Surgical outcomes of trabeculectomy in patients with glaucoma over 80 years of age - Duman, F.; Waisbourd, M.; Faria, B.M.; Addis, V.; Hsieh, M.; Ekici, F.; Hark, L.A.; Spaeth, G.L. (Investigative Ophthalmology and Visual Science, 2014)
Purpose: To compare the surgical outcomes of trabeculectomy performed in elderly patients (>80 years) with those of younger controls. Methods: We retrospectively reviewed the charts of patients who underwent trabeculectomy from 1/1/2009 through 4/31/2011 at the Wills Eye Hospital. Patients over 80 years of age were compared with younger controls. Outcome measures included intraocular pressure (IOP), visual acuity, number of glaucoma medications, surgical complications and surgical failure. Surgical failure was deffned as IOP >21 mmHg, <20% reduction below baseline IOP, IOP<5 mmHg, reoperation for glaucoma, or loss of light perception. In addition, the number of missed postoperative visits was documented. Results: Eighty-six eyes of patients over 80 years of age (81-94) were compared with 86 eyes of younger controls (22-79). Mean follow-up time was 23.9±8.0 and 25.1±8.0 months for each group, respectively. Failure rate was 31.3% in the elderly group, compared with 29.5% in the control group (P=0.98). Post-operative complications were similar between the groups (P=0.25). Elderly patients were less likely to return for their follow-up appointments (P=0.04). Conclusions: The surgical outcomes of trabeculectomy in patients older than 80 years of age were similar to those of younger controls. Taking into consideration their general health condition and life expectancy, elderly patients with glaucoma may benefit from surgery in order to preserve their visual function. Appointment reminders and patient navigators may help improve follow-up adherence.
Keywords: aged; aging; control group; controlled study; female; follow up; glaucoma; hospital; human; intraocular pressure; jurisprudence; life expectancy; major clinical study; male; peroperative complication; postoperative complication; reoperation; surgery; trabeculectomy; treatment failure; very elderly; vision; visual acuity

Detection of non-glaucomatous ocular pathology and barriers to follow-up in a community glaucoma detection program - Hu, W.D.; Hu, C.X.; Tran, J.; Pequignot, E.; Waisbourd, M.; Hark, L.A.; Katz, L.J. (Investigative Ophthalmology and Visual Science, 2014)
Purpose: To evaluate the detection rates of non-glaucomatous ocular pathology requiring follow-up care and to identify the barriers to this follow-up care in a Centers for Disease Control and Prevention (CDC)-sponsored community glaucoma detection program. Methods: Subjects 18 or older participated in a CDC-sponsored community-based exam to detect glaucoma throughout Philadelphia, Pennsylvania. An ophthalmologist conducted a slit lamp examination, gonioscopy, and an undilated fundus exam. Octopus® perimetry and optic nerve head photography were also performed. Subjects who were recommended for follow-up ophthalmic care at their own eye care provider for non-glaucomatous ocular pathology were also recorded. These subjects were given a telephone survey to assess rates of follow-up and to evaluate potential barriers to follow-up. Survey results were correlated with attendance of a follow-up exam using the Wilcoxon nonparametric test and Fisher's exact test. Results: Eight hundred and ninety-nine (899) subjects were examined from January 2013 to August 2013. One hundred three (103) subjects (11%) diagnosed with nonglaucomatous ocular pathology were recommended follow-up ophthalmic care for visually significant cataracts (6.9%), diabetic retinopathy (1.0%), macular degeneration (1.7%) and other ocular pathology (2.2%). Fifty-eight of the 103 subjects (56%) responded to the telephone survey. The average age of respondents was 58 years and females (64%) and African-Americans (69%) predominated. Of the respondents, 29% attended a follow-up appointment. Subjects who did not remember their results and recommendations were less likely to attend their follow-up appointment (p=0.036 and 0.039, respectively). Subjects' primary language (p=0.73), education level (p=0.68), type of transportation (p=1.0), type of health insurance (p=0.18), and interval of time between their last visit to an eye specialist and the glaucoma exam (p=0.053) were not significantly associated with attending their follow-up appointment. Conclusions: A community-based glaucoma exam is able to detect a significant amount of non-glaucomatous ocular pathology requiring further ophthalmic followup. However, actual follow-up rates at participants' own eye care provider are poor and warrant the need to continue follow-up eye care at these community sites.
Keywords: adult; African American; cataract; diabetic retinopathy; diagnosis; disease control; education; eye care; female; follow up; glaucoma; gonioscopy; health insurance; human; language; macular degeneration; major clinical study; middle aged; nonparametric test; ophthalmologist; optic disk; Pennsylvania; perimetry; photography; prevalence; prevention; slit lamp microscopy; stomach fundus; telephone interview

Clinic-based glaucoma care in the era of surgical subspecialization - Campbell, R.J.; Bell, C.M.; Gill, S.S.; Whitehead, M.; Campbell, E.D.L.P.; Xu, K.; El-Defrawy, S.R. (American Journal of Ophthalmology, 2014)
Purpose To evaluate the impact of surgeon practice profile on clinic-based glaucoma care. Design Population-based study of glaucoma care patterns in Ontario, Canada from 2000-2010. Methods Using comprehensive physician services data from the Ontario Health Insurance Plan database, ophthalmologists were divided into 5 surgical practice subgroups. The role of each subgroup in the provision of glaucoma care was evaluated. Consultations and office visits were used to assess nonsurgical care, while laser trabeculoplasty procedures were used to assess clinic-based procedural care. Results Between 2000 and 2010, the population rate of glaucoma consultations and follow-up visits provided by ophthalmologists who do not perform incisional glaucoma surgery increased at average annual rates of 1.6% (P <.0002) and 3.3% (P <.0001), respectively. In contrast, no significant growth in the rate of glaucoma consultations or follow-up visits provided by glaucoma surgeons was observed (0.8%/year [P =.2] for consultations; 0.2%/year [P =.6] for follow-up visits). Between 2000 and 2010, the rate of laser trabeculoplasty procedures provided by ophthalmologists who do not perform incisional glaucoma surgery increased 19.3% annually (P <.0001), while growth among glaucoma surgeons was more modest (annual growth of 9.2% [P =.0002]). Conclusions While subspecialization is a growing reality in most areas of medicine, we found that the provision of clinic-based glaucoma care remains dependent on ophthalmologists who do not perform incisional glaucoma surgery. With increasing focus on integrated care, these findings will have important implications for residency education programs and their accrediting bodies and will inform decisions of health care policymakers, hospitals, and academic departments.
Keywords: ambulatory care; article; Canada; consultation; follow up; glaucoma; glaucoma surgery; health service; human; laser; ophthalmologist; patient care; priority journal; retrospective study; surgeon; trabeculoplasty

Sustained drug delivery in glaucoma - Knight, O.J.; Lawrence, S.D. (Current Opinion in Ophthalmology, 2014)
PURPOSE OF REVIEW: This article reviews recently published studies and important clinical trials of novel drug delivery systems for glaucoma and evaluates the potential of these systems to provide sustained therapeutic benefits. RECENT FINDINGS: The efficacy of topical medications to lower intraocular pressure (IOP) is limited by poor patient adherence, low bioavailability of drug and the potential for local and systemic side effects. Recent studies highlight the potential for sustained drug delivery through innovative delivery platforms. Nanoparticle-based formulations, drug-eluting contact lenses, punctum inserts and bioadhesive matrices placed in the conjunctival sac can enhance drug delivery by increasing precorneal residence time, enhancing corneal permeation and lowering the systemic absorption of drug. Periocular injections and surgically implanted drug reservoirs could offer even greater duration of drug delivery, particularly when the drug is packaged within stable vehicles. SUMMARY: Novel platforms for providing sustained drug delivery in glaucoma continue to evolve. The ability to incorporate effective commercially available drugs into more stable compounds is an important element. Although more research is needed to establish their clinical efficacy, novel delivery systems will allow for more targeted medical therapy and for the opportunity to further explore neuroprotective and gene-based therapies. © 2014 Wolters Kluwer Health.
Keywords: nanoparticle; polymer; clinical trial (topic); contact lens; drug delivery system; drug formulation; glaucoma; human; intraocular pressure; patient compliance; periocular drug administration; priority journal; review; sustained drug release

Trends and technologies of eye droppers - Marx, D.; Birkhoff, M. (Pharmazeutische Industrie, 2014)
Multi-dose containers for eye drops are cost efficient for the treatment of chronic conditions like "dry eye" and glaucoma. Most eye drops are preserved to prevent a microbial contamination during storage and when in use. More and more evidence emerged that the preservatives may worsen or even induce the symptoms of an ocular surface disease. This was discussed controversially for a long time because not all patients are affected to the same degree. But patients suffering from side effects are more likely not to adhere to the prescribed treatment schedule. In glaucoma, this bears the risk of becoming blind. The European Medicines Agency (EMA) recognized this problem and, in 2009, published a recommendation to use unpreserved eye drops for chronic conditions. The search for alternatives to preserved medications is a long one. This article gives an overview on the most relevant approaches and introduces the Ophthalmic Squeeze Dispenser (OSD), a new device for unpreserved formulations. © ECV Editio Cantor Verlag, Aulendorf (Germany).
Keywords: eye drops; blindness; cost benefit analysis; drug delivery device; drug formulation; drug storage; dry eye; glaucoma; human; medication compliance; microbial contamination; ocular surface disease; ophthalmic squeeze dispenser; patient compliance; risk factor; short survey; unspecified side effect

A qualitative investigation into patients' views on visual field testing for glaucoma monitoring - Glen, F.C.; Baker, H.; Crabb, D.P. (BMJ Open, 2014)
Objectives: To investigate the views and experiences of patients regarding their glaucoma follow-up, particularly towards the type and frequency of visual field (VF) testing. Design: A qualitative investigation using focus groups. The group discussion used broad open questions around the topics in a prompt guide relating to experiences of glaucoma follow-up, and in particular, VF monitoring. All the groups were taped, transcribed and coded using manual and computer-aided methods. Setting: Three National Health Service (NHS) hospitals in England; two focus groups took place at each hospital. Participants: 28 patients (mean (SD) age: 74 (9) years; 54% women) diagnosed with glaucoma for at least 2 years. Each focus group consisted of 3-6 patients. Primary and secondary outcomes: (1) Attitudes and experiences of patients with glaucoma regarding VF testing. (2) Patients' opinions about successful follow-up in glaucoma. Results: These patients did not enjoy the VF test but they recognised the importance of regular monitoring for preserving their vision. These patients would agree to more frequent VF testing on their clinician's recommendation. A number of themes recurred throughout the focus groups representing perceived barriers to follow-up care. The testing environment, waiting times, efficiency of appointment booking and travel to the clinic were all perceived to influence the general clinical experience and the quality of assessment data. Patients were also concerned about aspects of patient-doctor communication, and often received little to no feedback about their results. Conclusions: Patients trust the clinician to make the best decisions for their glaucoma follow-up. However, patients highlighted a number of issues that could compromise the effectiveness of VF testing. Addressing patient-perceived barriers could be an important step for devising optimal strategies for follow-up care.
Keywords: aged; article; clinical article; clinical assessment; computer aided design; doctor patient relationship; female; follow up; glaucoma; hospital management; human; male; national health service; patient attitude; patient monitoring; perimetry; personal experience; qualitative research; United Kingdom

Travoprost with sofZia® preservative system lowered intraocular pressure of Japanese normal tension glaucoma with minimal side effects - Mizoue, S.; Nakano, T.; Fuse, N.; Iwase, A.; Matsumoto, S.; Yoshikawa, K.; Yaoeda, K.; Hara, T.; Kimura, I.; Kimura, T.; Suzumura, H.; Tsumura, T.; et al. (Clinical Ophthalmology, 2014)
Background: This study aimed to evaluate the effect of travoprost with sofZia® preservative system for lowering the intraocular pressure (IOP) of Japanese normal tension glaucoma (NTG) patients. Methods: In this prospective, multicenter, open-label study, Japanese NTG patients with baseline IOPs <20 mmHg were enrolled after three consecutive time measurements taken at screening and baseline visits. Travoprost with sofZia® was instilled once daily. Lowering effect on IOP, conjunctival hyperemia, superficial punctate keratopathy, and adverse events were examined at week 4, 8, and 12 after drug instillation. Results: One-hundred and three of the 107 enrolled patients (baseline IOP =15.2±2.0 mmHg [mean ± standard deviation]) completed the study. The mean IOP value as well as percent reduction was significantly reduced at each visit after travoprost with sofZia® initiation (P<0.0001). The conjunctival hyperemia score was 1 or less throughout the study, though it increased significantly over time. No significant change was observed in superficial punctate keratopathy. The cumulative incidence of side effects such as eyelash changes, eyelid pigmentation, and deepening of the upper lid was 47.6%, 27.2%, and 16.5%, respectively. Conclusion: Travoprost preserved with sofZia® effectively lowered the IOP of Japanese NTG patients. It was well tolerated with few discontinuations due to adverse events. © 2014 Mizoue et al.
Keywords: preservative; travoprost; adult; aged; article; conjunctival hyperemia; diastolic blood pressure; drug efficacy; drug instillation; drug safety; drug tolerability; drug withdrawal; eye discharge; eye irritation; eyelash growth; eyelid pigmentation; female; hair growth; human; intraocular foreign body; intraocular pressure; Japanese (people); keratopathy; low tension glaucoma; major clinical study; male; multicenter study; ocular pruritus; open study; patient compliance; pigmentation; prospective study; pulse rate; systolic blood pressure; unspecified side effect; very elderly; visual field; travatan z; sofzia

Once-daily nepafenac ophthalmic suspension 0.3% to prevent and treat ocular inflammation and pain after cataract surgery: Phase 3 study - Modi, S.S.; Lehmann, R.P.; Walters, T.R.; Fong, R.; Christie, W.C.; Roel, L.; Nethery, D.; Sager, D.; Tsorbatzoglou, A.; Philipson, B.; Traverso, C.E.; Reiser, H. (Journal of Cataract and Refractive Surgery, 2014)
Purpose To evaluate once-daily nepafenac 0.3% to prevent and treat ocular pain and inflammation after cataract surgery. Setting Sixty-five centers in the United States and Europe. Design Randomized double-masked vehicle- and active-controlled phase 3 study. Methods Patients received nepafenac 0.3% once daily, nepafenac 0.1% 3 times daily, or their respective vehicles from day -1 to day 14 after cataract extraction. An additional drop of study drug was administered 30 to 120 minutes preoperatively. The primary endpoint was the percentage of patients with a cure for inflammation (score of 0 for both aqueous cells and flare) at day 14. Results Of randomized patients, 817 received nepafenac 0.3%, 819 received nepafenac 0.1%, and 200 and 206 received the respective vehicles. Significantly more nepafenac 0.3% patients had no inflammation (68.4% versus 34.0%) and were pain free (91.0% versus 49.7%) at day 14 than vehicle patients (both P<.0001). Nepafenac 0.3% was noninferior to nepafenac 0.1% for inflammation (95% confidence interval [CI], -5.73% to 3.17%) and pain-free rates (95% CI, -3.08% to 2.70%). At all postoperative visits, fewer treatment failures (P≤.0012) and more clinical successes (P≤.0264) were observed with nepafenac 0.3% versus vehicle. Nepafenac 0.3% was well tolerated and had a safety profile comparable to that of nepafenac 0.1%. Conclusions Once-daily nepafenac 0.3% was noninferior to nepafenac 0.1% 3 times daily for prevention and treatment of ocular inflammation and pain following cataract surgery. The safety of nepafenac 0.3% was comparable to that of nepafenac 0.1%, with the added convenience of once-daily dosing. © 2013 ASCRS and ESCRS.
Keywords: NCT01109173; nepafenac; nonsteroid antiinflammatory agent; adult; article; cataract; cataract extraction; controlled study; dosage schedule comparison; double blind procedure; drug efficacy; drug formulation; drug hypersensitivity; drug safety; drug withdrawal; eye pain; female; headache; human; inflammation of the eye and surrounding structures; intraocular hypertension; intraocular pressure; major clinical study; male; multicenter study; patient compliance; phase 3 clinical trial; postoperative care; postoperative pain; priority journal; randomized controlled trial; treatment failure; treatment outcome; visual acuity

