOC. Patients & Methods: CORAL was a multi-centre, open-label, non-randomised, 2-stage phase II clinical trial. Eligible patients had progression within 12 months of last systemic therapy and no prior hormonal anti-cancer agents. Patients received abiraterone 1000 mg daily plus 5 mg prednisone until progression. The primary endpoint was objective response rate (ORR) according to combined Response Evaluation Criteria in Solid Tumours/Gynaecological Cancer Intergroup (RECIST/GCIG) criteria at 12 weeks. Secondary endpoints included clinical benefit rate (CBR) at 12 weeks. Results: A total of 42 patients were recruited; median age 65 (range 34–85) years; 37 (88.1%) had high-grade serous tumours; 20 (48%) had at least three prior lines of therapy; 29/40 (72.5%) were AR+. In stage 1, 1/26 response was observed (in an AR+, low-grade serous EOC); response lasted 47 weeks. Overall, 12 week ORR was 1/42 (2%), CBR was 11/42 (26%) (8/29 (28%) in AR+ patients). Disease control was ⩾6 months for 4/29 (14%). One patient (AR+, low-grade serous) had a RECIST response at 82 weeks. Four (10%) had grade ⩾3 hypokalaemia; 11 (26%) had dose delays. Conclusions: CORAL represents the first trial of an AR targeted agent in ovarian cancer. While responses were rare, a subset of patients achieved sustained clinical benefit. Targeting AR in EOC including low-grade serous cancer warrants further investigation. Trial registration: CORAL is registered on the ISRCTN registry: ISRCTN63407050; http://www.isrctn.com/ISRCTN63407050.
Keywords: ISRCTN63407050; abiraterone; androstenedione; doxorubicin; estradiol; prasterone sulfate; prednisolone; prednisone; testosterone; abdominal discomfort; abdominal pain; adult; aged; anemia; article; atrial fibrillation; backache; cancer recurrence; clinical article; computer assisted tomography; constipation; controlled clinical trial; controlled study; coughing; decreased appetite; diarrhea; drug withdrawal; dyspepsia; dyspnea; fatigue; female; glaucoma; headache; hematuria; histology; hot flush; human; hypertension; hypertransaminasemia; hypokalemia; lower respiratory tract infection; middle aged; muscle spasm; muscle weakness; nausea; nuclear magnetic resonance imaging; ovary carcinoma; overall survival; patient compliance; peripheral edema; peripheral neuropathy; phase 2 clinical trial; progression free survival; prospective study; rash; tachycardia; treatment duration; treatment response; urinary tract infection; very elderly; vomiting

Loss to follow-up amongst glaucoma patients in selected hospitals of the Limpopo Province, South Africa - Tshivhase, S.E.; Khoza, L.B.; Tshitangano, T.G. (African Vision and Eye Health, 2020)
Background: Glaucoma is associated with visual field loss for which elevated intraocular pressure is the primary risk factor. Proper medication adherence requires daily intake of prescribed medication for a lifetime. Non-adherence patients are at greater risk of poor outcome than adherent Aim: To identify behavioural determinants contributing to loss to follow-up amongst glaucoma patients. Setting: The study was conducted in selected hospitals of South Africa. Methods: A hospital-based cross-sectional study was conducted on glaucoma patients with age ranging from 18 years and above. Quantitative methods were used to collect data from purposefully selected glaucoma patients. Structured questionnaires were distributed to collect data from patients attending glaucoma clinics. The patients should have missed an appointment review at least once during the 12-month period. Results: Amongst the 429 glaucoma patients interviewed, the majority (79%, n = 341) of the patients missed their follow-up more than once during the 12-month period. The most cited contributory barriers to poor follow-up were accessibility (26%) followed by lack of escort and financial cost at 22% and 21%, respectively. About 115 of the 429 study respondents were found to be non-adherent. The main reasons given were shortage of medication and forgetfulness at 36% and 29%, respectively. Conclusion: Accessibility and lack of escort were significant barriers to loss to follow-up. Identifying the predictors of poor follow-up can help in improving follow-up care. Therefore, patient education and support may improve adherence to glaucoma therapy.
Keywords: adult; article; cross-sectional study; female; finance; follow up; glaucoma; human; interview; major clinical study; male; patient attendance; patient escort service; quantitative analysis; rural hospital; South Africa; structured questionnaire; young adult

Outcomes in pediatric glaucoma - Kapoor, C.; Jiang, A.; Brandt, J.D. (Journal of Investigative Medicine, 2020)
Purpose of study To determine visual outcomes and risk factors for vision loss for patients with childhood-onset glaucoma, to externally validate a provisional glaucoma severity scale, and to explore potential additional risk factors impact long term visual outcomes. Methods used Retrospective review of electronic medical records of patients with a history of pediatric glaucoma. Data collected included initial presentation characteristics such as age, IOP, and refraction status, prior surgeries, acquired and non-acquired ocular conditions, glaucoma subtype, number and types of glaucoma surgeries, unilateral and bilateral disease, insurance type, patient adherence to prescribed follow-up (number of no-show appointments), along with demographic characteristics. Univariate analysis was used to determine associations between each putative factor and ultimate visual outcome. Summary of results 177 patients with a diagnosis of childhood glaucoma were identified; 153 eyes of 93 patients met inclusion criteria. Male:Female ratio was 49:51. Mean age at presentation was 4.69 ± 6.23 years. Mean duration of follow-up was 9.64 ± 3.60 years. Ethnicity (non-Hispanic and Hispanic or Latino) was associated with poor visual outcomes (p=0.005). Of our 93 patients, 52 (56%) had private insurance, 33 (35%) had Medicaid, and 8 (9%) had unknown insurance type; private insurance was associated with a better outcome (p=0.021). Many patients missed appointments (3.98 ± 5.44 average no-show rate) but increased no-shows were associated with poor visual acuity (p=0.024). Conclusions Previously-documented risk factors for poor visual outcome include glaucoma subtype and ethnicity. We identified new risk factors including increased no-show appointments and non-private insurance type as strongly correlated with poor visual outcomes. These factors' influence on visual outcomes can help develop targeted interventions for glaucoma care.
Keywords: blindness; child; childhood; conference abstract; controlled study; demography; electronic medical record; ethnicity; female; follow up; glaucoma surgery; Hispanic; human; intraocular pressure; low vision; major clinical study; male; medicaid; patient history of surgery; preschool child; retrospective study; risk factor; univariate analysis

Noncompliance with prescribed eyedrop regimens among patients undergoing cataract surgery-prevalence, consequences, and solutions - Matossian, C. (US Ophthalmic Review, 2020)
Following cataract surgery, patients are typically prescribed antibiotic, non-steroidal anti-inflammatory drug and corticosteroid eyedrops, each of which may be administered with a different frequency. However, patient noncompliance with prescribed eyedrop treatment is prevalent and may lead to a less than ideal outcome, with potential complications such as infection or inflammation. Numerous studies have been conducted to evaluate the extent of patient noncompliance and to identify contributing factors. The majority of these studies have focused on patients with glaucoma, because it is a chronic disease requiring lifelong use of eyedrops. Patients who have undergone cataract surgery may face greater challenges with drop instillation than glaucoma patients because of limited experience with eyedrops prior to surgery. Additionally, cataracts most often affect older persons, in whom physical or cognitive limitations may further impede successful eyedrop administration. New methods of drug delivery that bypass patient compliance are currently available. They include surgery with fewer drops as well as medication delivery systems injected or deposited into ocular structures perioperatively. These drug delivery methods not only reduce topical drop administration, but have supplanted eyedrop use in many countries. Alternative drug delivery systems are increasingly being adopted in the USA.
Keywords: ophthalmic drug insert; antibiotic agent; dexamethasone; eye drops; nonsteroid antiinflammatory agent; placebo; steroid; cataract; cataract extraction; drug absorption; drug delivery system; drug efficacy; drug instillation; drug safety; endophthalmitis; Food and Drug Administration; health belief; human; intraocular hypertension; medication compliance; patient attitude; patient compliance; postoperative care; postoperative infection; postoperative pain; prescription; prevalence; retina macula cystoid edema; review; treatment refusal; dextenza; dexycu

Big data analysis to uncover determinants of patient appointment compliance at Kresge Eye Institute - Khambati, A.; Dowell, L.; Juzych, D.; Jayakumar, J.; Rao, S.; Ramesh, P.; Ravi, J.; Kim, C.; Syeda, S.; Juzych, M.; Kumar, A. (Investigative Ophthalmology and Visual Science, 2020)
Purpose : Patient appointment compliance (AC) remains a major obstacle to the physicianpatient relationship and in health care delivery. This study aims to uncover appointment and patient characteristics functioning as determinants to AC at Kresge Eye Institute (KEI). Methods : Retrospective analysis of electronic medical records (EMR) was performed across all appointments scheduled 01/2014 to 12/31/2018 at KEI's 23 out-patient Michigan locations. Patient arrival to appointment was classidied as compliant (CO) and patient cancellation/no-show was classidied as non-compliant (NC). Driving distance (DD) was generated from patient zip code. Appointment rank (appt rank) describes relative chronology in patient appointments. The following statistical analyses were used: chisquare (categorical and binary variables), Mann-Whitney U (continuous variables), and logistic regression (to control for covariates). Results : A total of 835,207 appointments across 13 ophthalmic specialties were studied. Our population was predominantly African American (59.65%), female (60.5%), and mean age at appointment was 57.6 yrs (IQR: 47.4-71.4; SD 20). Medicare was the most frequent primary insurance at 258,414 appointments. Mean DD was 17.4 miles (range 0.3-578; SD 9.3). Overall, 60.3% of appointments were classidied as CO. Relative to NC, CO appointments were associated with patients who were older (62.8 vs. 58.8 years; p<0.00001), male (40.1% vs. 38%; p<0.0001), higher appointment rank (7 vs. 6; p<0.00001), and Medicare insurance (32.2% vs. 29.1%; p<0.0001). Retina and Glaucoma specialties had significantly more CO than NC patients (p<0.0001). DD differed significantly across CO and NC (CO IQR:13.4 to 20 miles; NC IQR: 16.8 to 20 miles). When covariates were controlled for (DD, age, race, sex, specialty, scheduling location/provider), then DD was found to be a significant predictor of AC (p<0.0001, OR: 0.997, 95 CI: 0.996 to 0.997)- though the most powerful predictor was sex (p<0.0001, OR: 1.087, 95 CI: 1.05 to 1.12). Conclusions : Demographic and administrative characteristics were found to be associated with AC. It is notable that driving distance was found to be associated with AC even when all other confounders were controlled for. Interestingly, patient sex was found to be the most powerful predictor of AC. In the future, patient accessibility and satisfaction can be considered with AC to better the quality of care.
Keywords: adult; African American; big data; chronology; clinical article; conference abstract; controlled study; demography; electronic medical record; female; glaucoma; health care delivery; human; male; medicare; Michigan; middle aged; outpatient; race; retina; retrospective study; satisfaction

Digital media effects in eye care: Overcoming language barriers to improve patient education and compliance - Parekh, J.G.; Sinha, R.; Parekh, S. (Investigative Ophthalmology and Visual Science, 2020)
Purpose : To determine if comprehension and compliance improve with Spanish digital media in primarily Spanish speaking glaucoma patients. Methods : Research was conducted at EyeCare Consultants of NJ's Woodland Park location. Two ophthalmologists treated and surveyed 75 glaucoma patients in three 25-person groups: primarily English speaking (ES), Spanish speaking (SS), and Arabic speaking (AS). Placement was determined by the language the doctor (ECPs) or translator spoke when communicating. At onset, all patients were shown the same glaucoma educational videos in English using CheckedUp's platform. At visit conclusion, patients were asked: "Did the videos help you better understand your condition?" In follow up, before seeing their ECPs, patients were shown the same videos except for SS group who saw Spanish versions instead. Patients were again asked the same concluding question to measure changes in understanding. ECPs also tracked treatment adherence after each visit to determine differences. Results : The survey results demonstrate all groups increased glaucoma comprehension after the second visit compared to the first. Only 60% of ES, 48% of AS, and 44% of SS patients felt CheckedUp videos helped them better understand glaucoma after the first visit. These figures rose to 88%, 64%, and 84% after the second visit. ECPs also noted SS and ES patients demonstrated improved adherence after the second visit, while AS patients' did not change. Conclusions : SS group showed the greatest increase between the first and second visits with regard to reporting better understanding of glaucoma. We conclude digital media translated into patients' comfort languages better serves to educate at the point of care. The ES group had the most patients reporting CheckedUp videos helped comprehension after the first visit. This is likely because every group was shown the same video in English, the ES group's comfort language, during the first visit. ES and AS groups showed less comprehension improvement between visits compared to the SS group. The improvement shown by the former two groups can be attributed to repetition. Trends indicate greater compliance accompanies better patient education when presented in a patient's comfort language. The findings demonstrate the need for digital solutions like CheckedUp to develop more language offerings so benefits can more inclusively improve all patients' experiences.
Keywords: adult; comfort; communication barrier; comprehension; conference abstract; consultation; eye care; female; follow up; forest; glaucoma; human; major clinical study; male; ophthalmologist; patient education; speech; videorecording

The role of digital education in eye care for a new immigrant population: The Bangladeshi-American experience - Parekh, B.; Patel, K.; Velasquez, N.; Parekh, S.; Parekh, J.G. (Investigative Ophthalmology and Visual Science, 2020)
Purpose : To determine whether digital media in conjunction with clinical counseling increases primarily Bengali speaking glaucoma patients' medical comprehension and compliance with treatment regimens. Methods : The research was conducted at EyeCare Consultants of New Jersey's location in Woodland Park, New Jersey. Two ophthalmologists treated and surveyed a total of 100 Bengali-American glaucoma patients randomly divided into two 50-person groups: one that received only clinical counseling with a family interpreter, and one that received digital media education in addition to clinical counseling. For the second group, at the start of their initial visit, all patients were shown the exact same set of glaucoma educational videos in English using the CheckedUp platform. A family member translated the videos while the visual media played. At the end of their visit, every patient was asked: “Did the videos help you to better understand your condition?” This same question was asked over the course of three visits to measure any changes in understanding. In addition, ophthalmologists tracked treatment adherence after each visit to determine any differences therein. Results : The survey results demonstrated that the patient group that received digital media education showed increased comprehension of glaucoma after their third visit as compared to the control group. Specifically, 60% of the Bangladeshi patients who received both clinical counseling and digital media education felt that the CheckedUp videos helped them better understand their glaucoma and what needed to be done to treat the condition. Conclusions : Considering that the variable patient group reported a greater percentage of patients who understood glaucoma, it was concluded that digital media alongside clinical counseling can serve to educate Bangladeshi immigrants at the point of care. Moreover, the doctors' observations indicate that patient education is strongly correlated to compliance, suggesting that digital media improves patient compliance. This digital tool may be indispensable for all immigrant-Americans who seek healthcare and where English may be a challenge, and eventually, we hope to have a system where the digital education is presented in the patients' native language.
Keywords: adult; American; Bangladeshi; comprehension; conference abstract; consultation; controlled study; counseling; eye care; female; forest; glaucoma; human; immigrant; language; major clinical study; male; New Jersey; ophthalmologist; patient education; randomized controlled trial; speech; videorecording

Weather patterns associated with 'no-shows' and cancellations in glaucoma clinic - Mehran, N.A.; Ojalvo, I.; Zhang, Q.; Myers, J.S.; Razeghinejad, R.; Kolomeyer, N.; Lee, D. (Investigative Ophthalmology and Visual Science, 2020)
Purpose : Patient non-adherence to follow-up appointments has been associated with more severe glaucomatous defects. Identifying weather-related factors that are associated with 'no-shows' and cancellations could result in considerable administrative insight and assist in designing interventions to avoid negative patient consequences. Methods : A retrospective review of appointment records from June 1, 2017 - May 31, 2019 was performed at an urban tertiary eye hospital. 36810 visits from 7383 patients were included in this study. Data collection included clinic type (resident vs. attending), patient age, gender, insurance, distance, and appointment type). Visits were divided into 3 groups based on appointment status: kept (64.6%), cancelled (23.5%), and no-show (11.8%); statistical correction was performed for repeat visits by the same patient. Daily Weather Records and Storm Events database were analyzed from the National Centers for Environmental Information website and included: average(avg), minimum(min), maximum(max) temperature (T in °F), avg precipitation (in), avg snowfall (in), avg wind speed (mph), and presence/type of storm event. Results : Age and gender were statistically different between patients who kept their appointments versus those who cancelled or were 'no-shows' (p < 0.0001, Kruskal-Wallis and Fischer Exact test). Using multivariable logistic regression the following factors were (positively or negatively) associated with likelihood of patient 'no-show': avg snowfall [OR 1.27 (95% CI: 1.17, 1.37)]; presence of a storm event [OR 1.41 (1.31, 1.51)]; avgT [OR 0.93 (0.90, 0.96)]; minT [OR 1.02 ( 1.01, 1.03)]; maxT [OR 1.04 ( 1.03, 1.06)]; and avg windspeed [OR 0.98 ( 0.97, 0.99)]. Using multivariable logistic regression the following factors were associated with likelihood of patient cancellation: avg snowfall [OR 1.37 (1.29, 1.45)]; avgT [OR 1.02 (1.01, 1.03)]; maxT [OR 0.99 ( 0.98, 0.99)]; and presence of a strom event [OR 1.12 (1.03, 1.21)]. Conclusions : Patient age, gender and daily weather (temperature, snowfall, wind speed, and storm events) were significantly associated with rates of patient cancellations and 'noshows' in glaucoma clinic. Understanding these variables will help plan for weather-related schedule adjustments and suggests weather is an under-analyzed factor in patient followup rates that warrants further investigation.
Keywords: adult; conference abstract; controlled study; female; follow up; gender; glaucoma; human; insurance; major clinical study; male; precipitation; resident; retrospective study; storm (weather); wind speed