Comparative efficacy, pharmacokinetic, pharmacodynamic activity, and interferon stimulated gene expression of different interferon formulations in HIV/HCV genotype-1 infected patients - Osinusi, A.; Bon, D.; Nelson, A.; Lee, Y.-J.; Poonia, S.; Shivakumar, B.; Cai, S.Y.; Wood, B.; Haagmans, B.; Lempicki, R.; Herrmann, E.; Sneller, M.; et al. (Journal of Medical Virology, 2014)
The effect of different formulations of interferon on therapeutic response in patients coinfected with HIV and HCV is unclear. In this study, the safety, tolerability, viral kinetics (VK) modeling and host responses among HIV/HCV coinfected patients treated with pegylated-IFN or albinterferon alfa-2b (AlbIFN) with weight-based ribavirin were compared. Three trials treated 57 HIV/HCV coinfected genotype-1 patients with PegIFN alfa-2b (1.5μg/kg/week) (n=30), PegIFN alfa-2a (180μg/week) (n=10), and AlbIFN (900μg/q2week) (n=17) in combination with weight-based ribavirin (RBV). HCV RNA, safety labs, and interferon stimulated gene expression (ISG) was evaluated. Adverse events were documented at all study visits. HCV viral kinetics using a full pharmacokinetic/pharmacodynamic model was also evaluated. Baseline patient characteristics were similar across the three studies. All three formulations exhibited comparable safety and tolerability profiles and efficacy. VK/PK/PD parameters for all three studies as measured by mean efficiency and rate of infected cell loss were similar between the three groups. Host responses (ISG expression and immune activation markers) were similar among the three groups. All three regimens induced significant ISG at week 4 (P<0.05) and ISG expression strongly correlated with therapeutic response (r=0.65; P<0.01). In summary, a comprehensive analysis of responses to three different interferon formulations in HIV/HCV coinfected patients demonstrated similar effects. Notably, interferon-based therapy results in a blunted host response followed by modest antiviral effect in HIV/HCV coinfected patients. This suggests that future treatment options that do not rely on host immune responses such as direct antiviral agents would be particularly beneficial in these difficult to treat patients. © 2013 Wiley Periodicals, Inc.
Keywords: albinterferon alpha2b; antiretrovirus agent; granulocyte colony stimulating factor; recombinant erythropoietin; peginterferon alpha2a; peginterferon alpha2b; recombinant erythropoietin; ribavirin; virus RNA; adult; amblyopia; anemia; antiviral activity; anxiety disorder; article; Bell palsy; cataract; CD4 lymphocyte count; cohort analysis; color vision defect; depression; diarrhea; drug blood level; drug dose titration; drug formulation; drug safety; drug tolerability; drug withdrawal; dry eye; enzyme linked immunosorbent assay; fatigue; female; fever; flow cytometry; gene expression; glaucoma; headache; hepatitis C; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; immunophenotyping; insomnia; irritability; liver fibrosis; lung toxicity; major clinical study; male; coinfection; mood disorder; nausea; neutropenia; nonhuman; open study; panic; patient compliance; pharmacodynamics; prospective study; psychosis; retina hemorrhage; side effect; skin toxicity; T lymphocyte; treatment response; virus load; vomiting; darbopoietin; procrit

Ophtalmologic delusional parasitosis in parkinson's disease - Durand-Arias, S.; De la Garza-Neme, Y. (Journal of Neuropsychiatry and Clinical Neurosciences, 2014)
Background: Delusional infestation (DI) is characterized by the fixed belief to be infested by small creatures or inanimate particles without medical evidence for this, and abnormal cutaneous sensations explained by these imaginary pathogens. DI has been described in several diseases. As for pathophysiology and neural basis of DI, some evidence suggest a pivotal role of dopamine and published cases secondary to localized brain lesions led to a hypothetical dysfunction in a frontostriato- thalamo-parietal network. We describe a unique case of Parkinson's Disease (PD) and ophtalmologic DI. Case History: A 62-year-old male, with a 5 year diagnosis of PD with poor treatment adherence presented a depressive episode two years before admission. He was hospitalized because he started referring pareidolias, visual and somatic hallucinations and the delirious idea of parasitosis, described as a Loa-loa nematode that moved around the right eye and sometimes exited across the lacrimal and toward the nose bones. He developed conjunctivitis and the ophtalmologic evaluation showed bilateral open angle glaucoma. He was given treatment with low dosis of clozapine with remission of the psychotic symptoms. Conclusions: The presence of psychotic symptoms in PD are considered a neuropsychiatric complication that may have many clinical presentations, being DI a rare symptom in PD. In this case we discuss the pathophysiology implications of PD, dopaminergic drugs, concomitant depressive disorder and ophtalmologic pathology in the development of a DI.
Keywords: dopamine; clozapine; delusional parasitosis; American; Parkinson disease; psychosis; pathophysiology; depression; infestation; skin sensation; diseases; brain damage; patient compliance; nematode; laryngeal mask; male; diagnosis; human; pathogenesis; hallucination; parasitosis; Loa loa; eye; nasal bone; conjunctivitis; open angle glaucoma; remission; pathology

Ophtalmologic Delusional Parasitosis in Parkinson’s Disease - Durand-Arias, S.; De La Garza-Neme, Y. (Journal of Neuropsychiatry and Clinical Neurosciences, 2014)
Background: Delusional infestation (DI) is characterized by the fixed belief to be infested by small creatures or inanimate particles without medical evidence for this, and abnormal cutaneous sensations explained by these imaginary pathogens. DI has been described in several diseases. As for pathophysiology and neural basis of DI, some evidence suggest a pivotal role of dopamine and published cases secondary to localized brain lesions led to a hypothetical dysfunction in a frontostriato-thalamo-parietal network. We describe a unique case of Parkinson’s Disease (PD) and ophtalmologic DI. Case History: A 62-year-old male, with a 5 year diagnosis of PD with poor treatment adherence presented a depressive episode two years before admission. He was hospitalized because he started referring pareidolias, visual and somatic hallucinations and the delirious idea of parasitosis, described as a Loa-loa nematode that moved around the right eye and sometimes exited across the lacrimal and toward the nose bones. He developed conjunctivitis and the ophtalmologic evaluation showed bilateral open angle glaucoma. He was given treatment with low dosis of clozapine with remission of the psychotic symptoms. Conclusions: The presence of psychotic symptoms in PD are considered a neuropsychiatric complication that may have many clinical presentations, being DI a rare symptom in PD. In this case we discuss the pathophysiology implications of PD, dopaminergic drugs, concomitant depressive disorder and ophtalmologic pathology in the development of a DI.
Keywords: dopamine; clozapine; delusional parasitosis; psychosis; pathophysiology; depression; infestation; skin sensation; diseases; brain damage; patient compliance; nematode; laryngeal mask; male; diagnosis; human; pathogenesis; hallucination; parasitosis; Loa loa; eye; nasal bone; conjunctivitis; open angle glaucoma; remission; pathology

Medication for alcohol use disorder which agents work best? - Robinson, S.; Meeks, T.W.; Geniza, C. (Current Psychiatry, 2014)
Keywords: acamprosate; baclofen; disulfiram; gabapentin; naltrexone; ondansetron; placebo; topiramate; abdominal pain; alcohol abstinence; alcohol consumption; alcoholism; alcoholism; anorexia; article; ataxia; blurred vision; clinical effectiveness; closed angle glaucoma; constipation; depression; diarrhea; dizziness; drinking behavior; drug approval; drug dependence treatment; drug dose increase; drug efficacy; drug mechanism; drug megadose; drug withdrawal; DSM-IV-TR; dyspepsia; epilepsy; eye pain; fatigue; Food and Drug Administration; headache; health program; human; hypertension; insomnia; intraocular pressure abnormality; liver toxicity; memory disorder; migraine; myopia; nausea; neurologic disease; neurotoxicity; off label drug use; paresthesia; patient compliance; pharmaceutical care; postherpetic neuralgia; psychosocial care; seizure; spasticity; tachycardia; treatment duration; vomiting

Zero order sustained drug delivery to the retina from a nanoporous film device - Bernards, D.A.; Bhisitkul, R.B.; Desai, T. (ONdrugDelivery, 2014)
This article describes how a team of senior UCSF researchers, including Daniel Bernards, PhD, Robert Bhisitkul, MD, PhD, and Tejal Desai, PhD, are developing a nanoporous membrane-based implant which can significantly improve drug delivery to the back of the eye. Zordera, Inc, is the company set up to take the device through commercial development. © 2014 Frederick Furness Publishing Ltd.
Keywords: antibody; biosimilar agent; nanowire; polymer; ranibizumab; cataract; cost; drug delivery system; drug release; glaucoma; human; instrument sterilization; membrane; nanopore; nanotechnology; nonhuman; note; patient compliance; retina; retina detachment; safety; syringe; technology; uveitis

Patient acceptance to smartphone technology to monitor and improve glaucoma health-care outcomes - Lee, R.M.H.; Oleszczuk, J.D.; Hyer, J.N.; Gazzard, G. (Eye (Basingstoke), 2014)
Keywords: eye drops; disease course; follow up; glaucoma; health care cost; health care quality; human; letter; mobile application; mobile phone; outcome assessment; patient attitude; patient compliance; patient education; patient monitoring; treatment refusal; visual field defect

Vision restoration training for glaucoma a randomized clinical trial - Sabel, B.A.; Gudlin, J. (JAMA Ophthalmology, 2014)
IMPORTANCE Visual field loss due to retinal damage is considered irreversible, and methods are needed to achieve vision restoration. Behavioral vision training, shown to improve visual fields in hemianopia and optic nerve damage, might comprise such amethod. OBJECTIVE To determine if behavioral activation of areas of residual vision using daily 1-hour vision restoration training for glaucoma for 3 months improves detection accuracy compared with placebo. DESIGN AND SETTING Prospective, double-blind, randomized, placebo-controlled clinical trial in an ambulatory care and home training setting. PARTICIPANTS Volunteer sample of patients with glaucoma (mean age, 61.7 years; age range, 39-79 years) with stable visual fields and well-controlled intraocular pressure. After randomization, 4 patients withdrew from the trial because of mild headaches (n = 2) or lack of time to complete the schedule (n = 2). INTERVENTIONS Computer-based vision restoration training for glaucoma (n = 15) or visual discrimination placebo training in the intact visual field (n = 15). MAIN OUTCOMES AND MEASURES The primary end pointwas change in detection accuracy in high-resolution perimetry. Secondary end points were 30° white-on-white and 30° blue-on-yellow near-threshold perimetry, as well as reaction time, eye movements, and vision-related and health-related quality of life. RESULTS Vision restoration training for glaucoma led to significant detection accuracy gains in high-resolution perimetry (P = .007), which were not found with white-on-white or blue-on-yellow perimetry. Furthermore, the pre-post differences after vision restoration training for glaucoma were greater compared with placebo in all perimetry tests (P = .02for high-resolution perimetry, P = .04 for white on white, and P = .04 for blue on yellow), and these results were independent of eyemovements. Vision restoration training for glaucoma (but not placebo) also led to faster reaction time (P = .009). Vision-related quality of life was unaffected, but the health-related quality-of-life mental health domain increased in both groups. CONCLUSIONS AND RELEVANCE Visual field defects caused by glaucoma can be improved by repetitively activating residual vision through training the visual field borders and areas of residual vision, thereby increasing their detection sensitivity. Our randomized clinical trial revealed evidence that visual field loss is in part reversible by behavioral, computer-based, online controlled vision training, comprising a new rehabilitation treatment option in glaucoma. Neuroplasticity of the visual cortex or higher cortical areas is the proposed mechanism of action. © 2014 American Medical Association. All rights reserved.
Keywords: adult; aged; ambulatory care; article; behavior therapy; controlled study; diabetic retinopathy; double blind procedure; eye movement; eye surgery; female; glaucoma; headache; human; intraocular pressure; major clinical study; male; mental health; motor dysfunction; nerve cell plasticity; perimetry; photosensitivity; priority journal; prospective study; quality of life; randomized controlled trial; reaction time; age related macular degeneration; treatment outcome; visual acuity; visual cortex; visual discrimination; visual field; visual field defect

Role of intracameral bevacizumab in combination with and without Panretinal Photocoagulation (PRP) in neovascular glaucoma patients in our population - Babar, Z.U.D.; Khan, T.P. (Pakistan Journal of Medical and Health Sciences, 2014)
Aim: To assess the efficacy of Intracameral (bevacizumab) in combination with and without pan retinal photocoagulation (PRP) in regressing anterior chamber iris and angle neovascularization and stabilizing IOP and improving outcome of secondary neovascular glaucoma in patients with proliferative retinal ischemic disorders in our population. Methods: A Prospective, consecutive, interventional case series study was conducted at AFIO RWP and CMH Khuzdar on a series of patients 25 to 70 years of age. Thirty patients (30 eyes) with NVG secondary to ischemic retinal disorders were enrolled in the study design. The study group included 18(60%) males and 12 (40%) females. Cases were divided into two groups (A, B) and written informed consent was taken prior to procedure. Group A (15 patients) were managed with Intracameral bevacizumab alone While group B (15 patients) received laser pan retinal photocoagulation in addition to Intracameral bevacizumab. Majority had proliferative diabetic retinopathy (21 cases) and remaining nine cases were secondary to ischemic central retinal vein occlusion (CRVO). Baseline records were documented after carrying out complete ophthalmic evaluation in all patients. Follow up was carried out for 03 to 06 months depending on patient compliance. Results: Significantly better reduction of Iris (rubeosis) and anterior chamber angle neovascularization and stabilizing of IOP was observed in Group B who received PRP in addition to Intracameral bevacizumab as compared to group A who were managed with Intracameral bevacizumab alone. Moreover early remission of neovascularization was observed in group A receiving bevacizumab only. Conclusions: Combined procedures seems to be more effective in regressing and stabilizing iris/angle neovascularization, and lowering IOP in patients with NVG particularly in advanced cases.
Keywords: bevacizumab; adult; aged; anterior eye chamber; anterior eye chamber angle; article; case study; central retina vein occlusion; clinical article; controlled study; diabetes mellitus; diabetic retinopathy; drug efficacy; female; fluorescence angiography; follow up; gonioscopy; human; intervention study; iris rubeosis; laser coagulation; male; neovascular glaucoma; oculoplethysmography; ophthalmoscopy; outcome assessment; panretinal photocoagulation; paracentesis; patient compliance; prospective study; remission; retina ischemia; retina neovascularization; slit lamp; visual acuity; visual acuity chart; avastin

The role of comorbidities in patients' hypertension self-management - Fix, G.M.; Cohn, E.S.; Solomon, J.L.; Cortés, D.E.; Mueller, N.; Kressin, N.R.; Borzecki, A.; Katz, L.A.; Bokhour, B.G. (Chronic Illness, 2014)
Objective: We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities. Methods: We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-á-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension. Results: We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed. Discussion: Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns. © The Author(s) 2013.
Keywords: antihypertensive agent; cholesterol; adult; aged; alcoholism; angina pectoris; antihypertensive therapy; anxiety; arthritis; article; asthma; backache; cholesterol blood level; chronic obstructive lung disease; clinical article; comorbidity; controlled study; depression; diabetes mellitus; disease course; disease severity; electronic medical record; erectile dysfunction; female; glaucoma; grounded theory; headache; health behavior; health belief; heart arrhythmia; heart disease; human; hyperlipidemia; hypertension; insomnia; kidney cancer; knee arthroplasty; knee disease; larynx cancer; leg disease; male; medical information; medication compliance; middle aged; nerve injury; obesity; Parkinson disease; pathophysiology; patient compliance; polypharmacy; posttraumatic stress disorder; prescription; prostate cancer; qualitative research; self care; semi structured interview; shoulder surgery; sleep disordered breathing

Management of conjunctival malignant melanoma: A review and update - Wong, J.R.; Nanji, A.A.; Galor, A.; Karp, C.L. (Expert Review of Ophthalmology, 2014)
Conjunctival malignant melanoma is a pigmented lesion of the ocular surface. It is an uncommon but potentially devastating tumor that may invade the local tissues of the eye, spread systemically through lymphatic drainage and hematogenous spread, and recur in spite of treatment. Despite its severity, the rarity of available cases has limited the evidence for diagnosis and management. This review will provide an overview of the epidemiology, risk factors, presentation, diagnosis, management, prognosis, staging, and surveillance of conjunctival melanoma, with an emphasis on recent advances in biological therapies to treat this disease. © 2014 Informa UK, Ltd.
Keywords: alpha2b interferon; B Raf kinase inhibitor; corticosteroid; dabrafenib; dacarbazine; imatinib; iodine 125; iodine 191; ipilimumab; mitomycin; radioisotope; ruthenium 106; strontium 90; taflinar; unclassified drug; vemurafenib; yttrium 90; allergic reaction; antineoplastic activity; biomicroscopy; blepharitis; blepharospasm; brachytherapy; cancer adjuvant therapy; cancer incidence; cancer mortality; cancer prognosis; cancer recurrence; cancer risk; cancer staging; cataract; chemosis; clinical feature; confocal microscopy; conjunctiva tumor; conjunctival hemorrhage; conjunctival malignant melanoma; conjunctivitis; contact dermatitis; cornea edema; cornea neovascularization; cornea ulcer; corneal endothelial cell loss; cryotherapy; cutaneous melanoma; diarrhea; differential diagnosis; diplopia; disease surveillance; drug megadose; dry eye; edema; enucleation; epiphora; episcleritis; evisceration; external beam radiotherapy; eye irritation; eyelid edema; fever; flu like syndrome; fluid retention; headache; histopathology; human; hyperemia; hyphema; impression cytology; iris atrophy; iritis; keratitis; keratoconjunctivitis; keratopathy; lacrimal duct occlusion; lacrimation; lymph node metastasis; medical history; melanoma; metastatic melanoma; molecular therapy; multiple cycle treatment; myalgia; nausea and vomiting; neovascular glaucoma; optic nerve disease; optical coherence tomography; pain; patient compliance; physical examination; predictive value; proton therapy; rash; review; risk factor; sensitivity and specificity; sentinel lymph node biopsy; side effect; symblepharon; systemic disease; trichiasis

Glaucoma: Early screening and treatment are key - Terrie, Y.C. (Pharmacy Times, 2014)
A lack of warning signs can delay detection and treatment of glaucoma.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; miotic agent; prostaglandin derivative; aqueous humor formation; aqueous humor outflow; article; awareness; blindness; continuing education; early intervention; glaucoma; health care personnel; human; patient compliance; patient counseling; patient education; pharmacist; primary health care; quality of life; risk factor; screening; trabeculoplasty; visual impairment

Electronic monitoring to assess adherence with once-daily glaucoma medications and risk factors for nonadherence: The automated dosing reminder study - Boland, M.V.; Chang, D.S.; Frazier, T.; Plyler, R.; Friedman, D.S. (JAMA Ophthalmology, 2014)
IMPORTANCE: Adherence with topical glaucoma medications is low in some patients. To identify these patients, we need more information on risk factors for nonadherence. OBJECTIVE: To assess adherence with once-daily glaucoma medication. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study involving patients whowere recruited from a university-based glaucoma clinic and treated with once-daily prostaglandin eyedrops. Baseline characteristics were recorded, and each patient was provided a medication bottle to hold his or her eyedrop bottle throughout the study. An electronic cap recorded each time the larger bottle holding the eyedrops was opened. Participants were administered standardized tests of depression and mental status and answered questions about their health and their attitudes toward medication adherence. They used the electronic monitors for 3 months, during which their adherence with medications was assessed. MAIN OUTCOMES AND MEASURES: Adherence with daily glaucoma medication and factors associated with poor adherence. RESULTS: Of the 491 participants enrolled, 407 (82.9%) successfully completed the 3-month adherence assessment. Of this group, 337 (82.8%) took their medication correctly on at least 75% of days and were deemed adherent. Compared with this adherent group, the 70 participants (17.2%) who were nonadherent were slightly younger, were more likely to be of African descent, took medications for a shorter time, had a lower level of educational attainment, and had worse scores on mental status and depression scales (P < .05 for all). Nonadherent participants were less likely to be able to name their glaucoma medications, reported a lower estimate of adherence, and were more likely to admit some missed doses over the past 2 weeks or in general (P < .05 for all). Those who were nonadherent were also less likely to agree that remembering their eyedrops is easy, more likely to strongly agree with the statement that eyedrops can cause problems, and less likely to agree that they followed physicians' orders. CONCLUSIONS AND RELEVANCE: Electronic monitoring of patient adherence documented that a sizable number of patients with glaucoma do not take their medications as prescribed. Factors were identified that may prove useful in targeting those nonadherent patients for interventions. Copyright 2014 American Medical Association. All rights reserved.
Keywords: prostaglandin; adult; article; automation; cohort analysis; educational status; ethnicity; female; follow up; glaucoma; human; major clinical study; male; medication compliance; mental health; Mini Mental State Examination; patient compliance; patient monitoring; priority journal; prospective study; reminder system; risk factor; text messaging; treatment duration

Automated telecommunication-based reminders and adherence with once-daily glaucoma medication dosing: The automated dosing reminder study - Boland, M.V.; Chang, D.S.; Frazier, T.; Plyler, R.; Jefferys, J.L.; Friedman, D.S. (JAMA Ophthalmology, 2014)
IMPORTANCE: Topical glaucoma medications lower intraocular pressure and alter the course of the disease. Because adherence with glaucoma medications is a known problem, interventions are needed to help those patients who do not take their medications as prescribed. OBJECTIVE: To assess the ability of an automated telecommunication-based intervention to improve adherence with glaucoma medications. DESIGN, SETTING, AND PARTICIPANTS: We performed a prospective cohort study of medication adherence, followed by a randomized intervention for those found to be nonadherent, of individuals recruited from a university-based glaucoma subspecialty clinic. A total of 491 participants were enrolled in the initial assessment of adherence. Of those, 70 were nonadherent with their medications after 3 months of electronic monitoring and randomized to intervention and control groups. INTERVENTIONS: A personal health record was used to store the list of patient medications and reminder preferences. On the basis of those data, participants randomized to the intervention received daily messages, either text or voice, reminding them to take their medication. Participants randomized to the control group received usual care. MAIN OUTCOMES AND MEASURES: Difference in adherence before and after initiation of the intervention. RESULTS: Using an intent-to-treat analysis, we found that the median adherence rate in the 38 participants randomized to the intervention increased from 53% to 64% (P < .05). There was no statistical change in 32 participants in the control group. To assess the real efficacy of the intervention, the same comparison was performed for the participants who successfully completed the study after randomization. Analyzed this way, the adherence rate in the 20 participants in the intervention group increased from 54% to 73% (P < .05), whereas there was again no statistical change in the 19 participants in the control group. Eighty-four percent of the participants who received reminders agreed they were helpful and would continue using them outside the study. CONCLUSIONS AND RELEVANCE: Automated telecommunication-based reminders linked to data in a personal health record improved adherence with once-daily glaucoma medications. This is an effectivemethod to improve adherence that could realistically be implemented in ophthalmology practices with a minimum amount of effort on the part of the practice or the patient. Copyright 2014 American Medical Association. All rights reserved.
Keywords: prostaglandin; adult; aged; article; automation; cohort analysis; controlled study; electronic medical record; female; follow up; glaucoma; human; intention to treat analysis; interactive voice response system; major clinical study; male; medication compliance; Mini Mental State Examination; patient compliance; priority journal; prospective study; randomized controlled trial; reminder system; risk factor; telecommunication

Nanomedicine for glaucoma: Sustained release latanoprost offers a new therapeutic option with substantial benefits over eyedrops - Wong, T.T.; Novack, G.D.; Natarajan, J.V.; Ho, C.L.; Htoon, H.M.; Venkatraman, S.S. (Drug Delivery and Translational Research, 2014)
Glaucoma is a chronic progressive optic neuropathy that is characterized by optic nerve changes and visual field loss. Elevated intraocular pressure (IOP) is the main modifiable risk factor. Chronic instillation of daily eyedrops to lower IOP is the primary treatment of choice, although it requires patient adherence and correct performance. We have developed a nanoliposome drug delivery system for the longer term delivery of latanoprost. In the present open-label, pilot study, the safety and efficacy of a single subconjunctival injection of liposomal latanoprost was evaluated in six subjects with a diagnosis of either ocular hypertension (OHT) or primary open-angle glaucoma (POAG). Subconjunctival injection of liposomal latanoprost was well tolerated by all six subjects. From a baseline IOP of 27.55 ± 3.25 mmHg, the mean IOP decreased within 1 h to 14.52 ± 3.31 mmHg (range 10-18 mmHg). This represented a mean decrease of 13.03 ± 2.88 mmHg (range 9-17 mmHg), or 47.43 ± 10.05 % (range 37-63 %). A clinically and statistically significant IOP reduction (≥20 % IOP reduction, P = 0.001 to 0.049) was observed through 3 months after injection. The nanomedicine reported here is the first nanocarrier formulation that has an extended duration of action in humans, beyond a couple of weeks. The findings in this study open up a new treatment modality, which will greatly enhance patient compliance and improve treatment outcomes. The current study provides the evidence and support for further clinical studies of liposomal latanoprost in the treatment of glaucoma. © 2014 Controlled Release Society.
Keywords: eye drops; latanoprost; nanocarrier; nanoliposome; unclassified drug; adult; aged; article; blurred vision; clinical article; drug delivery system; drug efficacy; drug safety; drug tolerability; eye discomfort; female; glaucoma; human; intraocular hypertension; intraocular pressure; liposomal delivery; male; nanomedicine; open angle glaucoma; patient compliance; priority journal; sustained release formulation; treatment outcome; xalatan

Diabetes, sleep apnea, obesity and cardiovascular disease: Why not address them together? - Surani, S.R. (World Journal of Diabetes, 2014)
Obesity, sleep apnea, diabetes and cardiovascular diseases are some of the most common diseases encountered by the worldwide population, with high social and economic burdens. Significant emphasis has been placed on obtaining blood pressure, body mass index, and placing importance on screening for signs and symptoms pointing towards cardiovascular disease. Symptoms related to sleep, or screening for sleep apnea has been overlooked by cardiac, diabetic, pulmonary and general medicine clinics despite recommendations for screening by several societies. In recent years, there is mounting data where obesity and obstructive sleep apnea sit at the epicenter and its control can lead to improvement and prevention of diabetes and cardiovascular complications. This editorial raises questions as to why obstructive sleep apnea screening should be included as yet another vital sign during patient initial inpatient or outpatient visit. © 2014 Baishideng Publishing Group Inc.
Keywords: airway obstruction; arterial wall thickness; article; blood pressure; body mass; cardiomyopathy; cardiovascular disease; cause of death; cerebrovascular accident; childhood obesity; chronic obstructive lung disease; congestive heart failure; coronary artery disease; depression; diabetes mellitus; disease association; end stage renal disease; false positive result; glaucoma; glucose blood level; health care cost; health care utilization; atrial fibrillation; heart ejection fraction; human; hypertension; incidence; insulin resistance; metabolic syndrome X; morbidity; mortality; ovary polycystic disease; pathophysiology; postoperative complication; prevalence; public health; REM sleep; screening test; sensitivity and specificity; sleep disordered breathing

Factors associated with adherence to glaucoma pharmacotherapy in the primary care setting - Castel, O.C.; Keinan-Boker, L.; Geyer, O.; Milmana, U.; Karkabi, K. (Family Practice, 2014)
Background: Primary open-angle glaucoma is a leading cause of irreversible blindness. Objectives: To identify factors associated with adherence to glaucoma pharmacotherapy in the primary care setting, focusing on physicians' role. Methods: Patients were recruited from primary care clinics and telephone-interviewed using a structured questionnaire that addressed patient-, medication-, environment- and physiciansrelated factors. Patients' data on pharmacy claims were retrieved to calculate the medication possession ratio for measuring adherence. Results: Seven hundred thirty-eight glaucoma patients were interviewed. The multivariate analysis identified eight variables that were associated independently with adherence. Barriers to adherence were found to be low income, believing that 'It makes no difference to my vision whether I take the drops or not' and relying on someone else for drop instillation (exp(B) = 1.91, P = 0.002; exp(B) = 2.61, P < 0.0001; exp(B) = 2.17, P = 0.001, respectively). Older age, having a glaucoma patient among close acquaintances, taking a higher number of drops per day, taking a prostaglandin drug and reporting that the ophthalmologist had discussed the importance of taking eye drops as prescribed, were found to promote adherence (exp(B) = 0.96, P < 0.0001; exp(B) = 0.54, P = 0.014; exp(B) = 0.81, P = 0.001; exp(B) = 0.37, P < 0.0001; exp(B) = 0.60, P = 0.034, respectively). No association was found between the patient's relationship with the family physician and adherence to glaucoma treatment. Conclusion: Adherence to glaucoma pharmacotherapy is associated with patient-related, medicationrelated, physician-related and environmental factors. Ophthalmologists have a significant role in promoting adherence. However, the potential role of family physicians is unfulfilled and unrecognized. © The Author 2014. Published by Oxford University Press.
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; dorzolamide plus timolol; eye drops; latanoprost plus timolol; pilocarpine; prostaglandin; timolol; adult; aged; article; cross-sectional study; daily life activity; doctor patient relationship; environmental factor; female; general practitioner; glaucoma; health status; human; lowest income group; major clinical study; male; medication compliance; ophthalmologist; patient compliance; prescription; primary medical care; self report; social status; structured questionnaire; telephone interview; vision

Special challenges in treatment and self-management of older women with asthma - Baptist, A.P.; Hamad, A.; Patel, M.R. (Annals of Allergy, Asthma and Immunology, 2014)
Keywords: acetylsalicylic acid; antiasthmatic agent; antiinflammatory agent; beta adrenergic receptor blocking agent; beta adrenergic receptor stimulating agent; corticosteroid; estrogen; progesterone; adrenal cortex insufficiency; aged; asthma; bone density; caregiver; cataract; comorbidity; corticosteroid induced osteoporosis; depression; disease exacerbation; dyspnea; elderly care; eosinophilia; female; fracture; Geriatric Depression Scale; glaucoma; health care access; health care cost; health care utilization; health insurance; heart arrhythmia; hormone substitution; human; income; lung function test; medicaid; medical assessment; medical decision making; menopause; nausea; obesity; onset age; patient attitude; patient referral; phenotype; poverty; priority journal; respiratory flowmeter; review; risk benefit analysis; self care; self monitoring; side effect; tremor

Microinvasive glaucoma surgery - Coming of age - Samuelson, T.W. (Journal of Cataract and Refractive Surgery, 2014)
Keywords: anterior eye chamber; cataract extraction; editorial; filtering operation; Food and Drug Administration; glaucoma; glaucoma surgery; human; intraocular pressure; muscle hypotonia; operating room; patient compliance; phacoemulsification; priority journal; reoperation; Schlemm canal; stent; surgical technique; trabecular meshwork; trabeculectomy; trabeculoplasty; treatment outcome; vision; visual acuity; visual impairment