Preservative-free versus preserved latanoprost eye drops for reducing intraocular pressure: A non-inferiority phase iii randomized, multi-center, single-blind, parallel-group controlled trial - Theodosiadis, P.; Konstas, A.; Halkiadakis, I.; Dimera, V.; Koufakis, D.; Georgakopoulos, C.D.; Kanonidou, E.; Zintzaras, E.; Soulele, K.; Maigaritis, A.; Kalantzi, L. (Medical Hypothesis, Discovery, and Innovation in Ophthalmology, 2020)
Background: The aim of this study was to test the non-inferiority of preservative-free (PF) latanoprost 50 μg/mL multi-dose ophthalmic solution versus the marketed benzalkonium chloride (BAK)-preserved latanoprost 50 μg/mL ophthalmic solution in patients with open-angle glaucoma and patients with ocular hypertension. Methods: This was a prospective, national, randomized, multi-center, observer-blind, parallel-group controlled clinical trial. Patients were randomized to receive either PF or BAK-preserved latanoprost once daily for 12 weeks. The primary endpoint was the change in intraocular pressure (IOP) at 8:00 AM in the affected eye between the end of the treatment (week 12) and the baseline (week 0). Secondary measurements were taken at weeks 2 and 6, with IOP being recorded at 8:00 AM, 12:00 PM, and 4:00 PM. Results: A total of 158 patients were included in the per protocol (PP) population (77 in the PF latanoprost treatment arm and 81 patients in the BAK-preserved latanoprost treatment arm). PF latanoprost was non-inferior to BAK-preserved latanoprost in reducing IOP at 8:00 AM in the study eye from the baseline (week 0) to the end of the treatment (week 12). The point estimate of the between-treatment difference was 0.1 mmHg (95% confidence interval: -0.646, 0.847). Mean between-group differences in IOP reduction from the baseline to each of the secondary measurements were also similar between the two treatment arms. The two treatments were well tolerated and had comparable adverse event profiles. Conclusions: PF latanoprost was non-inferior to BAK-preserved latanoprost in reducing IOP in patients with open-angle glaucoma or ocular hypertension. Both treatments were well tolerated.
Keywords: EU-CTR201700291029; visual acuity chart; benzalkonium chloride; Benzalkonium chloride preserved latanoprost; drug preservative; latanoprost; adult; aged; arterial pressure; article; best corrected visual acuity; blepharitis; blurred vision; conjunctival hyperemia; controlled study; drug efficacy; drug safety; drug tolerability; drug withdrawal; dry eye; erythema; evaluation and follow up; eye burning; eye disease; eye irritation; eye movement; eye pain; eye redness; eye surgery; female; good clinical practice; headache; human; informed consent; intraocular foreign body; intraocular hypertension; long term care; major clinical study; male; middle aged; multicenter study; multiple cycle treatment; ocular pruritus; patient compliance; periocular skin irritation; phase 3 clinical trial; physical sensitivity and tolerance; prospective study; punctate keratitis; risk factor; single blind procedure; skin irritation; slit lamp microscopy; visual acuity; visual analog scale; xalatan

A double masked randomised 4-week, placebo-controlled study in the USA, Thailand and Taiwan to compare the efficacy of oral valganciclovir and topical 2% ganciclovir in the treatment of cytomegalovirus anterior uveitis: Study protocol - Takhar, J.S.; Joye, A.S.; Somkijrungroj, T.; Laovirojjanakul, W.; Lin, C.-P.; Lietman, T.M.; Porco, T.C.; Keenan, J.D.; Gebreegziabher, E.A.; Seitzman, G.D.; Rose-Nussbaumer, J.; Doan, T.A.; et al. (BMJ Open, 2019)
Introduction Cytomegalovirus (CMV) anterior uveitis is a recognised cause of anterior uveitis in immunocompetent patients and is preventable cause of vision loss. Ocular sequelae include corneal endothelial damage which can cause corneal oedema and failure, as well as glaucoma. Recurrences of inflammation are common and therefore patients are often exposed to long-term therapy. Oral therapy is available in the form of valganciclovir, although with the caveat of systemic side effects such as bone marrow suppression and renal failure necessitating regular interval laboratory monitoring. Recent reports have demonstrated that topical 2% ganciclovir solution may offer promising treatment outcomes in patients with CMV anterior uveitis with superior safety, cost-effectiveness and convenience profiles. An investigation into the relative equipoise of these therapies is warranted for these reasons. Methods and analysis The Systemic and Topical Control of Cytomegalovirus Anterior uveitis: Treatment Outcomes (STACCATO) trial is designed as a multicentre, block randomised by site, double-masked, placebo-controlled trial comparing the efficacy of oral valganciclovir, 2% topical ganciclovir and placebo in treating PCR-proven CMV anterior uveitis. Participant clinical evaluation will occur at three study time points by a masked study ophthalmologist over a 28-day period to assess resolution of ocular inflammation (secondary outcome). A control group will provide additional information about the possible impact that the infected host's immune response may play in controlling local viral replication. The primary analysis is an analysis of covariance (three arms) correcting for baseline to compare quantitative CMV viral load in the anterior chamber (AC) aqueous fluid before and 7 days after treatment. Ethics and dissemination The University of California San Francisco Committee on Human Research and the Khon Kaen University Institutional Review Board have given ethical approval. The results of this trial will be presented at local and international meetings and submitted for peer-reviewed journals for publication. Trial registration number NCT03576898.
Keywords: NCT03576898; ganciclovir; placebo; valganciclovir; adult; anterior eye chamber; aqueous humor; article; clinical evaluation; clinical outcome; clinical trial protocol; comparative effectiveness; controlled study; cost effectiveness analysis; Cytomegalovirus; cytomegalovirus infection; double blind procedure; drug safety; equipoise; eye inflammation; human; immune response; iridocyclitis; multicenter study; nonhuman; patient compliance; polymerase chain reaction; quantitative analysis; randomized controlled trial; Taiwan; Thailand; treatment response; United States; virus load; virus replication

A systematic review of the adverse events and economic impact associated with oral corticosteroids in asthma - Al Efraij, K.; Johnson, K.M.; Wiebe, D.; Sadatsafavi, M.; FitzGerald, J.M. (Journal of Asthma, 2019)
Background: Oral corticosteroids (OCSs) are often used to achieve asthma control. OCS-related comorbidities increase the burden of disease for patients and healthcare providers. Most studies characterizing OCS use and risk of adverse events (AEs) are in non-asthma patients. We sought to systematically review the literature on the burden of OCS use among adults with asthma. Methods: We systematically reviewed the literature including MEDLINE (1946–May 2017), EMBASE (1974–May 2017), and the Cochrane Library (2005–May 2017) to identify studies that considered AEs due to OCS treatment of adults with asthma, their burden on healthcare utilization, and costs. Results: We retrieved 9,589 citations; and 15 studies were included. AEs were significantly higher among OCS-users compared with non-OCS users with pooled adjusted odds ratio (OR) 1.68 (95% CI 1.15–2.46) for diabetes mellitus and 1.34 (95% CI 1.23–1.46) for hypertension. Among high dose OCS-users (>10 mg) compared with non-OCS users, the pooled adjusted ORs for development of any complication was 3.35 (95% CI 2.94–3.82), and bone and muscle complications 2.30 (95% CI 2.18–2.42). The risk of any complication increased with higher doses of OCS, with pooled adjusted OR from 2 studies of 2.26 (95% CI 1.37–3.72), 2.94 (95% CI 2.62–3.29) and 3.35 (95% CI 2.94–3.82) for low dose (<6 mg), medium dose (5–12 mg) and high dose (>10 mg) respectively compared with no OCS use. Conclusions: The use of OCS in the management of asthma is associated with a higher risk of complications. This risk is higher as the OCS dose increases.
Keywords: corticosteroid; adverse drug reaction; article; asthma; bone disease; cardiovascular disease; cataract; corticosteroid therapy; diabetes mellitus; drug dose comparison; drug megadose; fracture; gastrointestinal disease; glaucoma; health care cost; health care utilization; human; hypertension; infection; low drug dose; obesity; osteoporosis; peptic ulcer; systematic review

Using Adherence-Contingent Rebates on Chronic Disease Treatment Costs to Promote Medication Adherence: Results from a Randomized Controlled Trial - Bilger, M.; Wong, T.T.; Lee, J.Y.; Howard, K.L.; Bundoc, F.G.; Lamoureux, E.L.; Finkelstein, E.A. (Applied Health Economics and Health Policy, 2019)
Background: Poor adherence to medications is a global public health concern with substantial health and cost implications, especially for chronic conditions. In the USA, poor adherence is estimated to cause 125,000 deaths and cost $US100 billion annually. The most successful adherence-promoting strategies that have been identified so far have moderate effect, are relatively costly, and raise availability, feasibility, and/or scalability issues. Objective: The main objective of SIGMA (Study on Incentives for Glaucoma Medication Adherence) was to measure the effectiveness on medication adherence of a novel incentive strategy based on behavioral economics that we refer to as adherence-contingent rebates. These rebates offered patients a near-term benefit while leveraging loss aversion and regret and increasing the salience of adherence. Methods: SIGMA is a 6-month randomized, controlled, open-label, single-center superiority trial with two parallel arms. A total of 100 non-adherent glaucoma patients from the Singapore National Eye Centre were randomized into intervention (adherence-contingent rebates) and usual care (no rebates) arms in a 1:1 ratio. The primary outcome was the mean change from baseline in percentage of adherent days at Month 6. The trial registration number is NCT02271269 and a detailed study protocol has been published elsewhere. Findings: We found that participants who were offered adherence-contingent rebates were adherent to all their medications on 73.1% of the days after 6 months, which is 12.2 percentage points (p = 0.027) higher than in those not receiving the rebates after controlling for baseline differences. This better behavioral outcome was achieved by rebates averaging 8.07 Singapore dollars ($US5.94 as of 2 November 2017) per month during the intervention period. Conclusion: This study shows that simultaneously leveraging several insights from behavioral economics can significantly improve medication adherence rates. The relatively low cost of the rebates and significant health and cost implications of medication non-adherence suggest that this strategy has the potential to cost-effectively improve health outcomes for many conditions.
Keywords: NCT02271269; antiglaucoma agent; eye drops; adherence contingent rebate; adult; aged; article; behavioral economics; chronic disease; controlled study; cost effectiveness analysis; female; glaucoma; human; major clinical study; male; medication compliance; open study; parallel design; patient compliance; randomized controlled trial; reimbursement; treatment duration; very elderly