Surgical care in low and middle-income countries: Burden and barriers - Ologunde, R.; Maruthappu, M.; Shanmugarajah, K.; Shalhoub, J. (International Journal of Surgery, 2014)
Surgically correctable pathology accounts for a sizeable proportion of the overall global burden of disease. Over the last decade the role of surgery in the public health agenda has increased in prominence and attempts to quantify surgical capacity suggest that it is a significant public health issue, with a great disparity between high-income, and low- and middle-income countries (LMICs). Although barriers such as accessibility, availability, affordability and acceptability of surgical care hinder improvements in LMICs, evidence suggests that interventions to improve surgical care in these settings can be cost-effective. Currently, efforts to improve surgical care are mainly coordinated by academia and intuitions with strong surgical and global health interests. However, with the involvement of various international organisations, policy makers, healthcare managers and other stakeholders, a collaborative approach can be achieved in order to accelerate progress towards improved and sustainable surgical care. In this article, we discuss the current burden of global surgical disease and explore some of the barriers that may be encountered in improving surgical capacity in LMICs. We go on to consider the role that international organisations can have in improving surgical care globally. We conclude by discussing surgery as a global health priority and possible solutions to improving surgical care globally. © 2014 Surgical Associates Ltd.
Keywords: acquired immune deficiency syndrome; behavior disorder; cataract; chronic respiratory tract disease; congenital malformation; cost effectiveness analysis; developing country; diabetes mellitus; glaucoma; health care access; health care availability; health care delivery; health care organization; human; Human immunodeficiency virus infection; income; lower respiratory tract infection; malignant neoplasm; mental disease; musculoskeletal disease; neurologic disease; newborn disease; patient compliance; peroperative care; priority journal; review

Compliance study of contact lens wearers in Japan - Part 2: Evaluation of a subscribed membership system - Shimamoto, S.; Ariwaka, Y.; Ichijima, H.; Sakata, H.; Cavanagh, H.D. (Eye and Contact Lens, 2014)
OBJECTIVE:: To examine the hypothesis that membership in a contact lens (CL) supply system is associated with better compliance for regular wearers (members) who belong to the subscription membership system. METHODS:: Subjects were 104 members and 100 nonmember wearers of 2-week frequent replacement silicone hydrogel CLs whose clinical information was retrospectively available for 1.5 to 2 years in the interval between September 2010 and August 2012. The average duration of use of a single lens was calculated from the number of lenses supplied during the observation period and surveyed using questionnaires. Subjective symptoms and eye complications were also documented and compared. RESULTS:: The average duration of use of a lens was significantly longer in nonmembers (17.8±5.6 days/lens; n=91) than in members (14.2±3.5 days/lens; n=98) (P<0.001, Mann-Whitney U test). The number of wearers who replaced their lenses within 15.4 days per lens wear was significantly higher in members (74.5%) as compared with nonmembers (45.1%) (P<0.001, Fisher exact test). Levels of compliance reported by wearers did not match with those indicated in clinical records. In recorded eye complications, the rate of incidence of allergic and giant papillary conjunctivitis tended to be higher in nonmembers as compared with members. CONCLUSIONS:: The hypothesis that a membership system could be associated with better compliance was found to be supported by clinical records. It is suggested that a membership system is useful for identifying wearers who want to be more compliant and that better compliance may reduce long-term complications of lens wear. Copyright © Contact Lens Association of Opthalmologists, Inc.
Keywords: asmofilcon A; balafilcon a; biomedical and dental materials; copolymer; lotrafilcon B; senofilcon A; silicone; unclassified drug; adult; allergic conjunctivitis; article; contact lens; controlled study; cornea disease; cornea edema; cornea erosion; cornea ulcer; corneal filtration; dry eye; eye discharge; eye pain; female; foreign body; foreign body sensation; giant papillary conjunctivitis; health survey; human; hydrogel; hyperemia; incidence; Japan; major clinical study; male; middle aged; organization and management; patient compliance; priority journal; pruritus; punctate keratitis; questionnaire; retrospective study; subscribed membership system; treatment duration; visual acuity; young adult; ACUVUE Oasys; AIR OPTIX; Freshfit; Medalist premia; PremiO

[Telesensoric contact lenses - new possibilities in intraocular pressure diagnostics]. - Poznański, Z.; Krzyzanowska-Berkowska, P.; Karasińska, A.; Przeździecka-Dołyk, J. (Polimery w medycynie, 2014)
Recently, on the European market, the contact lenses allowing for a 24-hour continuous measurement of intraocular pressure - Triggerfish, became available. They are designed for the diagnostics of glaucoma in adult patients. This is a unique method that allows for continuous recording of intraocular pressure, giving almost 300 readings during 24 hours. Aim of the project is to use this new diagnostic instrument in children and evaluate clinical usefulness of the new method in glaucoma diagnostics. It also seeks to familiarize readers with new diagnostic possibilities that telesensoric contact lenses provide. The "Triggerfish" silicone contact lenses were used in the study in order to perform a continuous, 24-hour measurement of the intraocular pressure. A diagnostic test kit consists of a contact lens with imbedded microchip with transceiver loop, adhesive antenna to affix around the patients eye and the recorder connected to the antenna by a cable. The measurements were performed in two patients at the age of 12 and 14. In both cases the graphs of 24-hour intraocular pressure recordings were obtained allowing for detection of the pathological features of the intraocular pressure. Patients reported no discomfort during the study. No adverse events were observed. Examination techniques using ocular telemetry sensors may be an alternative to conventional methods and throwing new light on the diagnosis and treatment of glaucoma.
Keywords: adult; ambulatory monitoring; article; child; contact lens; devices; equipment design; evaluation study; glaucoma; human; intraocular pressure; methodology; oculoplethysmography; telemetry

Beliefs and adherence to glaucoma treatment: A comparison of patients from diverse cultures - Rees, G.; Chong, X.-L.; Cheung, C.Y.; Aung, T.; Friedman, D.S.; Crowston, J.G.; Lamoureux, E.L. (Journal of Glaucoma, 2014)
PURPOSE:: To determine adherence rates and beliefs about glaucoma and its treatment in white Americans, African Americans, white Australians, and Singaporeans of Chinese descent. PATIENTS AND METHODS:: Cross-sectional study of 475 glaucoma patients using topical eye drops for at least 6 months. The sample consisted of white Americans (n=133), African Americans (n=58), white Australians (n=107), and Singaporeans of Chinese descent (n=117). Self-reported adherence and beliefs about glaucoma and its treatment were assessed using the Reported Adherence to Medication scale, the Brief Illness Perception Questionnaire, and the Beliefs about Medicines-Specific Questionnaire. RESULTS:: Accounting for sociodemographic differences, significant differences in self-reported adherence rates were identified (P<0.001). White Americans and Australians reported significantly higher adherence (65.4%, 67.7% reported complete adherence) than African Americans or Singaporeans (56.9%, 47.5%, respectively; P<0.05). Beliefs about glaucoma treatment were predictive of adherence only in the Australian and white American samples (P<0.05). CONCLUSIONS:: In western cultures, attempts to improve adherence may benefit from greater examination of individual's concerns about, and perceived need, for glaucoma treatment. Further studies are needed to identify the critical predictors of adherence in nonwestern cultures and to validate measures in these populations. Copyright © 2012 by Lippincott Williams & Wilkins.
Keywords: African American; aged; article; attitude to illness; Chinese; comparative study; cross-sectional study; cultural anthropology; educational status; European American; female; glaucoma; human; major clinical study; male; medication compliance; patient attitude; patient compliance; priority journal; self report; treatment duration

Microbial keratitis secondary to unintended poor compliance with scleral gas-permeable contact lenses - Zimmerman, A.B.; Marks, A. (Eye and Contact Lens, 2014)
PURPOSE: To report a case of neurotrophic keratitis in which scleral contact lenses improved vision from 20/100 to 20/20, however, due to poor lens care, an incident of microbial keratitis developed. METHODS: A 64-year-old man with an ocular history of neurotrophic keratitis secondary to herpes simplex in each eye was successfully fit with scleral lenses. He subsequently developed microbial keratitis due to a number of risk factors. RESULTS: The lesion was culture negative, yet was very responsive to treatment with moxifloxacin. The lesion fully healed, and the patient did not suffer additional vision loss. CONCLUSIONS: This case demonstrates the ability of scleral lenses to correct visual impairments secondary to poor epithelial integrity and illustrates the importance of the practitioner providing detailed lens care instruction. © 2013 Contact Lens Association of Ophthalmologists.
Keywords: aciclovir; artificial tear; moxifloxacin; adult; article; case report; contact lens; cornea endothelium; eye pain; Fusarium; gas permeable contact lens; herpes simplex keratitis; Herpes simplex virus; human; infection risk; keratomycosis; male; middle aged; patient compliance; priority journal; risk factor; scleral contact lens; slit lamp; telephone interview; visual acuity; visual impairment

Canadian ophthalmologists' opinions concerning complementary and alternative medicine (CAM) use in Glaucoma - Bower, T.N.; Muhsen, S.; Overbury, O.; Birt, C.; Kasner, O. (Journal of Glaucoma, 2014)
PURPOSE:: Our goal is to investigate the opinion and practice pattern of Canadian ophthalmologists regarding the use of and recommendations for complementary and alternative medicine (CAM) for their glaucoma patients. METHODS:: Institutional review board approval for this prospective, cross-sectional survey was obtained from the Research Ethics Board of Sunnybrook Health Sciences Centre. The survey was sent to all ophthalmologists in Canada electronically through the e-mail lists of 4 ophthalmology associations. RESULTS:: A total of 241 ophthalmologists representing all provinces in Canada responded to the questionnaire. Twenty-two percent felt that CAM does have a role in glaucoma therapy with specialists being more likely to believe there is a role (P<0.05). Of the total respondents, 26% ask their patients if they use CAM with those in practice for <20 years more likely to encourage use (P<0.05). Of the respondents, 9% recommend CAM and if an ophthalmologist was in practice for <20 years he/she was significantly more likely to recommend CAM (P<0.01). Respondents (62%) in general do not discourage CAM with younger ophthalmologists (younger than 50 y, P<0.02) and ophthalmologists in practice for <20 years (P<0.05) being less likely to discourage CAM use. Respondents (41%) believe that CAM rarely ever affects compliance with ophthalmologists from an urban practice (P<0.01) and academic practice (P<0.05) more likely to deny effect on compliance. Respondents believe that CAM sometimes (46%) results in patient morbidity with ophthalmologists being in practice for <20 years believing that morbidity is less likely (P<0.05). CONCLUSION:: A substantial minority of respondents believe that CAM has a role in glaucoma therapy, recommend its use, and ask their patients if they use CAM. Younger doctors are more likely to encourage alternatives; those in practice for <20 years are more likely to ask about alternative medicine use, recommend its use, and believe that morbidity usually does not result from the use of alternative treatments. Copyright © 2013 by Lippincott Williams & Wilkins.
Keywords: alpha tocopherol; antioxidant; antioxidant vitamin; ascorbic acid; cannabis; cyanocobalamin; retinol; riboflavin; thiamine; unclassified drug; vitamin; acupuncture; adult; aged; alternative medicine; article; Canada; Canadian; Chinese medicine; chiropractic; cross-sectional study; demography; diet; Euphrasia; exercise; female; fruit; Ginkgo biloba; glaucoma; herbal medicine; homeopathy; human; language; low fat diet; low sugar diet; major clinical study; male; meditation; morbidity; ophthalmologist; patient compliance; physician attitude; priority journal; prospective study; protein diet; questionnaire; running; sodium restriction; bilberry; vegetable; walking; weight lifting

Long-term systemic glucocorticoid therapy: Patients' representations, prescribers' perceptions, and treatment adherence - Nassar, K.; Janani, S.; Roux, C.; Rachidi, W.; Etaouil, N.; Mkinsi, O. (Joint Bone Spine, 2014)
Introduction: Glucocorticoids have been used since 1948 for their anti-inflammatory and structural effects in various inflammatory diseases. The optimal use of glucocorticoids remains controversial. Patients may have a number of concerns about the effects of glucocorticoids. Many factors can adversely affect treatment adherence. Objectives: To evaluate the main adverse effects reported by patients and physicians, and to assess representations associated with glucocorticoid therapy and the underlying disease, via measurements of treatment adherence, with the goal of optimizing treatment strategies and improving patient information. Methods: From December 2011 to May 2012, we conducted two surveys in 125 patients receiving long-term glucocorticoid therapy and followed-up at the rheumatology department of the teaching hospital in Casablanca, Morocco, and in 85 hospital physicians in various specialties, respectively. Results: Mean glucocorticoid therapy duration was 6. years, mean maximal prescribed dosage was 44.87. mg/d, and 50.4% of the patients had inflammatory joint disease. Adverse neuropsychiatric effects were reported by 70 out of 125 (56%) patients. Weight gain was the adverse effect deemed most bothersome by the physicians, who significantly underestimated the occurrence of neuropsychiatric adverse effects (27% vs 56%, P=0.034). Adherence was poor in 80 out of 125 (64%) patients, and 22 out of 125 (18%) patients reported episodes of treatment discontinuation. Conclusion: Prescribers underestimate the frequency of neuropsychiatric adverse effects of long-term systemic glucocorticoid therapy. Regular follow-up visits during treatment, with collection of systemic adverse effects might improve treatment adherence. © 2013 Société française de rhumatologie.
Keywords: antidepressant agent; glucocorticoid; abnormal blood pressure; absence of side effects; acne; adult; amenorrhea; arthritis; article; asthenia; body weight disorder; cataract; corticosteroid therapy; depression; diabetes mellitus; drowsiness; drug induced headache; drug safety; dyslipidemia; eating disorder; female; fracture; glaucoma; heartburn; hirsutism; hospital physician; human; hyperhidrosis; insomnia; leg edema; lipodystrophy; major clinical study; male; middle aged; Morocco; myopathy; osteoporosis; patient compliance; patient information; persecutory delusion; personality disorder; prescription; psychiatric treatment; recurrent infection; skin contusion; stomach pain; stria; suicide attempt; systemic therapy; teaching hospital; treatment duration; tremor; unspecified side effect; xerostomia

Local chemotherapeutic agents for the treatment of ocular malignancies - Fernandes, B.F.; Nikolitch, K.; Coates, J.; Novais, G.; Odashiro, A.; Odashiro, P.P.; Belfort, R.N.; Burnier, M.N. (Survey of Ophthalmology, 2014)
We critically analyze available peer-reviewed literature, including clinical trials and case reports, on local ocular cancer treatments. Recent innovations in many areas of ocular oncology have introduced promising new therapies, but, for the most part, the optimal treatment of ocular malignancies remains elusive. © 2014 Elsevier Inc.
Keywords: alpha2b interferon; carboplatin; cytarabine; dexamethasone; doxorubicin; etoposide; fluorouracil; melphalan; methotrexate; mitomycin; placebo; alpha2b interferon; thiotepa; topotecan; vinblastine; vincristine; acute leukemia; allergic reaction; bladder carcinoma; blepharitis; bone marrow suppression; breast adenocarcinoma; breast cancer; cancer chemotherapy; cancer resistance; carcinoma in situ; carcinoma in situ of the conjunctiva; carcinoma in situ of the conjunctiva; carcinoma in situ of the cornea; carcinoma in situ of the cornea; cataract; cellulitis; chorioretinal atrophy; chorioretinal atrophy; chorioretinopathy; colon cancer; condyloma acuminatum; conjunctiva disease; conjunctiva tumor; conjunctival hyperemia; conjunctival melanoma; conjunctival melanoma; conjunctival scarring; conjunctival scarring; conjunctivitis; cornea disease; cornea edema; cornea erosion; cornea opacity; cornea tumor; corneal epithelial defect; corneal epithelial defect; corneal scleral melt; corneal scleral melt; corneoconjunctival intraepithelial neoplasia; corneoconjunctival intraepithelial neoplasia; diarrhea; disciform keratitis; disciform keratitis; disease free interval; disease free survival; drug administration route; drug dose comparison; drug efficacy; drug mechanism; drug megadose; drug tissue level; drug tolerability; drug withdrawal; dry eye; encapsulation; endophthalmitis; epiphora; event free survival; Ewing sarcoma; eye cancer; eye irritation; eye lavage; eye movement disorder; eye redness; eye swelling; eye toxicity; eyelash loss; eyelash loss; eyelid erythema; eyelid tumor; fever; filamentary keratitis; filamentary keratitis; flu like syndrome; follicular conjunctivitis; follicular conjunctivitis; foreign body; hair loss; hairy cell leukemia; headache; hepatitis C; Hodgkin disease; human; hydrogel