Philadelphia glaucoma detection and treatment project: ocular outcomes and adherence to follow-up at a single health centre - Adeghate, J.O.; Hark, L.A.; Brown, H.; Henderer, J.D.; Waisbourd, M.; Molineaux, J.; Malik, K.; Maity, A.; Chuang, D.; Donches, K.; Heres, C.; Eburuoh, R.; et al. (Canadian Journal of Ophthalmology, 2019)
Objectives: To determine ocular outcomes and factors associated with adherence to ophthalmic follow-up in a medically underserved population at a single health centre in Philadelphia. Design: Retrospective chart review. Participants: Patients from a community glaucoma screening program. Methods: Chart review was conducted for participants who received a complete eye examination at the Philadelphia District Health Center 5 between January 1, 2012 and May 31, 2014 within the Philadelphia Glaucoma Detection and Treatment Project. Multivariate logistic regression was used to determine factors related to ophthalmic follow-up adherence. Results: A total of 249 participants completed an eye examination (mean age = 57.7 ± 6.9 years). Most were African American (n = 220; 88.4%); female (n = 129; 51.8%). Forty-seven participants (18.9%) received glaucoma-related diagnoses, 20 (8.0%) were prescribed ocular medication, and 26 (10.4%) underwent laser therapy. Ninety (36.1%) attended their recommended follow-up eye examination at the health centre. Glaucoma-related diagnosis (p ≤ 0.001), recommendation of a 4- to 6-week follow-up period (p < 0.001), prescribed eye drops (p < 0.001), or received laser therapy (p = 0.047) were factors most predictive of ophthalmic follow-up adherence. Conclusions: The collaborative effort of eye care providers and health centres offers an important opportunity to detect, treat, and manage glaucoma and other ocular pathology in medically underserved communities. Having a glaucoma-related diagnosis, initiating treatment, and scheduling regular follow-up visits are the most important factors influencing adherence to follow-up eye appointments.
Keywords: eye drops; adult; African American; article; cataract extraction; clinical outcome; controlled study; diabetic retinopathy; eye care; eye examination; female; follow up; glaucoma; health center; human; low level laser therapy; major clinical study; male; medical record review; medically underserved; middle aged; patient compliance; Pennsylvania; refraction error; retrospective study; screening

Determining patient preferences in a glaucoma service: A discrete choice experiment - Lu, T.C.; Angell, B.; Dunn, H.; Ford, B.; White, A.; Keay, L. (Clinical and Experimental Ophthalmology, 2019)
Importance: Patient perspectives are crucial in informing design of acceptable services. Background: This study determined patient preferences in glaucoma care. Design: A discrete choice experiment was used to evaluate the relative importance of out-of-pocket costs, waiting time, continuity of care, service location and expertise. Participants: Ninety-eight glaucoma suspects or glaucoma patients were recruited from one public and two private clinics in Sydney. Methods: Twelve choice-tasks were presented in random order and forced-choice preferences were elicited. Choice data were analysed using a multinominal logit model (NLOGIT 4.0). Main Outcome Measures: The relative importance and the likelihood of choosing services with each attribute were determined. Willingness-to-pay and willingness-to-wait were calculated. Analyses were stratified by whether the patient attended a public or private glaucoma clinic and other demographic features. Results: Choice was influenced by four or five attributes: greater clinician expertise, the same clinician each visit, lower out-of-pocket costs and shorter wait times (all P <.05). Respondents were willing to pay an additional (Australian dollars) $325 (95% confidence interval [CI] 188-389) to see a senior eye doctor, and $87 (95% CI 60-116) to see the same clinician each visit. Respondents were willing to wait for these attributes; however, the estimates had wide confidence intervals and were beyond the range tested. Private patients had a stronger preference for expertise and continuity of care compared to public patients. Conclusions and Relevance: Expertise and continuity of care were important to glaucoma patients in this setting, and they were willing to pay out-of-pocket and concede longer waiting times to secure these preferences.
Keywords: adult; aged; article; Australia; demography; female; glaucoma; health care cost; health care personnel; health service; hospital admission; human; major clinical study; male; medical expert; medical fee; middle aged; ophthalmologist; patient attendance; patient preference; pilot study; private hospital; public hospital; Willingness To Pay; work experience

Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis - Utz, V.M.; Bulas, S.; Lopper, S.; Fenchel, M.; Sa, T.; Mehta, M.; Ash, D.; Lovell, D.J.; Kaufman, A.H. (Pediatric Rheumatology, 2019)
Background: Refractory non-infectious uveitis is a serious condition that leads to ocular complications and vision loss and requires effective systemic treatment to control disease. The effectiveness of long-term infliximab [IFX] in refractory non-infectious childhood uveitis and the impact of treatment adherence on disease control were evaluated. Methods: Retrospective, single-center study between December 2002 and April 2016 of 27 children with refractory non-infectious uveitis [17 with juvenile idiopathic arthritis, JIA] treated with long-term IFX [9+ months]. Disease activity was assessed prior to and while on IFX using the Standardization of Uveitis Nomenclature [SUN]. Number of visits per year with active uveitis was analyzed by repeated measures logistic regression analysis from 2 years prior to IFX initiation or from onset of uveitis until most recent visit on IFX. Incomplete treatment adherence was assessed for each visit and defined as any deviance in corticosteroid use, prescribed infusion frequency, and/or follow-up examination frequency. Results: Primary outcomes were sustained uveitic and systemic disease control prior to and during IFX treatment and the impact of incomplete adherence on uveitic disease control while on IFX. Secondary outcomes included corticosteroid and glaucoma medication requirement, ocular complications and need for surgical intervention. Mean age at IFX initiation was 10.4 ± 4.5 years; initial mean dose was 6.6 ± 2.2 mg/kg [and given at weeks 0, 2, 4 and q4 weeks thereafter for 93%]. Median duration on IFX was 35 [range 9-128] months. Prior to IFX, 14/27 patients had failed adalimumab ± methotrexate [MTX]; 21/27 failed MTX. IFX led to uveitis control in 89% and arthritis control in 76% (13/17). The odds ratio of having controlled disease after IFX was 4.1 (2.6, 6.4) compared to pre-treatment visits. Topical corticosteroids and glaucoma medications were statistically decreased (p = 0.007 right eye [OD], 0.003 left eye [OS] and p = 0.001 OD, p = 0.028 OS respectively). Incomplete adherence to treatment showed 10.3 times greater odds (7.1, 15.0) of having disease activity than full adherence. Conclusions: This study adds significantly to the IFX literature by documenting outstanding uveitis control with long-term IFX treatment in non-infectious pediatric uveitis patients. Higher dosage and shorter interval were utilized without adverse effects. Importantly, this is the first study, to our knowledge, to document the significant impact of treatment adherence on uveitis control.
Keywords: adalimumab; antiglaucoma agent; difluprednate; infliximab; methotrexate; prednisolone acetate; article; band keratopathy; cataract; child; clinical article; controlled study; disease activity; disease assessment; disease control; drug effect; female; follow up; human; hypotension; juvenile rheumatoid arthritis; long term care; male; medication compliance; outcome assessment; patient compliance; prescription; priority journal; retina macula cystoid edema; retrospective study; school child; standardization; treatment duration; treatment outcome; uveitis

Toward Better Health Outcomes in Rural and Under-served Areas: L. V. Prasad Eye Institute’s Diagonal Model of Glaucoma Care - Choudhari, N.S.; Mundhe, G.; Khanna, R.; Rathi, V.; Garudadri, C.S. (Ophthalmic Epidemiology, 2019)
Purpose: L. V. Prasad Eye Institute has adopted horizontal approach of eye care delivery for the past 22 years at one of its rural secondary centers. The recent implementation of a diagonal model for enhancing glaucoma care at this center and its outcomes are reported. Methods: This was a retrospective case-control study. We included newly and consecutively diagnosed adult glaucoma patients. A comprehensive ophthalmologist provided glaucoma care. During the study period, an experienced glaucoma specialist supported the care for 2 days every month in a structured format that consisted of triaging glaucoma patients for defined protocols of therapy along with hands-on and remote online guidance to the comprehensive ophthalmologist. The data from the worst or single eye were analyzed. Results: We have included 231 patients (151 study and 80 historical controls). Sixty (75%) control patients were managed at the study center and 20 (25%) were referred. The comprehensive ophthalmologist managed 70 (48.2%) study patients and co-managed 75 (51.7%) with the glaucoma specialist. The latter changed the diagnosis in 15 eyes and altered the treatment plan in 44 eyes. Six were excluded. Successful outcome was achieved in 52 (65%) eyes in the control group and 120 (84.5%) eyes in the study group (P <.01). Additionally, study group did better in terms of case detection rate, compliance to treatment and saving on expenses for patients. Conclusion: The new model has shown better clinical outcomes of glaucoma care in an under-served geographic area. The model has the potential for wider applicability.
Keywords: adult; article; case control study; clinical outcome; closed angle glaucoma; conservative treatment; controlled study; cost control; disease severity; eye care; female; glaucoma; glaucoma surgery; gonioscopy; health care cost; health care delivery; human; laser surgery; major clinical study; male; medical specialist; medically underserved; open angle glaucoma; ophthalmologist; patient care; patient compliance; patient safety; priority journal; retrospective study; rural health care; rural population; secondary glaucoma; treatment outcome

Referral to community care from school-based eye care programs in the United States - Shakarchi, A.F.; Collins, M.E. (Survey of Ophthalmology, 2019)
Approximately 25% of school-aged children in the United States have vision abnormalities, most commonly refractive error that can be corrected with spectacles. Limited follow-up adherence after failed school-based vision screening led to an increase in school-based eye care programs that provide screening, eye examinations, and spectacle prescription at the school. These programs address the access barrier and often provide the first point of contact between children and eye care. Nevertheless, several lower prevalence conditions, such as amblyopia, strabismus, and glaucoma, cannot be adequately treated in the school setting, and some require frequent and long-term follow-up, necessitating referral to eye care providers in the community. We conducted a literature review and identified 10 programs that provided school-based screening, examinations, and spectacle prescription and reviewed their referral rates, criteria, mechanisms, adherence, ocular findings at referral, and long-term care plans. Most programs referred 1% to 5% of screened children. Most communicated with parents or guardians through referral letters and used various strategies to incentivize adherence. Referral adherence was 20-50% in the four programs that reported these data. School-based eye care programs rarely referred children for long-term follow-up care needs, such as updating spectacle prescriptions annually.
Keywords: community care; eye care; eye examination; follow up; health care access; health care delivery; human; long term care; mass screening; patient compliance; patient referral; priority journal; review; risk factor; school; United States; vision test

Prescription pattern of ocular hypotensive drugs in Portugal and its comparison with the European guidelines – PEM Study - Pimenta, G.; Sousa, D.C.; Leal, I.; Marques-Neves, C.; Abegão Pinto, L. (Acta Ophthalmologica, 2019)
Keywords: beta adrenergic receptor blocking agent; prostaglandin derivative; drug efficacy; glaucoma; human; intraocular pressure; letter; patient care; patient compliance; Portugal; practice guideline; prescription; priority journal

Characteristics of Infectious Keratitis in Bandage Contact Lens Wear Patients - Zhu, B.; Liu, Y.; Lin, L.; Huang, X.; Zhang, Y.; Zheng, J.; Jin, X. (Eye and Contact Lens, 2019)
Objective:The aim of this study was to determine the characteristics of infectious keratitis in patients wearing bandage contact lenses (BCLs).Methods:The BCL-related infectious keratitis cases were reviewed at the eye center of the Second Affiliated Hospital at the Zhejiang University School of Medicine from January 2015 to August 2018. Detailed information about the patients with infectious keratitis was collected, including the age, gender, clinical characteristics, culture results, and other measures. All the data analyses were performed using IBM SPSS Statistics for Windows version 24.0.Results:From January 2015 until August 2018, 6,385 eyes of 6,188 patients, including 3,410 males and 2,778 females, received BCLs at our hospital. The mean age of these patients was 48.10±20.81 years (range=15-78 years). The mean BCL wearing time was 18.98±23.72 days (range=1-58 days). Eight patients (0.13%) with infectious keratitis were identified, and the mean age of these patients was 54.33±28.14 years (range=16-75 years). Seven of the infectious keratitis patients were older than 50 years, and one patient was 16 years old. The infectious keratitis incidence rate of the older patients (≥50 years) was significantly higher than that of the young patients (<50 years) (χ2=9.647, P=0.002). There was a higher postkeratoplasty risk of BCL-related infectious keratitis than that in the corneal epithelial defect (χ2=21.371, P=0.000) and pterygium surgery (χ2=16.037, P=0.000) cases, but not in the corneal collagen cross-linking cases (χ2=1.792, P=0.181). The mean onset time of BCL-related infectious keratitis was 22.63±18.72 days (range=3-58 days) after wearing the BCLs. Among these 8 infected patients, 3 were noncompliant with their eye drop use and 2 extended their BCL wearing time past 30 days.Conclusion:Bandage CL-related infectious keratitis is more likely to occur in older patients. The most common risk factor for BCL-related infectious keratitis was postkeratoplasty use. Overall, appropriate indications, good compliance, and close follow-up attention are required for BCL wearers.
Keywords: autorefractor; bandage contact lens; corneal collagen cross-linking device; soft contact lens; eye drops; levofloxacin; adolescent; adult; age; aged; article; clinical feature; controlled study; cornea disease; corneal epithelial defect; female; gender; human; infection risk; keratoplasty; major clinical study; male; medical device complication; microbial keratitis; patient compliance; patient identification; postoperative complication; postoperative infection; priority journal; pterygium; retrospective study; PureVision; SureSight

Anti-vascular endothelial growth factor intravitreal therapy for retinopathy of prematurity - VanderVeen, D.K.; Cataltepe, S.U. (Seminars in Perinatology, 2019)
Retinopathy of prematurity treatment modalities have expanded over the years, from cryotherapy to laser therapy and now, anti-vascular endothelial factor (VEGF) therapy by intravitreal injection. Use of anti-VEGF treatment varies regionally and depends on multiple factors including severity and progression of ROP, availability of alternative treatments, experience of the local ophthalmologists, medical status of the infant, and expectations for long-term follow-up. While the advantages and disadvantages of anti-VEGF intravitreal treatment on the eye are relatively well-described, few studies provide information about potential long-term systemic effects of this treatment, which is known to transiently reduce systemic VEGF concentrations.
Keywords: aflibercept; bevacizumab; pegaptanib; ranibizumab; vasculotropin inhibitor; adverse outcome; cataract; drug absorption; drug efficacy; endophthalmitis; eye disease; eye inflammation; glaucoma; health care utilization; human; intraocular hemorrhage; long term care; low level laser therapy; priority journal; retina disease; retrolental fibroplasia; review; therapy effect; vitreous hemorrhage; avastin; eylea; lucentis; macugen

Effect of Corticosteroid-Sparing Treatment with Mycophenolate Mofetil vs Methotrexate on Inflammation in Patients with Uveitis: A Randomized Clinical Trial - Rathinam, S.R.; Gonzales, J.A.; Thundikandy, R.; Kanakath, A.; Murugan, S.B.; Vedhanayaki, R.; Lim, L.L.; Suhler, E.B.; Al-Dhibi, H.A.; Doan, T.; Keenan, J.D.; Rao, M.M.; et al. (JAMA - Journal of the American Medical Association, 2019)
Importance: Methotrexate and mycophenolate mofetil are commonly used immunomodulatory therapies for achieving corticosteroid-sparing control of noninfectious uveitis, but there is uncertainty about which drug is more effective. Objective: To compare the effect of methotrexate and mycophenolate for achieving corticosteroid-sparing control of noninfectious intermediate uveitis, posterior uveitis, and panuveitis. Design, Setting, and Participants: The First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial screened 265 adults with noninfectious uveitis requiring corticosteroid-sparing immunosuppressive therapy from 9 referral eye centers in India, the United States, Australia, Saudi Arabia, and Mexico between August 22, 2013, and August 16, 2017. Follow-up ended on August 20, 2018. Interventions: Patients were randomized to receive oral methotrexate, 25 mg weekly (n = 107), or oral mycophenolate mofetil, 3 g daily (n = 109). Main Outcomes and Measures: The primary outcome was treatment success at 6 months, which was defined as having control of inflammation in both eyes, no more than 7.5 mg prednisone daily and less than or equal to 2 drops of prednisolone acetate 1%, and no treatment failure due to safety or intolerability. Patients underwent follow-up to 12 months while receiving the same treatment or switched to the other antimetabolite, depending on their 6-month outcome. Results: Among 216 patients who were randomized (median age, 38 years; 135 (62.5%) women), 194 (89.8%) completed follow-up through 6 months. Treatment success occurred in 64 (66.7%) patients in the methotrexate group vs 56 (57.1%) in the mycophenolate group (difference, 9.5% [95% CI, -5.3% to 21.8%]; odds ratio [OR], 1.50 [95% CI, 0.81 to 2.81]; P =.20). Among patients with posterior uveitis or panuveitis, treatment success was achieved in 58 (74.4%) in the methotrexate group vs 42 (55.3%) in the mycophenolate group (difference, 19.1% [95% CI, 3.6% to 30.6%]; OR, 2.35 [95% CI, 1.16 to 4.90]; P =.02); whereas among patients with intermediate uveitis treatment success occurred in 6 (33.3%) in the methotrexate group vs 14 (63.6%) in the mycophenolate group (difference, -30.3% [95% CI, -51.6% to 1.1%]; OR, 0.29 [95% CI, 0.08 to 1.05]; P =.07; P for interaction =.004). Elevated liver enzymes were the most common nonserious laboratory adverse event, occurring in 14 patients (13.0%) in the methotrexate group and 8 patients (7.4%) in the mycophenolate group. Conclusions and Relevance: Among adults with noninfectious uveitis, the use of mycophenolate mofetil compared with methotrexate as first-line corticosteroid-sparing treatment did not result in superior control of inflammation. Further research is needed to determine if either drug is more effective based on the anatomical subtype of uveitis.
Keywords: NCT01829295; alanine aminotransferase; aspartate aminotransferase; creatinine; hemoglobin; methotrexate; mycophenolate mofetil; prednisolone acetate; prednisone; adult; allergic reaction; angina pectoris; ankle edema; anxiety; apathy; arthralgia; article; Australia; bloating; cataract; cerebrovascular accident; chickenpox; confusion; congestive heart failure; constipation; coughing; depression; diarrhea; disability; dizziness; drug dose increase; drug dose reduction; drug fatality; drug substitution; drug withdrawal; dyspnea; eye burning; eye irritation; eye pain; eye redness; face edema; fatigue; female; fever; flank pain; follow up; frustration; gastroesophageal reflux; genital tract infection; glaucoma; hair loss; headache; heart arrhythmia; heart palpitation; heartburn; human; hyperglycemia; hypertransaminasemia; India; infection; influenza; intraocular hypertension; leg pain; leukocyte count; major clinical study; male; malignant neoplasm; Mexico; middle aged; mood change; mouth pain; multicenter study (topic); muscle cramp; muscle weakness; myalgia; nausea; neck pain; nightmare; ocular pruritus; odds ratio; paresthesia; patient compliance; photophobia; priority journal; randomized controlled trial (topic); retina detachment; Saudi Arabia; side effect; sinus congestion; sleep disorder; sleep disordered breathing; sore throat; stomach pain; tinnitus; treatment outcome; tremor; United States; uveitis; visual acuity; visual impairment