The effect of positional changes on intraocular pressure during sleep in patients with and without glaucoma - Lazzaro, E.C.; Mallick, A.; Singh, M.; Reich, I.; Elmann, S.; Stefanov, D.G.; Lazzaro, D.R. (Journal of Glaucoma, 2014)
PURPOSE:: To determine whether sleeping at a 20-degree head-up position decreases nocturnal intraocular pressure (IOP) compared with lying supine (flat) in patients with and without glaucoma. DESIGN:: Prospective, nonrandomized comparative case series. MATERIALS AND METHODS:: Thirty patients were recruited based on self-reported disease status with 15 glaucoma and 15 nonglaucoma patients; a total of 60 eyes were tested. Patients were evaluated in a sleep laboratory on 2 separate nights, lying flat 1 night and lying on a wedge pillow at a 20-degree head-up position another night. Baseline IOP was measured during the awake period (10 PM), then measured at 2-hour intervals during the sleep period (12, 2, 4, and 6 AM). RESULTS:: IOP measurements during the 10 PM awake period did not significantly differ between the 2 positions (P=0.55). During the sleep period (12 to 6 AM), the mean IOP was 1.51 mm Hg lower in the 20-degree head-up position when compared with the flat position (95% confidence interval, 0.99 to 2.04 mm Hg), with an average drop of 1.56 and 1.47 mm Hg in glaucoma and nonglaucoma patients, respectively. This corresponds to a 9.33% and 8.67% IOP reduction in glaucoma and nonglaucoma patients, respectively. Twenty-five of 30 patients (83.3%) had lower mean IOPs in the 20-degree head-up position. Mean IOP reduction was >10% for 11 of 30 patients (36.7%) when sleeping in the head-up position. CONCLUSIONS:: The 20-degree head-up position correlates with lower nocturnal IOP as compared with the supine position in glaucoma and nonglaucoma patients. No significant difference in IOP reduction was observed in glaucoma patients when compared with nonglaucoma patients. Copyright © 2012 by Lippincott Williams & Wilkins.
Keywords: adult; article; body position; clinical article; controlled study; female; glaucoma; head up position; human; intraocular pressure; male; night; patient comfort; patient compliance; priority journal; prospective study; self report; sleep; supine position

Use of health care claims data to study patients with ophthalmologic conditions - Stein, J.D.; Lum, F.; Lee, P.P.; Rich III, W.L.; Coleman, A.L. (Ophthalmology, 2014)
Objective To describe what information is or is not included in health care claims data, provide an overview of the main advantages and limitations of performing analyses using health care claims data, and offer general guidance on how to report and interpret findings of ophthalmology-related claims data analyses. Design Systematic review. Participants Not applicable. Methods A literature review and synthesis of methods for claims-based data analyses. Main Outcome Measures Not applicable. Results Some advantages of using claims data for analyses include large, diverse sample sizes, longitudinal follow-up, lack of selection bias, and potential for complex, multivariable modeling. The disadvantages include (a) the inherent limitations of claims data, such as incomplete, inaccurate, or missing data, or the lack of specific billing codes for some conditions; and (b) the inability, in some circumstances, to adequately evaluate the appropriateness of care. In general, reports of claims data analyses should include clear descriptions of the following methodological elements: the data source, the inclusion and exclusion criteria, the specific billing codes used, and the potential confounding factors incorporated in the multivariable models. Conclusions The use of claims data for research is expected to increase with the enhanced availability of data from Medicare and other sources. The use of claims data to evaluate resource use and efficiency and to determine the basis for supplementary payment methods for physicians is anticipated. Thus, it will be increasingly important for eye care providers to use accurate and descriptive codes for billing. Adherence to general guidance on the reporting of claims data analyses, as outlined in this article, is important to enhance the credibility and applicability of findings. Guidance on optimal ways to conduct and report ophthalmology-related investigations using claims data will likely continue to evolve as health services researchers refine the metrics to analyze large administrative data sets. © 2014 by the American Academy of Ophthalmology.
Keywords: vasculotropin; article; billing and claims; clinical pharmacy; cost benefit analysis; data analysis; drug use; endophthalmitis; eye care; eye disease; eye surgery; follow up; glaucoma; health care utilization; health insurance; health service; human; medicaid; medical information; medicare; ophthalmology; outcome assessment; patient coding; patient information; priority journal; systematic review

Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups - Vivas-Consuelo, D.; Usó-Talamantes, R.; Trillo-Mata, J.L.; Caballer-Tarazona, M.; Barrachina-Martínez, I.; Buigues-Pastor, L. (Health Policy, 2014)
Background: Risk adjustment instruments applied to existing electronic health records and administrative datasets may contribute to monitoring the correct prescribing of medicines. Objective: We aim to test the suitability of the model based on the CRG system and obtain specific adjusted weights for determined health states through a predictive model of pharmaceutical expenditure in primary health care. Methods: A database of 261,054 population in one health district of an Eastern region of Spain was used. The predictive power of two models was compared. The first model (ATC-model) used nine dummy variables: sex and 8 groups from 1 to 8 or more chronic conditions while in the second model (CRG-model) we include sex and 8 dummy variables for health core statuses 2-9. Results: The two models achieved similar levels of explanation. However, the CRG system offers higher clinical significance and higher operational utility in a real context, as it offers richer and more updated information on patients. Conclusions: The potential of the CRG model developed compared to ATC codes lies in its capacity to stratify the population according to specific chronic conditions of the patients, allowing us to know the degree of severity of a patient or group of patients, predict their pharmaceutical cost and establish specific programmes for their treatment. © 2014 Elsevier Ireland Ltd.
Keywords: article; asthma; atc model; chronic disease; clinical risk group; controlled study; Crohn disease; cystic fibrosis; depression; diabetes mellitus; drug classification; drug cost; electronic medical record; epilepsy; glaucoma; gout; health care management; health care system; health care utilization; health service; health status; human; hyperlipidemia; hypertension; mathematical model; Parkinson disease; peripheral vascular disease; pharmacy (shop); prescription; primary health care; psychosis; respiratory tract disease; risk assessment; Spain; thyroid disease; tuberculosis; ulcerative colitis

Glaucoma medication adherence in veterans and influence of coexisting chronic disease - Asefzadeh, B.; Rett, D.; Pogoda, T.K.; Selvin, G.; Cavallerano, A. (Journal of Glaucoma, 2014)
BACKGROUND:: The aim of this study was to characterize veterans' adherence to glaucoma medications and follow-up eye care, and to examine the influence of coexisting chronic conditions such as posttraumatic stress disorder (PTSD)/anxiety. PATIENTS AND METHODS:: A retrospective review of computerized medical records was performed for 161 veterans taking topical glaucoma medications. Medication possession ratio (MPR) was calculated using pharmacy data. Mean follow-up ratio (FUR) was calculated using the number of days between visits. RESULTS:: Among the health conditions examined, the most prevalent was hearing loss (0.34), followed by arthritis (0.29), PTSD, or other anxiety disorder (0.27), and dementia or other memory disorder (0.09). The average rates of MPR and FUR were 0.69±0.20 and 0.84±0.19, respectively.Group comparisons found that patients with hearing loss had higher MPR compared with patients without hearing loss, and patients who were white had higher FUR than African American patients. When demographic and health characteristics were examined simultaneously in multiple linear regressions, hearing loss emerged as a significant predictor of MPR, and being older was significantly related to FUR. Younger age was also associated with MPR and being white (vs. African American) or having a PTSD/other anxiety disorder was related to FUR, although these findings did not reach statistical significance. CONCLUSIONS:: FUR was better than MPR in a veteran population being treated for glaucoma.Hearing loss was significantly related to higher MPR, whereas being older was significantly associated with higher FUR. These characteristics should be taken into consideration in future programs to improve adherence to glaucoma care. © 2014 by Lippincott Williams & Wilkins.
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin derivative; African American; aged; anxiety disorder; arthritis; article; Caucasian; chronic disease; clinical assessment; dementia; demography; eye care; female; follow up; glaucoma; groups by age; hearing impairment; human; major clinical study; male; mean follow up ratio; medical record review; medication compliance; medication possession ratio; memory disorder; patient compliance; posttraumatic stress disorder; priority journal; veteran

Controlled ocular drug delivery with nanomicelles - Vaishya, R.D.; Khurana, V.; Patel, S.; Mitra, A.K. (Wiley Interdisciplinary Reviews: Nanomedicine and Nanobiotechnology, 2014)
Many vision threatening ocular diseases such as age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, and proliferative vitreoretinopathy may result in blindness. Ocular drug delivery specifically to the intraocular tissues remains a challenging task due to the presence of various physiological barriers. Nonetheless, recent advancements in the field of nanomicelle-based novel drug delivery system could fulfil these unmet needs. Nanomicelles consists of amphiphilic molecules that self-assemble in aqueous media to form organized supramolecular structures. Micelles can be prepared in various sizes (10-1000nm) and shapes depending on the molecular weights of the core and corona forming blocks. Nanomicelles have been an attractive carrier for their potential to solubilize hydrophobic molecules in aqueous solution. In addition, small size in nanometer range and highly modifiable surface properties have been reported to be advantageous in ocular drug delivery. In this review, various factors influencing rationale design of nanomicelles formulation and disposition are discussed along with case studies. Despite the progress in the field, influence of various properties of nanomicelles such as size, shape, surface charge, rigidity of structure on ocular disposition need to be studied in further details to develop an efficient nanocarrier system. For further resources related to this article, please visit the WIREs website. Conflict of interest: The authors have declared no conflicts of interest for this article. © 2014 Wiley Periodicals, Inc.
Keywords: antisense oligonucleotide; chitosan; cyclosporine; dexamethasone; ethoxzolamide; hydrogenated castor oil; macrogol stearate; metipranolol; mucin; nanocarrier; nanomaterial; nanomicelle; pilocarpine; poloxamer; rapamycin; surfactant; unclassified drug; voclosporin; aqueous solution; article; case study; cell surface; critical micelle concentration; delayed drug release; drug absorption; drug bioavailability; drug delivery system; drug penetration; drug release; drug uptake; encapsulation; endocytosis; eye disease; human; hydrogen bond; hydrophobicity; intraocular pressure; macromolecule; micellization; molecular weight; nonhuman; osmolarity; particle size; patient compliance; polymerization; priority journal; rigidity; static electricity; surface charge; vitreous body

Acanthamoeba keratitis: A new normal - Tu, E.Y. (American Journal of Ophthalmology, 2014)
Keywords: disinfectant agent; hydrogen peroxide; Acanthamoeba keratitis; biocompatibility; biofilm; contact lens; cyst (resting stage); disinfection system; editorial; environmental factor; epidemic; Food and Drug Administration; human; incidence; infection risk; instrument sterilization; medical specialist; motivation; patient compliance; priority journal; prospective study; reinforcement (psychology); risk factor; United States

Does government assistance improve utilization of eye care services by low-income individuals? - Hong, C.J.; Trope, G.E.; Buys, Y.M.; Robinson, B.E.; Jin, Y.-P. (Canadian Journal of Ophthalmology, 2014)
Objective To examine whether government-funded, low-income vision care programs improve use of eye care services by low-income individuals in Canada. Design Cross-sectional survey. Participants 27,375 white respondents to the Canadian Community Health Survey (CCHS) Healthy Aging 2008/2009. Methods Government-funded, low-income vision care programs were reviewed. The amount of assistance provided was compared with professional fee schedules for general/routine eye examinations and market prices for eyeglasses. The utilization of eye care providers was derived from the CCHS. Results To receive low-income vision care assistance, individuals must be in receipt of social assistance. Criteria for receiving social assistance are stringent. The Canadian Financial Capability Survey revealed that 7.9% of Canadians aged 45 to 64 years and 5.5% aged ≥65 years received social assistance in 2009. The CCHS found in 2008/2009 that 12.5% of citizens aged 45 to 64 years and 13.2% of those aged ≥65 years had difficulty paying for basic expenses such as food. In 5 provinces, low-income vision care assistance fully covers a general/routine eye examination. In the remainder, the assistance provided is insufficient for a general/routine eye examination. The assistance for eyeglasses is inadequate in 5 provinces, requiring out-of-pocket copayments. Among middle-aged whites who self-reported not having glaucoma, cataracts, diabetes, or vision problems not corrected by lenses, utilization of eye care providers was 28.1% among those with financial difficulty versus 41.9% among those without (p < 0.05), giving a prevalence ratio 0.68 (95% CI 0.57-0.80) adjusted for age, sex and education. Conclusions Despite government assistance, low-income individuals use vision care services less often than wealthy individuals. © 2014 Canadian Ophthalmological Society.
Keywords: adult; age; aged; article; Canada; Caucasian; controlled study; cross-sectional study; eye care; eye examination; female; financial deficit; government; health care survey; health care utilization; health program; human; lowest income group; major clinical study; male; medical fee; spectacles

Electronic medication packaging devices and medication adherence: A systematic review - Checchi, K.D.; Huybrechts, K.F.; Avorn, J.; Kesselheim, A.S. (JAMA - Journal of the American Medical Association, 2014)
IMPORTANCE: Medication nonadherence, which has been estimated to affect 28% to 31% of US patients with hypertension, hyperlipidemia, and diabetes, may be improved by electronic medication packaging (EMP) devices (adherence-monitoring devices incorporated into the packaging of a prescription medication). OBJECTIVES: To investigate whether EMP devices are associated with improved adherence and to identify and describe common features of EMP devices. EVIDENCE REVIEW: Systematic review of peer-reviewed studies testing the effectiveness of EMP systems in the MEDLINE, EMBASE, PsycINFO, CINAHL, International Pharmaceutical Abstracts, and Sociological Abstracts databases from searches conducted to June 13, 2014, with extraction of associations between the interventions and adherence, as well as other key findings. Each study was assessed for bias using the Cochrane Handbook for Systematic Reviews of Interventions; features of EMP devices and interventions were qualitatively assessed. FINDINGS: Thirty-seven studies (32 randomized and 5 nonrandomized) including 4326 patients met inclusion criteria (10 patient interface-only "simple" interventions and 29 "complex" interventions integrated into the health care system [2 qualified for both categories]). Overall, the effect estimates for differences in mean adherence ranged from a decrease of 2.9% to an increase of 34.0%, and the those for differences in the proportion of patients defined as adherent ranged from a decrease of 8.0% to an increase of 49.5%. We identified 5 common EMP characteristics: recorded dosing events and stored records of adherence, audiovisual reminders to cue dosing, digital displays, real-time monitoring, and feedback on adherence performance. CONCLUSIONS AND RELEVANCE: Many varieties of EMP devices exist. However, data supporting their use are limited, with variability in the quality of studies testing EMP devices. Devices integrated into the care delivery system and designed to record dosing events are most frequently associated with improved adherence, compared with other devices. Higher-quality evidence is needed to determine the effect, if any, of these low-cost interventions on medication nonadherence and to identify their most useful components.
Keywords: amfebutamone; antidiabetic agent; antihypertensive agent; candesartan; cinacalcet; clopidogrel; fluticasone propionate; hydrochlorothiazide; hydroxymethylglutaryl coenzyme A reductase inhibitor; immunosuppressive agent; ipratropium bromide; irbesartan; lercanidipine; lithium salt; metformin; neuroleptic agent; pilocarpine; steroid; sulfonylurea derivative; telmisartan; travoprost; asthma; chronic obstructive lung disease; cost benefit analysis; data analysis; diabetes mellitus; electronic medication packaging device; electronics; glaucoma; health care system; heart failure; highly active antiretroviral therapy; human; Human immunodeficiency virus infection; hyperglycemia; hyperlipidemia; hyperparathyroidism; hypertension; inflammatory bowel disease; information processing; kidney graft; medication compliance; mental disease; meta analysis; packaging material; patient compliance; randomized controlled trial (topic); review; smoking cessation; systematic review; thrombocyte