Systematic review of the appropriateness of eye care delivery in eye care practice - Ho, K.C.; Stapleton, F.; Wiles, L.; Hibbert, P.; Alkhawajah, S.; White, A.; Jalbert, I. (BMC health services research, 2019)
BACKGROUND: Health care systems are continually being reformed, however care improvement and intervention effectiveness are often assumed, not measured. This paper aimed to review findings from published studies about the appropriateness of eye care delivery, using existing published evidence and/or experts' practice and to describe the methods used to measure appropriateness of eye care. METHODS: A systematic search was conducted using Medline, Embase and CINAHL (2006 to September 2016). Studies reporting the processes of eye care delivery against existing published evidence and/or experts' practice were selected. Data was extracted from published reports and the methodological quality using a modified critical appraisal tool. The primary outcomes were percentage of appropriateness of eye care delivery. This study was registered with PROSPERO, reference CRD42016049974. RESULTS: Fifty-seven studies were included. Most studies assessed glaucoma and diabetic retinopathy and the overall methodological quality for most studies was moderate. The ranges of appropriateness of care delivery were 2-100% for glaucoma, 0-100% for diabetic retinopathy and 0-100% for other miscellaneous conditions. Published studies assessed a single ocular condition, a sample from a single centre or a single domain of care, but no study has attempted to measure the overall appropriateness of eye care delivery. CONCLUSIONS: These findings indicated a wide range of appropriateness of eye care delivery, for glaucoma and diabetic eye care. Future research would benefit from a comprehensive approach where appropriateness of eye care is measured across multiple conditions with a single methodology, to guide priorities within eye care delivery and monitor quality improvement initiatives.
Keywords: ambulatory care; eye disease; female; health care delivery; health care quality; human; male; meta analysis; program evaluation

Medication adherence in patients with ocular hypertension or glaucoma - Robin, A.L.; Muir, K.W. (Expert Review of Ophthalmology, 2019)
Introduction: Nonadherence to medication is a challenge to effective treatment of many chronic diseases, including glaucoma, and persists even with interventions aimed at improving adherence. The reported rates of nonadherence to topical glaucoma medication vary widely from 16% to 67%, and it is estimated that less than a third of patients remained on their initial therapy after 12 months. Nonadherence can lead to disease progression and increased economic burden. Areas covered: This review examines factors that contribute to nonadherence in patients with glaucoma, including the severity of the disease, complexity of treatment, lack of knowledge in patients, poor communications between physician and patient, difficulty with self-administration of drops, side-effects, and medication costs. We discuss the unique challenges in identifying nonadherence in glaucoma patients and investigate the current approaches to improving adherence. Expert opinion: Strategies for improving adherence should combine new treatment methods with enhanced patient education. New pharmaceuticals may comprise multiple medications in a single bottle, making dosing regimens simpler. Novel drug delivery systems are in development, such as injectable products and implants releasing IOP-lowering medication without the need for self-administration. A comprehensive approach involving these new methods and more effective patient-physician communication may lead to improved adherence.
Keywords: medication adherence monitoring system; angiotensin receptor antagonist; antihypertensive agent; bimatoprost; corticosteroid; eye drops; forsight; hydroxymethylglutaryl coenzyme A reductase inhibitor; promethazine; travoprost; acute heart infarction; asthma; attitude to health; awareness; blindness; breast cancer; clinical education; clinical trial (topic); disease exacerbation; doctor patient relationship; drug delivery system; drug self administration; facial recognition; glaucoma; health care access; health insurance; hospitalization; human; hypertension; insulin treatment; interpersonal communication; intraocular hypertension; intraocular hypotension; intraocular pressure; medication compliance; meta analysis (topic); ophthalmologist; polypharmacy; questionnaire; randomized controlled trial (topic); review; survival analysis; telecommunication; treatment refusal; forsight

Utilization of secondary eye care services in western Kenya - Rono Mmed, H.K.; Macleod, D.; Bastawrous, A.; Wanjala, E.; Gichangi, M.; Burton, M.J. (International Journal of Environmental Research and Public Health, 2019)
Background: Eye care provision is currently insufficient to meet the population’s eye health needs in Kenya. Many people remain unnecessarily visually impaired or at risk of becoming so due to treatable or preventable conditions. A lack of access and awareness of services are key barriers, in large part due to their being too few eye care providers in the health system for this unmet need. Methods: A hospital-based, retrospective analysis of patients who attended Kitale eye unit, Trans Nzoia County, Kenya from 1st January 2013 to 31st December 2015. Age and sex standardized hospital attendance rates by residence, age group, and sex were calculated for Trans Nzoia county and each subcounty. The changing trends in attendance rates were estimated by calculating the difference between base year and last year. Incidence rate ratios for attendance for each age-group, sex, and residence were estimated using a multivariable regression model. Results: 20,695 patients from the county were seen in Kitale Eye Unit in 2013, 2014 and 2015. In that period, 8.3% had either uncorrected refractive error, cataracts or glaucoma, the priority VISION2020 diseases, and 61.0% had allergic or other conjunctivitis or normal eyes, which could potentially be managed at primary eye care. During the study period, overall average annual attendance rate increased from 609 to 792 per 100, 000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26–1.35). Attendance rates increased more in females than males (34.7% vs. 25.1%, respectively), IRR 1.07 (1.04–1.10). Attendance rates increased with increasing age, (highest among the elderly compared to the young). We found that in extreme age groups (>75 years and <15years) females were less likely to attend than males and there was reduced utilization from those based furthest from the hospital. Conclusion: Specialist eye services are heavily utilized by people with conditions that could be managed at the primary health care level. Barriers to accessing eye services were distance and gender, especially among the most vulnerable groups (young and the elderly). Integration of primary and secondary eye care services could lower barriers to essential eye care services to the population whilst lowering pressure on the limited specialist services by ensuring more appropriate utilization.
Keywords: adolescent; adult; aged; allergic conjunctivitis; article; cataract; chalazion; child; conjunctivitis; cornea disease; eye allergy; eye care; eye injury; female; glaucoma; health care utilization; human; incidence; infant; Kenya; major clinical study; male; newborn; patient attendance; presbyopia; refraction error; regression analysis; retina disease; retrospective study; sex ratio; uveitis; very elderly

Clinical Effectiveness of Intravitreal Fluocinolone Acetonide (FAc) (ILUVIEN™) in Patients with Diabetic Macular Oedema (DMO) Refractory to Prior Therapy: The Manchester Experience - Young, J.F.; Walkden, A.; Stone, A.; Mahmood, S. (Ophthalmology and Therapy, 2019)
Introduction: Diabetic macular oedema (DMO) remains a significant cause of sight loss in the UK. Despite macular laser and anti-VEGF agents, a large proportion of patients remain with persistent DMO. We present our results of using 0.19 mg fluocinolone acetonide (FAc) intravitreal implant in this cohort with up to 3 years of follow-up. Methods: This is a single-centre retrospective review of patients treated with FAc implant for refractory DMO. The primary efficacy end point was visual acuity and secondary efficacy end point was central retinal thickness (CRT) on OCT. A primary safety end point was a rise in IOP requiring treatment. Results: Twenty-one eyes were identified with an average follow-up of 27 months (6–36 months). Visual acuity change from baseline was − 0.1 ETDRS letters at year 1 (n = 13), 8.1 letters at year 2 (n = 13) and 10.7 letters at year 3 (n = 10). CRT improved by − 132.1 µm at year 1 (n = 15), − 172.8 µm at year 2 (n = 13) and − 157.8 µm at year 3 (n = 10). Five eyes (24%) required further anti-VEGF during follow-up and two (9.5%) required further focal laser. IOP rise requiring treatment was noted in eight eyes (38%). Seven were steroid induced. One was caused by rubeotic glaucoma. Six (75%) were managed medically and the remaining two also required surgery. Conclusion: This data add to the limited real-world data on FAc in DMO with 3 years of follow-up. Vision and macular architectures both improved at varying rates over 3 years in patients with refractory DMO. IOP rise is a risk but, in the majority, it can be managed medically.
Keywords: optical coherence tomography device; optical coherence tomography device; visual prosthesis; fluocinolone acetonide; mitomycin; adult; article; central retinal thickness; clinical article; diabetic macular edema; drug efficacy; eye axis length; female; follow up; human; implantation; male; middle aged; oculoplethysmography; optical coherence tomography; patient compliance; priority journal; retinal thickness; retrospective study; trabeculectomy; visual acuity; iluvien; 3D OCT 2000

What is the role of iStent in glaucoma management in 2019? - Chan, H.H.L.; Brooks, A.M.V. (Clinical and Experimental Ophthalmology, 2019)
Keywords: glaucoma drainage implant; nonvalved ophthalmic drainage device; cataract extraction; cost effectiveness analysis; device safety; editorial; filtering operation; glaucoma; human; hyphema; intraocular pressure; meta analysis (topic); patient compliance; patient selection; phacoemulsification; quality of life; stent complication; stent malapposition; Hydrus microstent; iStent; iStent inject

Dealing with the pressure of glaucoma management - Greener, M. (Prescriber, 2019)
Despite the availability of numerous treatments, glaucoma is still one of the leading causes of blindness in the UK. This article examines some of the factors that might be responsible, including poor compliance with eye drops and pressure on ophthalmology services, and discusses how these problems might be overcome.
Keywords: microneedle; punctal plug; alpha adrenergic receptor stimulating agent; benzalkonium; beta adrenergic receptor blocking agent; brain derived neurotrophic factor; calcium channel blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; ciliary neurotrophic factor; eye drops; n methyl dextro aspartic acid receptor; nerve growth factor; pilocarpine; prostaglandin derivative; Rho kinase inhibitor; ripasudil; age related macular degeneration; apoptosis; article; cataract; cataract extraction; closed angle glaucoma; congenital glaucoma; depression; disease exacerbation; drug delivery system; drug efficacy; follow up; glaucoma; human; iatrogenic disease; intraocular hypertension; intraocular pressure; necrosis; neuroprotection; ocular surface disease; open angle glaucoma; oxidative stress; patient compliance; physical disability; retina ganglion cell; retinal nerve fiber layer; sustained drug release; visual field; visual impairment

Real-world assessment of topical glaucoma medication persistence rates based on national pharmaceutical claim data in a defined population - Zhu, Z.; Jiang, Y.; Wang, W.; Scheetz, J.; Shang, X.; Zhang, L.; He, M. (Clinical and Experimental Ophthalmology, 2019)
Importance: The rate and determinants of persistence to topical glaucoma medications are important for identifying patients at high risk of discontinuing medications and designing targeted approaches to improve persistence. Background: To evaluate the rate and determinants of persistence to topical glaucoma medications among middle-aged and older Australian adults. Design: Population-based cohort study. Participants: Participants in need of persistent topical glaucoma medications in the 45 and Up Study. Methods: The 45 and Up Study is a large-scale population-based cohort study. Participants were classified as needing persistent topical glaucoma medications if at least three claims with related prescriptions were recorded. Persistence was defined as topical glaucoma medications were filled within 90 days. Main Outcome Measures: The rates and determinants of medication persistence at 2-year follow-up. Results: A total of 12 899 patients requiring persistent topical glaucoma medications were identified. Among them, 9019 (69.9%) had persisted with their glaucoma medications for at least 2 years. Multiple logistic regression analysis documented significant effects of patient-related factors (gender, socioeconomic status, language spoken at home, lifestyle and comorbidities) and drug-related factors (total number and drug class) on the persistence rate. Those most at risk groups of non-persistence were those patients living in remote areas (odds ratio, OR: 0.59, 95% confidence interval, CI: 0.37-0.92), having family income over 70 000 AUD/year (OR: 0.53, 95% CI: 0.45-0.62), speaking other languages at home (OR: 0.61, 95% CI: 0.53-0.68), and using cholinergic classes of medications (OR: 0.55, 95% CI: 0.38-0.79). Conclusions and Relevance: Our data has shown a medium level of persistence to topical glaucoma medication among middle-aged and older Australian adults. However, efforts are still needed to improve the rate of persistence.
Keywords: antiglaucoma agent; cholinergic receptor stimulating agent; adult; aged; article; Australia; Australian; clinical assessment; cohort analysis; comorbidity; controlled study; drug industry; family income; female; follow up; gender; glaucoma; health insurance; human; lifestyle; linguistics; major clinical study; male; medication compliance; middle aged; patient compliance; population research; prescription; prospective study; questionnaire; randomized controlled trial; residential area; risk assessment; social status

A Path Analysis of Effects of Patients' Underlying Conditions, Treatment Satisfaction, and Adherence on Quality of Life among Korea Glaucoma Patients - Kim, C.Y.; Park, K.H.; Ahn, J.; Ahn, M.-D.; Cha, S.C.; Kim, H.-S.; Kim, J.M.; Kim, M.J.; Kim, T.-W.; Kim, Y.Y.; Lee, J.W.; Park, S.-W.; et al. (Journal of Glaucoma, 2019)
Précis:This observed patient-specific features and treatment-driven conditions that were significantly associated with the impairment of health-related quality of life (HRQOL) among glaucoma patients. The results suggest that more systematic strategies should be implemented to improve an HRQOL.Purpose:To determine factors contributing to an HRQOL and assess total, direct and indirect, effects that may exist between the determinants using path analysis.Materials and Methods:Data were derived from previous Korea glaucoma outcomes research. A total of 847 glaucoma outpatients with ≤2 years of eye-drop use were included in the present study. Including factors and their hypothetical pathways to an HRQOL were based on the literature review and consultation with specialists. Age, sex, comorbidities, and education levels were included as underlying conditions and treatment patterns were defined by the number of daily instillations of prescribed eye-drops. Treatment satisfaction and adherence were estimated using a Treatment Satisfaction Questionnaire for Medication, which assessed side-effects, effectiveness, convenience, global satisfaction, and pill count. An HRQOL was assessed by EQ-5D and EQ-visual analogue scale (EQ-VAS).Results:In EQ-5D analysis, male individuals showed total effects (β=0.102, P=0.0026), including both direct (β=0.076, P=0.0095) and indirect effects (β=0.0253, P=0.0020), which were mediated by treatment satisfaction in the side effects and global satisfaction categories. Higher education (β=0.197, P=0.0020) and satisfaction in the side effect (β=0.095, P=0.0076) and global satisfaction (β=0.075, P=0.0414) categories were found to have direct effects on EQ-5D. For EQ-VAS, higher education levels had significant total effects (β=0.153, P=0.0020) accounting for direct effects (β=0.131, P=0.0030) and indirect effects (β=0.0223, P=0.0531) through global satisfaction. In addition, male individuals had indirect effects (β=0.274, P=0.0165), which was indirectly mediated by satisfaction in the global satisfaction category. Comorbidity (β=-0.096, P=0.0090) and satisfaction in the effectiveness (β=0.094, P=0.0302), convenience (β=0.076, P=0.0390), and global satisfaction (β =0.144, P=0.0020) categories showed indirect effect on EQ-VAS.Conclusion:Higher education and better treatment satisfaction had positive effects on HRQOL both in direct and indirect ways whereas comorbidities indirectly showed negative associations with HRQOL.
Keywords: eye drops; adult; age; article; comorbidity; educational status; European Quality of Life 5 Dimensions 5 Level questionnaire; female; glaucoma; human; Korean (people); major clinical study; male; outcomes research; outpatient; patient attitude; patient compliance; patient satisfaction; priority journal; quality of life; questionnaire; sex; visual analog scale

A Metric to Consider on the Global Accessibility of Glaucoma Surgery - Mansouri, K.; Gillmann, K.; Bravetti, G.E. (JAMA Ophthalmology, 2019)
Keywords: developed country; developing country; disease burden; glaucoma; glaucoma surgery; health care access; health care cost; human; letter; priority journal; visual impairment