Ulcerative colitis: Epidemiology, diagnosis, and management - Feuerstein, J.D.; Cheifetz, A.S. (Mayo Clinic Proceedings, 2014)
Ulcerative colitis is a chronic idiopathic inflammatory bowel disease characterized by continuous mucosal inflammation that starts in the rectum and extends proximally. Typical presenting symptoms include bloody diarrhea, abdominal pain, urgency, and tenesmus. In some cases, extraintestinal manifestations may be present as well. In the right clinical setting, the diagnosis of ulcerative colitis is based primarily on endoscopy, which typically reveals evidence of continuous colonic inflammation, with confirmatory biopsy specimens having signs of chronic colitis. The goals of therapy are to induce and maintain remission, decrease the risk of complications, and improve quality of life. Treatment is determined on the basis of the severity of symptoms and is classically a step-up approach. 5-Aminosalycilates are the mainstay of treatment for mild to moderate disease. Patients with failed 5-aminosalycilate therapy or who present with more moderate to severe disease are typically treated with corticosteroids followed by transition to a steroid-sparing agent with a thiopurine, anti-tumor necrosis factor agent, or adhesion molecule inhibitor. Despite medical therapies, approximately 15% of patients still require proctocolectomy. In addition, given the potential risks of complications from the disease itself and the medications used to treat the disease, primary care physicians play a key role in optimizing the preventive care to reduce the risk of complications.
Keywords: 6 mercaptopurine derivative; adalimumab; aminosalicylic acid; azathioprine; balsalazide; budesonide; calcineurin inhibitor; corticosteroid; cyclosporine; golimumab; infliximab; mercaptopurine; mesalazine; natalizumab; nonsteroid antiinflammatory agent; prednisone; probiotic agent; steroid; tacrolimus; tumor necrosis factor inhibitor; vedolizumab; adrenal insufficiency; antibiotic therapy; avascular necrosis; bile duct carcinoma; bone marrow suppression; cataract; clinical feature; colon resection; colorectal cancer; congestive heart failure; cost effectiveness analysis; delirium; demyelinating disease; diabetes mellitus; diarrhea; disease severity; general practitioner; genetic risk; genetic variability; glaucoma; headache; hemolytic anemia; hepatitis; hepatitis B; histopathology; human; hyperkalemia; hypertension; hypertrichosis; ileostomy; infection; infusion related reaction; injection site reaction; insomnia; interstitial nephritis; intestine biopsy; laboratory test; leukopenia; lupus erythematosus; lymphoma; melanoma; mood disorder; nausea; nephrotoxicity; non melanoma skin cancer; nonhodgkin lymphoma; osteopenia; osteoporosis; pancreatitis; paradoxical drug reaction; pathogenesis; patient compliance; pharynx disease; physician attitude; primary sclerosing cholangitis; proctocolectomy; progressive multifocal leukoencephalopathy; psoriasis; review; risk assessment; risk factor; seizure; skin cancer; smoking habit; treatment outcome; tuberculosis; ulcerative colitis; vomiting; wound healing impairment

Resource utilization and use of life-extending therapies and corticosteroids in prostate cancer patients with corticosteroid-sensitive comorbidities - Bui, C.N.; Wang, L.; Baser, O. (Current Medical Research and Opinion, 2014)
Objectives: Corticosteroids (CSs) are used concomitantly with life-extending therapies (LETs) in patients with castration-resistant prostate cancer (CRPC). This study examined time to LETs, LETs and concomitant CS adherence, and monthly all-cause healthcare utilization and costs in patients with CPRC with and without CS-sensitive comorbidities in the Veterans Health Administration population. Methods: Patients had CRPC if records showed prostate cancer diagnosis, medical/surgical castration and ≥2 prostate-specific antigen increases through 1 June 2007-31 May 2012. CS-sensitive comorbidities were assessed 6 months prior to the index date. Adherence, defined as medication possession ratio (MPR) ≥0.8, among patients initiating LETs (cabazitaxel, docetaxel, or abiraterone acetate) before 30 November 2011, resource utilization and costs among patients with concomitant CS were assessed. Statistical analysis included descriptive, Cox proportional hazards, and logistic regression models. Results: Common CS-sensitive conditions among 12,128 patients with CRPC included hypertension (75.74%) and hyperlipidemia (54.69%). Those with glaucoma (hazard ratio [HR]=0.67), ischemic heart disease (HR=0.78), and peripheral vascular disease (PVD) (HR=0.78) were less likely to be prescribed LETs (all p<0.01). Duration of LET was shorter among patients with CS-sensitive comorbidities (125.02 vs 133.08 days; p=0.04) in the 6 month follow-up period. Among LET-treated patients with and without CS-sensitive comorbidities, less than half had MPR≥0.8 (LET: 48.72% vs 54.05%; concomitant CS: 42.19% vs 40.54%, respectively). Cerebrovascular disease (odds ratio=0.107; 95% confidence interval=0.012 to 0.966) and PVD (odds ratio=0.523; 95% confidence interval=0.276 to 0.991) were associated with reduced CS adherence. Among patients with concomitant CS, those with CS-sensitive comorbidities had more inpatient stays than those without (20.45% vs 12.88%; p=0.033), incurring higher monthly inpatient costs ($1157 vs $342; p<0.0001) and total costs ($5725 vs $4772; p=0.036). Conclusion: CS-sensitive conditions influence initiation and duration of LETs, concomitant CS adherence, inpatient stays, and total costs. Future efforts should focus on specific strategies for treating prostate cancer patients with CS-sensitive comorbidities to ensure that they have appropriate access to LETs and to reduce costs and inpatient stays. Study limitations include the use of retrospective claims data and the relatively restricted subpopulation of older North American males.
Keywords: abiraterone acetate; cabazitaxel; corticosteroid; docetaxel; adult; article; cancer diagnosis; cancer therapy; castration resistant prostate cancer; cerebrovascular disease; clinical assessment; comorbidity; confidence interval; controlled study; corticosteroid therapy; follow up; glaucoma; health care cost; health care utilization; hospital patient; human; hyperlipidemia; hypertension; ischemic heart disease; major clinical study; male; medical record; medication compliance; North American; peripheral vascular disease; prescription; proportional hazards model; statistical analysis; treatment duration; veterans health

Intravitreal aflibercept for macular edema secondary to central retinal vein occlusion: 18-month results of the phase 3 GALILEO study - Ogura, Y.; Roider, J.; Korobelnik, J.-F.; Holz, F.G.; Simader, C.; Schmidt-Erfurth, U.; Vitti, R.; Berliner, A.J.; Hiemeyer, F.; Stemper, B.; Zeitz, O.; Sandbrink, R. (American Journal of Ophthalmology, 2014)
Purpose: To evaluate intravitreal aflibercept for treatment of macular edema secondary to central retinal vein occlusion (CRVO). Design: Randomized, double-masked, phase 3 study. Methods: A total of 177 patients with macular edema secondary to CRVO were randomized to receive 2 mg intravitreal aflibercept (n[106) or sham (n[71) every 4 weeks for 20 weeks. From weeks 24 to 48, patients were monitored every 4 weeks; the former group received intravitreal aflibercept as needed (PRN), and the sham group received sham. From weeks 52 to 76, patients were monitored every 8 weeks, and both groups received intravitreal aflibercept PRN. The primary endpoint (proportion of patients who gained ≥15 letters) was at week 24. This study reports exploratory outcomes at week 76. Results: The proportion of patients who gained ≥15 letters in the intravitreal aflibercept and sham groups was 60.2%vs 22.1%at week 24 (patients discontinued before week 24 were considered nonresponders; P < .0001), 60.2% vs 32.4% at week 52 (last observation carried forward, P <.001), and 57.3% vs 29.4% at week 76 (last observation carried forward; P < .001). Mean mm change from baseline central retinal thickness was L448.6 vs L169.3 at week 24 (P < .0001), L423.5 vs L219.3 at week 52 (P < .0001), and L389.4 vs L306.4 at week 76 (P = .1122). Over 76 weeks, the most common ocular serious adverse event in the intravitreal aflibercept group was macular edema (3.8%). Conclusion: The visual and anatomic improvements seen after fixed, monthly dosing at week 24 were largely maintained when treatment intervals were extended. Patients with macular edema following CRVO benefited from early treatment with intravitreal aflibercept.
Keywords: NCT01012973; aflibercept; article; central retina vein occlusion; central retinal thickness; controlled study; double blind procedure; drug withdrawal; evaluation study; faintness; glaucoma; human; humerus fracture; iischemia; iischemia; iris disease; macular edema; macular fibrosis; macular fibrosis; macular ischemia; macular ischemia; major clinical study; ocular fibrosis; patient compliance; patient monitoring; phase 3 clinical trial; pneumonia; quality of life; randomized controlled trial; retina vein occlusion; rhinopharyngitis; treatment outcome; treatment withdrawal; unilateral blindness; visual disorder; vitreous body detachment; vitreous hemorrhage

Investigation of hydrogel membranes containing a combination of timolol maleate and brimonidine tartrate for ocular delivery - Prabhu, P.; Dubey, A.; Uchil, D. (Asian Journal of Pharmaceutics, 2014)
Hydrogels are comprised of a cross-linked network of polymers. Water penetrates these networks, resulting in swelling and giving the hydrogel a soft and rubbery consistency, thereby maintaining the integrity of the membrane. Because of the drawback of conventional therapy for ocular delivery, a hydrogel membrane containing a combination of timolol maleate and brimonidine tartrate were formulated for the treatment of glaucoma. In the present investigation, hydrogel membranes were prepared using polymers like gelatin, PVA and chitosan, which were cross-linked using physical and/or chemical methods. The cross-linking of the membranes was confirmed by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD) and Differential scanning calorimetry (DSC) studies. From the scanning electron microscopy (SEM) of the membranes, it appeared homogenous and showed no separation. The pH of the membranes ranged from 7.21-7.4. The hydrogels showed a considerably good swelling ratio ranging from 91.66-372.72%. The drug content ranged from 82.78-95.62%. The in vitro drug release study indicated that there was a slow and sustained release of the drug from the membranes that were sufficiently cross-linked and followed zero order release. The Intraocular pressure (IOP) lowering activity of the prepared formulation was compared with the marketed formulation, and it was found that the IOP lowering action was sustained for a long period of time. Stability studies proved that the formulations could be stable when stored at room temperature. Results of the study indicate that it is possible to develop a safe and physiologically effective hydrogel that is patient compliant.
Keywords: brimonidine; chitosan; gelatin; timolol maleate; timolol maleate; article; cross linking; differential scanning calorimetry; drug release; glaucoma; human; hydrogel; in vitro study; infrared spectroscopy; intraocular pressure; patient compliance; pH; room temperature; scanning electron microscopy; sustained drug release; X ray diffraction

Low bioavailability steroids in inflammatory bowel disease: An old chestnut or a whole new ballgame? - Saibeni, S.; Meucci, G.; Papi, C.; Manes, G.; Fascì-Spurio, F. (Expert Review of Gastroenterology and Hepatology, 2014)
At present, therapy of inflammatory bowel disease is still far from being fully satisfactory; old drugs like steroids, for instance, still represent a cornerstone in the treatment of active disease despite their associated important side effects and incomplete clinical efficacy. In the last years, new therapeutic strategies have been suggested in order to avoid or at least limit steroids use and in this direction the so-called low bioavailability steroids appeared to be a promising therapeutic weapon; however, some grey areas about their real utility and manner of use still remain. The aim of this review is to evaluate the available evidence about the use of oral budesonide and beclomethasone dipropionate in inflammatory bowel disease, to critically assess their current position in the therapeutic algorithm of these diseases and to give simple and practical indications for their use in every-day clinical practice.
Keywords: beclomethasone dipropionate; budesonide; corticosteroid; ethyl cellulose; eudragit; hydrocortisone; mesalazine; methylprednisolone; placebo; prednisolone; prednisone; add on therapy; adrenal insufficiency; antiinflammatory activity; cataract; clinical practice; controlled release formulation; corticosteroid induced osteoporosis; Crohn disease; Crohn Disease Activity Index; drug bioavailability; drug dose comparison; drug dose reduction; drug efficacy; drug indication; drug metabolism; drug use; emotional disorder; evidence based medicine; first pass effect; fluid retention; glaucoma; growth retardation; human; hydrocortisone blood level; hyperglycemia; hypertension; hypophysis disease; infection; inflammatory bowel disease; meta analysis (topic); multicenter study (topic); patient compliance; practice guideline; randomized controlled trial (topic); recurrence risk; remission; review; treatment duration; ulcerative colitis; unspecified side effect; wound healing impairment

Gaps in glaucoma care: A systematic review of monoscopic disc photos to screen for glaucoma - Newman-Casey, P.A.; Verkade, A.J.; Oren, G.; Robin, A.L. (Expert Review of Ophthalmology, 2014)
One important gap in glaucoma care is the lack of an optimized screening protocol for detecting glaucoma on a population level. A systematic review of the literature was conducted to evaluate the effectiveness of monoscopic disc photos as a screening tool for detecting glaucoma. Six studies met inclusion and exclusion criteria out of 221 possible titles. The specificity of monoscopic photos to detect glaucoma compared to clinical exam was excellent (93.6-100%), while the sensitivity was much lower (50-67.4%). Monoscopic disc photos are highly specific in identifying glaucoma, though additional testing, such as perimetry, may be needed to improve their sensitivity. Further research is needed to evaluate whether monoscopic disc photos are a cost-effective way to screen for glaucoma in a primary care setting utilizing new technological advances in ophthalmic imaging such as portable non-mydriatic fundus cameras.
Keywords: clinical effectiveness; clinical examination; comparative effectiveness; cost effectiveness analysis; eye care; eye photography; fundus camera; glaucoma; health care utilization; human; intermethod comparison; monoscopic disc photo; ophthalmoscope; perimetry; primary medical care; review; screening test; sensitivity analysis; sensitivity and specificity; stereoscopic vision; systematic review; telemedicine; visual system examination

Clinicians' perspectives on the use of drug-eluting contact lenses for the treatment of glaucoma - Taniguchi, E.V.; Kalout, P.; Pasquale, L.R.; Kohane, D.S.; Ciolino, J.B. (Therapeutic Delivery, 2014)
Glaucoma is the leading cause of irreversible blindness worldwide. The perspective of clinicians who treat the disease is important and may ultimately dictate the adoption of new treatment modalities, such as drug-eluting contact lenses. Recent advances have enabled contact lenses to serve as a sustained-release drug-delivery platform capable of treating glaucoma. This review covers the medical treatment of glaucoma, suboptimal adherence rates to treatment, and factors that may influence the clinical applicability of drug-eluting contact lenses. Ophthalmologists who treat glaucoma were surveyed to determine their perspective on treatment adherence, bandage contact lens use and the use of a drug-eluting contact lens to treat glaucoma. Given the challenge of treating glaucoma and the clinical need for improved drug delivery, drug-eluting contact lenses appear to be a promising treatment option.
Keywords: antiglaucoma agent; polymer; bandage contact lens; contact lens; drug delivery system; drug eluting contact lens; drug release; glaucoma; human; patient compliance; physician attitude; punctal plug; review; sustained drug release; visual impairment