Medication management issues identified during home medication reviews for ambulatory community pharmacy patients - Papastergiou, J.; Luen, M.; Tencaliuc, S.; Li, W.; van den Bemt, B.; Houle, S. (Canadian Pharmacists Journal, 2019)
Background: The health risks associated with poor medication practices in the home suggest that patients would benefit from home-based medication reviews that could detect and resolve these issues. However, remuneration for home visits often excludes ambulatory, nonhomebound patients. A subset of these patients have issues that cannot be adequately identified and resolved during the course of a typical pharmacy-based medication review. Purpose: This study aims to characterize the prevalence and nature of “hidden in the home” medication management issues in nonhomebound patients. Methods: Pharmacists facilitated subject enrollment among patients at 6 community pharmacies in Toronto over a 15-month period, from January 2016 to March 2017. Patients taking 5 or more chronic medications who were ambulatory (able to visit the pharmacy) and scored 3 points or higher on a prescreening questionnaire were invited to participate. Visits included a standard medication review, the identification of drug therapy problems and an assessment of the patient’s medication and organization/storage practices, followed by a medication cabinet cleanup. Results: One hundred patients were recruited, with a mean age of 76.9 years and taking on average 10 chronic medications. Pharmacists identified a total of 275 drug therapy problems (2.75 per patient). The most common issues reported additional therapy required (23.6%), nonadherence (23.3%) and adverse drug reactions (17.8%). For those patients 65 years or older (87%), 32% were found to be using at least 1 medication on the Beers Criteria list, while 6% were using 3 or more. Sulfonylureas, non-steroidal anti-inflammatory drugs and short-acting benzodiazepines were the most commonly implicated drugs. Medications were removed from the homes of 67% of the patients, with expiry of medication being the most common reason for removal (54.2%). The mean duration of a home visit was 49.5 minutes. Conclusion: Pharmacist-directed home medication reviews offer an effective mechanism to address the pharmacotherapy issues of patients taking multiple medications. These findings highlight the frequency of medication management issues in this group and suggest that home medication reviews could serve to minimize inappropriate use of medication and maximize health care cost savings in this unique patient population. Can Pharm J (Ott) 2019;152:xx-xx.
Keywords: benzodiazepine; nonsteroid antiinflammatory agent; sulfonylurea; adverse drug reaction; aged; ambulatory monitoring; article; asthma; cardiovascular disease; caregiver; chronic kidney failure; clinical assessment; clinical pharmacy; clinical practice; degenerative disease; diabetes mellitus; dyslipidemia; female; follow up; glaucoma; health care personnel; home care; human; hypertension; hypothyroidism; intervention study; major clinical study; male; medication compliance; medication therapy management; mood disorder; osteoarthritis; osteoporosis; patient compliance; pharmacist; primary medical care; public health; questionnaire; screening; swallowing; technical and domestic health care assistance; treatment duration

Stereotyping as a barrier to the social participation of older adults with low vision: A qualitative focus group study - Fraser, S.; Beeman, I.; Southall, K.; Wittich, W. (BMJ Open, 2019)
Objective In order to better understand the barriers that limit the social participation of older people with low vision, the aim of this study was to describe and clarify the factors that shape the social participation of older adults with vision loss. Methods As part of a study on rehabilitation access barriers, six qualitative focus groups were conducted in a private room in a hospital, with 21 individuals with low vision (aged 38-92 years) who had or had not accessed low vision services. During the focus groups, participants often spoke of the challenges they faced when interacting with people with 'normal' vision; this discussion led to a modification of the interview guide in order to capture barriers to social participation. Focus group discussions were audiotaped and transcribed, and content analysis was conducted. Results Content analysis revealed that personal as well as environmental factors influenced the social participation of older adults with low vision. Four themes emerged: 1) experiencing the onset of impairment and degenerating ability, 2) the physical environment, 3) attitudes and responses from others and 4) individual internal attitude and responses during social interactions. Lived and perceived stigma from the perspective of the insider (person living with low vision) interacting with an outsider (person with 'normal' vision) and difficult environmental contexts were described as barriers to social participation and optimal functioning. Conclusion At a personal level, transitioning from an outsider to an insider influenced self-identity and social participation. Further, insiders experiencing stereotypes associated with older adults who are blind had a negative impact on their social participation. Findings highlight the importance of stigma and stereotyping in the lived experience of older adults with low vision. Stigma is persistent, but strategies to reduce stigma will ultimately facilitate the social participation of older adults with low vision.
Keywords: age related macular degeneration; aged; aging; article; clinical article; content analysis; daily life activity; diabetic retinopathy; emotion; environmental factor; female; frustration; functional status; glaucoma; health care access; helplessness; hopelessness; human; interpersonal communication; locus of control; low vision; male; patient attitude; qualitative research; rehabilitation care; rehabilitation center; retina detachment; retinitis pigmentosa; social interaction; social participation; social stigma; stereotyping; support group

Comparison of prostaglandin analog treatment patterns in glaucoma and ocular hypertension - Heo, J.H.; Rascati, K.L.; Wilson, J.P.; Lawson, K.A.; Richards, K.M.; Nair, R. (Journal of Managed Care and Specialty Pharmacy, 2019)
BACKGROUND: Prostaglandin analogs (PGAs) are considered an initial therapy to manage increased intraocular pressure (IOP) for patients with glaucoma. When the initial PGA treatment fails to lower IOP adequately, the patient may add or change medications or have surgery/laser treatment. OBJECTIVE: To compare medication adherence, duration of therapy, and treatment patterns among 3 PGAs—latanoprost, travoprost, and bimatoprost—as initial therapies for patients with glaucoma or ocular hypertension. METHODS: This was a retrospective cohort study using administrative claims data. The cohort consisted of patients newly diagnosed with glaucoma or ocular hypertension with at least 1 prescription claim for latanoprost, travoprost, or bimatoprost and enrolled in a Medicare Advantage plan between 2007 and 2012. The 24-month medication possession ratio (MPR) was used to measure medication adherence. Discontinuation of first-line PGA therapy was defined as nonpersistence (90-day gap allowance) of the index PGA or a change in therapy during the 24-month follow-up period. Types of second-line therapy (i.e., switch, addition, and surgery) were identified. The 1:1:1 propensity score matching was used. RESULTS: Patients who met the inclusion criteria were propensity score matched, resulting in 1,296 patients per PGA group. Latanoprost users showed higher adherence (50.1%) than travoprost (48.8%) and bimatoprost (43.0%) users. The latanoprost and travoprost groups had significantly higher MPRs than bimatoprost (P<0.0001). The latanoprost group showed significantly longer duration of first-line therapy (372 days) than the bimatoprost group (343 days; P=0.003) but not the travoprost group (361 days). After controlling for demographic and clinical characteristics, a Cox proportional hazards model showed that the travoprost and bimatoprost groups had a higher risk of discontinuation of first-line therapy than the latanoprost group (P<0.0001). The percentage of patients continuing on the index PGA without treatment pattern change (i.e., switches, additions, and surgery) was higher for latanoprost users (52.9%) compared with travoprost (39.0%) or bimatoprost users (42.1%; P<0.001). CONCLUSIONS: Patients who used latanoprost as their initial therapy were more likely to adhere and persist to the index PGA compared with bimatoprost users. The latanoprost group demonstrated a lower risk of discontinuing first-line therapy than the travoprost and bimatoprost groups. The results may assist ophthalmologists in determining the optimal management of this patient population with respect to treatment patterns.
Keywords: bimatoprost; latanoprost; travoprost; adult; aged; article; cohort analysis; comparative study; drug substitution; drug withdrawal; female; glaucoma; human; intraocular hypertension; laser surgery; major clinical study; male; medicare; medication compliance; monotherapy; patient compliance; prescription; retrospective study; treatment duration; very elderly

Prostaglandin analogue drops for the treatment of soft tissue expansion and exophthalmos in patients with inactive thyroid eye disease - Eiger-Moscovich, M.; Stiebel-Kalish, H.; Yassur, I.; Barash, D.; Gaton, D.; Avisar, I. (Canadian Journal of Ophthalmology, 2019)
Objective: Thyroid eye disease (TED) is characterized by an inflammatory response leading to soft tissue expansion within the bony orbit, which may cause exophthalmos. Studies of glaucoma patients reported periorbital fat atrophy after treatment with prostaglandin analogue drops. We hypothesize that owing to this side effect, prostaglandin analogue drops may benefit patients with TED-induced exophthalmos. Design: Interventional prospective pilot study. Participants: Five adults with inactive TED and exophthalmos treated with a single daily drop of bimatoprost to both eyes for 6 months. Methods: The effect of treatment was evaluated by clinical examinations, Hertel exophthalmometry, marginal reflex distance (MRD), and comparison of digital photographs from before and after treatment by 3 masked oculoplastic surgeons. Patients’ subjective satisfaction was recorded as well. Results: Hertel exophthalmometry showed an improvement in exophthalmos after treatment in 3 patients and no change in 2. Both MRD1 and MRD2 increased (for MRD2 p = 0.007). Two observers correctly identified the photograph taken after treatment in 4 patients, and the third observer correctly identified 2 patients and was indecisive about the others. Four patients reported an improvement in their appearance, although additional eyelid retraction was observed. Adverse effects were minimal. Conclusion: Topical prostaglandin analogue treatment of TED-associated exophthalmos appears safe. Although this pilot study was statistically underpowered to show positive results, our findings suggest a treatment-related reduction in periorbital fat volume in most cases and a subjective improvement in appearance. These findings have potential implications for the treatment of exophthalmos in the clinical setting, but more research is required.
Keywords: exophthalmometer; bimatoprost; adult; aged; application site discomfort; article; clinical article; clinical evaluation; clinical examination; clinical trial; cohort analysis; comparative study; conjunctival hyperemia; digital imaging; diplopia; drug efficacy; drug safety; drug withdrawal; endocrine ophthalmopathy; exophthalmos; eye examination; eye photography; eyelid retraction; female; human; intervention study; male; marginal reflex distance; medication compliance; middle aged; oculoplastic surgeon; patient compliance; patient dropout; patient satisfaction; pilot study; pregnancy; prospective study; side effect; single drug dose; soft tissue disease; soft tissue expansion; statistically significant result; surgeon; therapy effect; topical treatment; treatment outcome; treatment response; visual system examination; lumigan