Chronic eye disease and the WHO universal eye health global action plan 2014-2019 - Gupta, N.; Kocur, I. (Canadian Journal of Ophthalmology, 2014)
Keywords: age related macular degeneration; cataract; chronic disease; diabetic retinopathy; editorial; evidence based medicine; eye care; eye disease; glaucoma; health care access; health care delivery; health care financing; health care policy; health insurance; human; leadership; low vision; medical information; poverty; refraction error; socioeconomics; visual impairment; World Health Organization

Long-term systemic glucocorticoid therapy: Patients' representations, prescribers' perceptions, and treatment adherence - Nassar, K.; Janani, S.; Roux, C.; Rachidi, W.; Etaouil, N.; Mkinsi, O. (Joint Bone Spine, 2014)
Introduction: Glucocorticoids have been used since 1948 for their anti-inflammatory and structural effects in various inflammatory diseases. The optimal use of glucocorticoids remains controversial. Patients may have a number of concerns about the effects of glucocorticoids. Many factors can adversely affect treatment adherence. Objectives: To evaluate the main adverse effects reported by patients and physicians, and to assess representations associated with glucocorticoid therapy and the underlying disease, via measurements of treatment adherence, with the goal of optimizing treatment strategies and improving patient information. Methods: From December 2011 to May 2012, we conducted two surveys in 125 patients receiving long-term glucocorticoid therapy and followed-up at the rheumatology department of the teaching hospital in Casablanca, Morocco, and in 85 hospital physicians in various specialties, respectively. Results: Mean glucocorticoid therapy duration was 6. years, mean maximal prescribed dosage was 44.87. mg/d, and 50.4% of the patients had inflammatory joint disease. Adverse neuropsychiatric effects were reported by 70 out of 125 (56%) patients. Weight gain was the adverse effect deemed most bothersome by the physicians, who significantly underestimated the occurrence of neuropsychiatric adverse effects (27% vs 56%, P= 0.034). Adherence was poor in 80 out of 125 (64%) patients, and 22 out of 125 (18%) patients reported episodes of treatment discontinuation. Conclusion: Prescribers underestimate the frequency of neuropsychiatric adverse effects of long-term systemic glucocorticoid therapy. Regular follow-up visits during treatment, with collection of systemic adverse effects might improve treatment adherence.
Keywords: glucocorticoid; acne; adult; amenorrhea; anxiety disorder; article; asthenia; cataract; connective tissue disease; corticosteroid therapy; cross-sectional study; depression; dermatomyositis; diabetes mellitus; drowsiness; dyslipidemia; eating habit; female; follow up; fracture; glaucoma; headache; health care survey; heartburn; hirsutism; hospital physician; human; hyperhidrosis; insomnia; irritability; leg edema; lipodystrophy; major clinical study; male; medical specialist; medication compliance; middle aged; Morocco; myopathy; osteoporosis; overlap syndrome; overlap syndrome; patient compliance; patient information; persecutory delusion; physician attitude; recurrent infection; rheumatoid arthritis; sarcoidosis; scleroderma; side effect; skin contusion; stomach pain; stria; suicide attempt; systemic lupus erythematosus; systemic therapy; teaching hospital; treatment duration; tremor; vasculitis; body weight gain; xerostomia

Repurposing diflunisal for familial amyloid polyneuropathy: A randomized clinical trial - Berk, J.L.; Suhr, O.B.; Obici, L.; Sekijima, Y.; Zeldenrust, S.R.; Yamashita, T.; Heneghan, M.A.; Gorevic, P.D.; Litchy, W.J.; Wiesman, J.F.; Nordh, E.; Corato, M.; et al. (JAMA - Journal of the American Medical Association, 2013)
IMPORTANCE: Familial amyloid polyneuropathy, a lethal genetic disease caused by aggregation of variant transthyretin, induces progressive peripheral nerve deficits and disability. Diflunisal, a nonsteroidal anti-inflammatory agent, stabilizes transthyretin tetramers and prevents amyloid fibril formation in vitro. OBJECTIVE: To determine the effect of diflunisal on polyneuropathy progression in patients with familial amyloid polyneuropathy. DESIGN, SETTING, AND PARTICIPANTS: International randomized, double-blind, placebo-controlled study conducted among 130 patients with familial amyloid polyneuropathy exhibiting clinically detectable peripheral or autonomic neuropathy at amyloid centers in Sweden (Umeå), Italy (Pavia), Japan (Matsumoto and Kumamoto), England (London), and the United States (Boston, Massachusetts; New York, New York; and Rochester, Minnesota) from 2006 through 2012. INTERVENTION: Participants were randomly assigned to receive diflunisal, 250 mg (n=64), or placebo (n=66) twice daily for 2 years. MAIN OUTCOMES AND MEASURES: The primary end point, the difference in polyneuropathy progression between treatments, was measured by the Neuropathy Impairment Score plus 7 nerve tests (NIS+7) which ranges from 0 (no neurological deficits) to 270 points (no detectable peripheral nerve function). Secondary outcomes included a quality-of-life questionnaire (36-Item Short-Form Health Survey [SF-36]) and modified body mass index. Because of attrition, we used likelihood-based modeling and multiple imputation analysis of baseline to 2-year data. RESULTS: By multiple imputation, the NIS+7 score increased by 25.0 (95% CI, 18.4-31.6) points in the placebo group and by 8.7 (95% CI, 3.3-14.1) points in the diflunisal group, a difference of 16.3 points (95% CI, 8.1-24.5 points; P < .001). Mean SF-36 physical scores decreased by 4.9 (95% CI, -7.6 to -2.2) points in the placebo group and increased by 1.5 (95% CI, -0.8 to 3.7) points in the diflunisal group (P < .001). Mean SF-36 mental scores declined by 1.1 (95% CI, -4.3 to 2.0) points in the placebo group while increasing by 3.7 (95% CI, 1.0-6.4) points in the diflunisal group (P = .02). By responder analysis, 29.7% of the diflunisal group and 9.4% of the placebo group exhibited neurological stability at 2 years (<2-point increase in NIS+7 score; P = .007). CONCLUSIONS AND RELEVANCE: Among patients with familial amyloid polyneuropathy, the use of diflunisal compared with placebo for 2 years reduced the rate of progression of neurological impairment and preserved quality of life. Although longer-term follow-up studies are needed, these findings suggest benefit of this treatment for familial amyloid polyneuropathy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00294671. Copyright 2013 American Medical Association. All rights reserved.
Keywords: NCT00294671; diflunisal; placebo; adult; article; body mass; clinical effectiveness; congestive heart failure; controlled clinical trial; controlled study; disease association; disease course; double blind procedure; drug efficacy; drug hypersensitivity; drug safety; drug tolerability; familial amyloid polyneuropathy; female; functional assessment; gastrointestinal hemorrhage; gastrointestinal symptom; glaucoma; headache; heart disease; human; kidney disease; kidney failure; major clinical study; male; middle aged; multicenter study; musculoskeletal disease; nausea; outcome assessment; patient assessment; patient compliance; priority journal; quality of life; randomized controlled trial; scoring system; sensitivity analysis; survival rate; survival time; treatment duration

Should you establish a medical marijuana dispensary? - Friedman, J. (Drug Topics, 2013)
Keywords: cannabis; ambulatory care; anxiety disorder; appetite disorder; chronic pain; drug industry; human; insomnia; intraocular hypertension; muscle spasm; nausea and vomiting; note; pharmacist

Peripheral ulcerative keratitis in association with sarcoidosis - Harthan, J.S.; Reeder, R.E. (Contact Lens and Anterior Eye, 2013)
Peripheral ulcerative keratitis (PUK) is a sight-threatening condition characterized by an epithelial defect, crescent-shaped stromal inflammation, and progressive stromal thinning. Peripheral ulcerative keratitis as a purely inflammatory entity is most commonly associated with collagen vascular diseases, including rheumatoid arthritis, polyarteritis nodosa, Wegener granulomatosis, systemic lupus erythematosus, and relapsing polychondritis. PUK can also be associated with infectious and inflammatory conditions such as hepatitis, syphilis, herpes simplex keratitis, fungal keratitis, Mooren ulcer, and marginal keratitis. We describe a case report of PUK associated with the inflammatory condition of sarcoidosis. © 2013 British Contact Lens Association.
Keywords: artificial tear; bacitracin; ciprofloxacin; metoprolol; prednisolone acetate; aged; article; case report; clinical feature; conjunctival hyperemia; conjunctivitis; cornea disease; cornea neovascularization; cornea scarring; corneal thinning; differential diagnosis; disease association; disease duration; drug cost; drug dose titration; epiphora; eye pain; female; follow up; graft failure; human; hypertension; keratitis; keratopathy; medical history; medication compliance; patient compliance; peripheral ulcerative keratitis; photophobia; priority journal; sarcoidosis; scar formation; sclerosing keratitis; sclerosing keratitis; slit lamp; treatment failure; visual acuity

First-line treatment in open-angle glaucoma: An update - Turner, S.A.; McNaught, A.I. (Expert Review of Ophthalmology, 2013)
This review paper sets out to evaluate the evidence for different modalities as first-line treatments for primary open-angle glaucoma. In current practice, initial treatment is commonly with medical therapy, whereas laser, or incisional surgery, is performed if medical therapy does not satisfactorily reduce initial intra-ocular pressure and/or prevent visual field progression. However, medical therapy is not without adverse effects, and poor compliance with treatment means that in some cases another primary therapy might be preferable. Glaucoma is a common, chronic disease requiring life-long care in order to prevent progressive optic nerve head atrophy and blindness. Demographic changes in the developed world are resulting in a growing treated population: issues concerning acceptability, efficiency and cost-effectiveness of initial glaucoma treatment will become increasingly important. © 2013, Informa UK, Ltd.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bimatoprost; carbonate dehydratase inhibitor; dorzolamide plus timolol; latanoprost; miotic agent; prostaglandin; timolol; travoprost; blindness; combination chemotherapy; conjunctival hyperemia; cost effectiveness analysis; drug cost; drug safety; human; intraocular pressure; long term care; low level laser therapy; open angle glaucoma; optic nerve atrophy; patient compliance; patient satisfaction; quality adjusted life year; review; trabeculectomy; trabeculoplasty; treatment duration; treatment indication; treatment response; visual field; cosopt

Omalizumab for the treatment of severe persistent allergic asthma: A systematic review and economic evaluation - Norman, G.; Faria, R.; Paton, F.; Llewellyn, A.; Fox, D.; Palmer, S.; Clifton, I.; Paton, J.; Woolacott, N.; McKenna, C. (Health Technology Assessment, 2013)
Background: Allergic asthma is a long-term disorder of the airways resulting from overexpression of immunoglobulin E (IgE) in response to environmental allergens. Patients with poorly controlled asthma are at high risk of exacerbations requiring additional treatment, including hospitalisations. Severe exacerbations are potentially life threatening. Guidelines identify five treatment steps for both adults and children. Omalizumab (Xolair®) is a recombinant DNA-derived humanised monoclonal antibody indicated as an add-on therapy in patients aged ≥6 years with severe persistent allergic asthma uncontrolled at treatment step 4 or 5. Objective: To determine the clinical effectiveness, safety and cost-effectiveness of omalizumab, as an add-on therapy to standard care, within its licensed indication, compared with standard therapy alone for the treatment of severe persistent allergic asthma in adults and adolescents aged ≥12 years and children aged 6-11 years. Data sources: Eleven electronic databases (including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials) and additional sources including regulatory agency reports were searched from inception to October 2011. Additional data sources include: the manufacturer's submission (MS); two previous National Institute for Health and Care Excellence (NICE) single technology appraisal (STA) submissions; and existing reviews on the safety of omalizumab and oral corticosteroids (OCSs). Review methods: Systematic reviews of the clinical effectiveness and cost-effectiveness evidence for omalizumab were performed. The primary outcome was number of clinically significant (CS) exacerbations. Other outcomes included asthma symptoms, unscheduled health-care use, asthma-related mortality, OCS use and health-related quality of life (HRQoL). Because of methodological and clinical heterogeneity between trials, a narrative synthesis was applied. Pragmatic reviews with best evidence syntheses were used to assess adverse events of omalizumab and OCSs. The cost-effectiveness of omalizumab was assessed from the perspective of the UK NHS in the two separate populations: adults and adolescents, and children, using a cohort Markov model. Costs and outcomes were discounted at 3.5% per annum. Results are presented for additional subgroup populations: (1) hospitalised for asthma in the previous year, (2) adults and adolescents on maintenance OCSs and (3) three or more exacerbations in the previous year. Results: Eleven randomised controlled trials (RCTs) and 13 observational studies were identified, including four RCTs/subgroups in the adult licensed population and one subgroup in children. A minority of patients were on maintenance OCSs. No evidence comparing omalizumab with OCSs was identified. Omalizumab significantly reduced the incidence of CS exacerbations in both adults and children [adults: INvestigatioN of Omalizumab in seVere Asthma Trial (INNOVATE): rate ratio 0.74; 95% CI 0.55 to 1.00; children IA-05 EUP (the a priori subgroup of patients who met the European Medicines Agency license criteria) 0.66; 95% CI 0.44 to 1.00]. Significant benefits were observed for a range of other outcomes in adults. Subgroup evidence showed benefits in adults on maintenance OCSs. Evidence for an OCS-sparing effect of omalizumab was limited but consistent. Omalizumab is available as 75mg and 150mg prefilled syringes at prices of £128.07 and £256.15 respectively. The incremental cost-effectiveness ratio (ICER) for adults and adolescents is £83,822 per quality-adjusted life-year (QALY) gained, whereas the ICER for children is £78,009 per QALY gained. The results are similar for the subgroup population of ≥3 exacerbations in the previous year, whereas the ICER for the other subgroup populations are lower; £46,431 for the hospitalisation subgroup in adults and adolescents, £44,142 for the hospitalisation subgroup in children and £50,181 for the maintenance OCS subgroup. Conclusion: Omalizumab reduces the incidence of CS exacerbations in adults and children, with benefits on other outcomes in adults. Limited, underpowered subgroup evidence exists that omalizumab reduces exacerbations and OCS requirements in adults on OCSs. Evidence in children is weaker and more uncertain. The ICERs are above conventional NHS thresholds of cost-effectiveness. The key drivers of cost-effectiveness are asthma-related mortality risk and, to a lesser extent, HRQoL improvement and OCS-related adverse effects. An adequately powered double-blind RCT in both adults and children on maintenance OCSs and an individual patient data meta-analysis of existing trials should be considered. A registry of all patients on omalizumab should be established. Study registration: The study was registered as PROSPERO CRD42011001625. Funding: This report was commissioned by the National Institute for Health Research Health Technology Assessment programme on behalf of NICE as project number HTA 10/128/01. © Queen's Printer and Controller of HMSO 2013.
Keywords: beta adrenergic receptor stimulating agent; corticosteroid; long acting drug; omalizumab; placebo; abdominal pain; add on therapy; adolescent; adrenal insufficiency; adult; allergic asthma; anaphylaxis; artery thrombosis; article; behavior disorder; body weight disorder; bronchitis; cardiovascular disease; cataract; cerebrovascular accident; child; clinical effectiveness; cohort analysis; controlled study; cost effectiveness analysis; diabetes mellitus; disease exacerbation; drug cost; drug effect; drug fever; drug indication; drug induced headache; drug megadose; drug safety; drug withdrawal; economic evaluation; endocrine disease; evidence based medicine; eye disease; femur fracture; fracture; fragility fracture; gastrointestinal disease; glaucoma; health care utilization; heart failure; heart infarction; hip fracture; hospitalization; human; hyperglycemia; incidence; injection site erythema; injection site pain; injection site pruritus; injection site reaction; injection site swelling; intraocular hypertension; ischemic heart disease; low drug dose; lower respiratory tract infection; maintenance therapy; malignant neoplasm; metabolic disorder; mood disorder; mortality; musculoskeletal disease; national health service; neurologic disease; nonhodgkin lymphoma; observational study; outcome assessment; peptic ulcer; population research; preschool child; prevalence; prognosis; quality adjusted life year; quality of life; randomized controlled trial (topic); rash; school child; severe persistent allergic asthma; severe persistent asthma; sinusitis; skin disease; sleep disorder; spine fracture; symptom; systematic review; thrombosis; United Kingdom; urticaria; body weight gain; xolair

Are preservatives necessary to improve efficacy of some glaucoma drops? - Irkec, M.; Bozkurt, B.; Mocan, M.C. (British Journal of Ophthalmology, 2013)
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; benzalkonium chloride; beta adrenergic receptor blocking agent; carbomer; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; dorzolamide plus timolol; drug preservative; eye drops; latanoprost; pilocarpine; prednisolone; prostaglandin derivative; t 2345; tafluprost; timolol; unclassified drug; antihypertensive activity; apoptosis; blindness; cornea epithelium; cornea injury; cytotoxicity; disease course; drug absorption; drug bioavailability; drug choice; drug delivery system; drug dosage form comparison; drug efficacy; drug formulation; drug penetration; drug safety; drug tolerability; editorial; eye inflammation; eye injury; gel; human; intraocular hypertension; intraocular pressure; lipophilicity; monotherapy; morning dosage; nonhuman; open angle glaucoma; patient compliance; priority journal; subconjunctival fibrosis; unspecified side effect; t 2345

The safety and efficacy of brinzolamide 1%/timolol 0.5% fixed combination versus dorzolamide 2%/timolol 0.5% in patients with open-angle glaucoma or ocular hypertension - Akçay, B.I.S.; Güney, E.; Bozkurt, K.T.; Ünlü, C.; Akçali, G. (Journal of Ocular Pharmacology and Therapeutics, 2013)
Purpose: The aim of this study was to compare the intraocular pressure (IOP) lowering efficacy and to determine patient preference based on ocular discomfort with fixed combination brinzolamide/timolol and fixed combination dorzolamide/timolol in patients with open-angle glaucoma or ocular hypertension who required a change in therapy due to elevated IOP while receiving IOP-lowering medication. Methods: This was a 3-month, randomized, double-blinded, active-controlled, parallel-group trial. Patients had open-angle glaucoma or ocular hypertension, which could not be controlled with monotherapy and were randomized to twice daily therapy with either brinzolamide 1%/timolol 0.5% or dorzolamide 2%/timolol 0.5%. IOP assessments were taken at 8 AM, 10 AM, and 4 PM at week 2 as well as at months 1, 2, and 3. Patients completed ocular discomfort assessments (based on stinging, burning, feeling of heat or warmth, or sharp pain) on their current IOP lowering therapy at baseline. Results: Of the 114 patients enrolled, 57 received Brinz/Tim and 57 received Dorz/Tim twice daily. Both medications produced statistically relevant IOP reductions, which were similar in both groups at each visit. The IOP reductions with Brinz/Tim ranged from 6.42 to 9.74 mmHg (26.09%-37.46%), whereas Dorz/Tim produced mean IOP reductions ranging from 8.16 to 12.41 mmHg (31.19%-41.44%) (P>0.05). Brinz/Tim showed significantly less ocular irritation (0.5% vs. 15.7%, respectively; P=0.0004) than Dorz/Tim. Conclusions: Both Brinz/Tim and Dorz/Tim showed similar significant and clinically relevant IOP-lowering efficacy, whereas Brinz/Tim provided superior outcomes in terms of ocular comfort. © Copyright 2013, Mary Ann Liebert, Inc. 2013.
Keywords: brinzolamide plus timolol; dorzolamide plus timolol; abnormal sensation; adult; article; blurred vision; burning sensation; comparative effectiveness; controlled study; crossover procedure; double blind procedure; drug efficacy; drug safety; drug tolerability; drug withdrawal; eye discomfort; eye irritation; eye pain; female; human; intraocular foreign body; intraocular hypertension; intraocular pressure; major clinical study; male; open angle glaucoma; outcome assessment; parallel design; patient compliance; patient preference; prospective study; randomized controlled trial; treatment duration; azarga; cosopt

Healthcare costs and utilization for privately insured patients treated for non-infectious uveitis in the USA - Chu, D.S.; Johnson, S.J.; Mallya, U.G.; Davis, M.R.; Sorg, R.A.; Duh, M.S. (Journal of Ophthalmic Inflammation and Infection, 2013)
Background: The purpose of this study was to describe comorbidities, healthcare costs, and resource utilization among patients with chronic non-infectious uveitis initiating corticosteroid, immunosuppressants, or biologics. In this retrospective cohort study, patients with a non-infectious uveitis diagnosis and continuous insurance coverage during a 6-month baseline were selected from a privately insured claims database with 80.7 million enrollees. Index dates were defined as the first prescription/administration of a corticosteroid, immunosuppressant, or biologic between 2003 and 2009. Comorbidities, healthcare costs, and utilization were analyzed in a per-member-per-month (PMPM) framework to account for varying between-patient treatment periods, defined as continuous medication use within the same class. Wilcoxon rank-sum and chi-square tests were used for comparisons of costs and categorical outcomes. Results: Patients on corticosteroids (N = 4,568), immunosuppressants (N = 5,466), and biologics (N = 1,694) formed the study population. Baseline PMPM inpatient admission rates were 0.029 for patients on corticosteroids, 0.044 for patients on immunosuppressants, and 0.045 for patients on biologics (p < 0.001 immunosuppressants or biologics versus corticosteroids); during treatment, PMPM inpatient admissions increased to 0.044 and 0.048 for patients taking corticosteroids and immunosuppressants, respectively, but decreased to 0.024 for patients taking biologics (p < 0.001 versus corticosteroids and p = 0.003 versus immunosuppressants). Baseline average PMPM costs for patients taking corticosteroids, immunosuppressants, and biologics were US$935, US$1,738, and US$1,439 (p < 0.001 between groups), while on-treatment PMPM costs excluding drug costs increased to US$1,129 for patients taking corticosteroids but lowered to US$1,592 for patients taking immunosuppressants, and US$918 for patients taking biologics (p < 0.001 versus corticosteroids or immunosuppressants). Conclusions: There is significant economic burden associated with existing treatments of uveitis. Corticosteroids may be overused as a treatment for uveitis. © 2013 Chu et al.
Keywords: biological product; corticosteroid; immunosuppressive agent; adolescent; adult; ankylosing spondylitis; article; blindness; cataract; child; cohort analysis; comorbidity; corticosteroid therapy; Crohn disease; drug cost; female; glaucoma; health care cost; health care utilization; hospital admission; human; infant; major clinical study; male; middle aged; newborn; preschool child; prescription; priority journal; private health insurance; psoriasis; reference database; retina detachment; retina macula cystoid edema; macular degeneration; retrospective study; rheumatoid arthritis; school child; United States; uveitis; visual disorder; young adult

Effect of hemodialysis on intraocular pressure and ocular perfusion pressure - Hu, J.; Bui, K.M.; Patel, K.H.; Kim, H.; Arruda, J.A.L.; Wilensky, J.T.; Vajaranant, T.S. (JAMA Ophthalmology, 2013)
Importance: Elevated intraocular pressure (IOP) and decreased ocular perfusion pressure (OPP) are risk factors for glaucoma development and progression. Unrecognized significant IOP elevation or OPP reduction during hemodialysis (HD) could lead to glaucomatous optic nerve damage and subsequent visual loss. Objective To evaluate changes in IOP and OPP during HD. Design, Setting, and Participants A cross-sectional observational studywas conducted in patients undergoing HD at an ambulatory care clinic at the University of Illinois at Chicago. EXPOSURES Forty-nine patients (97 eyes) undergoing HD were enrolled. Exclusion criteria included preexisting corneal abnormalities, history of corneal surgery, allergy to topical anesthetic agents, and current eye infection. Nine patients had previous diagnoses of open-angle glaucoma (OAG) or suspected glaucoma. At 3 time points, IOP was measured using a pneumatonometer and blood pressure was recorded. Measurements were made with the patient in a seated position approximately 15 minutes before starting HD (T1), approximately 2 hours after starting HD (T2), and approximately 15 minutes after ending HD (T3). Mean arterial pressure (MAP) and OPP (systolic, diastolic, and mean OPP) were calculated. Main Outcomes and Measures: Intraocular pressure and OPP. Results: From T1 to T3, IOP significantly increased by 3.1mmHg (both eyes, P < .001), MAP significantly decreased by 5.8mmHg (P = .05), and all OPP measures significantly decreased from baseline (all P ≤ .02). Using previously reported thresholds of increased glaucoma development and progression risk, 53%of the right eyes (26 of 49) and 46%of the left eyes (22 of 48) had a systolic OPP of 101mmHg or less, 71%of the right eyes (35 of 49) and 73% of the left eyes (35 of 48) had a diastolic OPP of 55mmHg or less, and 63%of the right eyes (31 of 49) and 65%of the left eyes (31 of 48) had a mean OPP of 42mmHg or less. Conclusions and Relevance: Significantly increased IOP and decreased OPP occur during HD, bringing both to levels that increase the risk of glaucoma development and progression. Clinicians should consider HD history in patients who have glaucoma progression, even when IOP has been well controlled. Such patients may benefit from IOP and blood pressure monitoring during HD sessions to minimize OPP changes resulting from IOP spikes and/or suboptimal blood pressure. © 2013 American Medical Association. All rights reserved.
Keywords: adult; aged; ambulatory care; article; clinical article; cross-sectional study; diastolic blood pressure; female; glaucoma; hemodialysis; human; intraocular pressure; male; mean arterial pressure; middle aged; observational study; ocular perfusion pressure; open angle glaucoma; patient positioning; perfusion pressure; priority journal; systolic blood pressure; tonometer; United States; very elderly; visual system parameters; Model 30 Classic

Trends in inpatient treatment in ophthalmology in Germany - Finger, R.P.; Köberlein-Neu, J.; Gass, P.; Holz, F.G.; Bertram, B. (Ophthalmologe, 2013)
Background: Over the last decade inpatient treatment has been reduced in favor of outpatient care or markedly shortened inpatient stays in most organ-specific surgical specialties such as ophthalmology in Germany. Methods: Data from the federal statistics agency on the international classification of disease (ICD), diagnosis-related groups (DRG) and performed operations and procedures from 2000 to 2010 as well as data from the Institute for Reimbursements of Hospitals (InEK) on average costs per DRG in every German DRG (G-DRG) version from 2004 to 2010 were analyzed for ophthalmology. Results: From 2000 to 2010, the number of cases with a main ophthalmological diagnosis decreased (-19 %), which was mostly due to a reduction in the number of cataract inpatients (-56 %). All subspecialties such as glaucoma (+82 %) and retina (+68 %) with the exception of primary strabismus diagnoses (-15 %) gained in number of cases. Inpatient cataract surgery was the most common surgery in 2004 but numbers decreased to 2010 (-9 %). The most often performed inpatient procedure was vitreoretinal surgery in 2007 and 2010 (increase 2004-2010 + 46 %). Average hospital stay decreased between 2005 and 2010 from 3. 9 to 3. 4 days and the average cost per case increased by 3. 6 % overall and by 13. 4 % for surgical cases. Conclusion: Ophthalmic healthcare provided as inpatient services decreased with a trend towards more complex cases being treated as inpatients from 2000 to 2010. © 2013 Springer-Verlag Berlin Heidelberg.
Keywords: adolescent; adult; aged; ambulatory care; article; child; diagnosis related group; eye disease; female; Germany; hospital patient; hospitalization; human; infant; male; middle aged; newborn; ophthalmology; outpatient; preschool child; prevalence; statistics; utilization review; very elderly; young adult

EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases - Duru, N.; Van Der Goes, M.C.; Jacobs, J.W.G.; Andrews, T.; Boers, M.; Buttgereit, F.; Caeyers, N.; Cutolo, M.; Halliday, S.; Da Silva, J.A.P.; Kirwan, J.R.; Ray, D.; et al. (Annals of the Rheumatic Diseases, 2013)
To develop recommendations for the management of medium to high-dose (ie, >7.5 mg but 7le;100 mg prednisone equivalent daily) systemic glucocorticoid (GC) therapy in rheumatic diseases. A multidisciplinary EULAR task force was formed, including rheumatic patients. After discussing the results of a general initial search on risks of GC therapy, each participant contributed 10 propositions on key clinical topics concerning the safe use of medium to high-dose GCs. The final recommendations were selected via a Delphi consensus approach. A systematic literature search of PubMed, EMBASE and Cochrane Library was used to identify evidence concerning each of the propositions. The strength of recommendation was given according to research evidence, clinical expertise and patient preference. The 10 propositions regarded patient education and informing general practitioners, preventive measures for osteoporosis, optimal GC starting dosages, risk-benefit ratio of GC treatment, GC sparing therapy, screening for comorbidity, and monitoring for adverse effects. In general, evidence supporting the recommendations proved to be surprisingly weak. One of the recommendations was rejected, because of conflicting literature data. Nine final recommendations for the management of medium to high-dose systemic GC therapy in rheumatic diseases were selected and evaluated with their strengths of recommendations. Robust evidence was often lacking; a research agenda was created.
Keywords: azathioprine; bisphosphonic acid derivative; calcium; cyclosporine; etanercept; glucocorticoid; hydrocortisone; infliximab; methotrexate; nonsteroid antiinflammatory agent; placebo; prednisone; proton pump inhibitor; vitamin D; adjuvant therapy; adrenal insufficiency; adrenal suppression; article; asthma; bone density; bone necrosis; cardiovascular disease; cholesterol blood level; chronic obstructive lung disease; comorbidity; consensus; corticosteroid induced osteoporosis; corticosteroid therapy; Delphi study; diabetes mellitus; diet; drug dose reduction; drug dose titration; drug efficacy; drug megadose; drug monitoring; drug substitution; drug withdrawal; exercise; eye disease; fragility fracture; giant cell arteritis; glaucoma; glucose intolerance; heart infarction; human; hypertension; immune deficiency; increased appetite; infection; intraocular pressure; kidney dysfunction; medication compliance; mental disease; myopathy; patient compliance; patient education; peptic ulcer; priority journal; recurrent infection; rheumatic disease; rheumatic polymyalgia; rheumatoid arthritis; side effect; skin atrophy; skin disease; body weight gain; wound care

The LV Prasad Institute turns 25: Vision for the future and reflection on achievements so far - Garudadri, C.S.; Balasubramanian, D.; Rao, G.N. (Expert Review of Ophthalmology, 2013)
'So that all may see' is an audacious goal in a nation where 800 million live in villages where water, food and healthcare are part of the daily struggle. While soft drink and shampoo sellers have penetrated the 'bottom of the pyramid', quality eye-care providers have not. To reach this goal the LV Prasad Eye Institute was started in 1987 in Hyderabad, India, as a nonprofit quality eye care center. Guided by the mission of 'excellence with equity' to serve the needs of the community, and in partnership with them, LV Prasad Eye Institute has developed an eye health pyramid. This pyramidal approach has served over 15 million people, predominantly rural. The features and the sustainability of this model are discussed. © 2013 Informa UK Ltd.
Keywords: article; cataract; community care; consultation; diabetic retinopathy; eye care; eye bank; genetic analysis; glaucoma; health care cost; health care delivery; health care quality; health care utilization; health service; human; laser surgery; medical society; patient education; practice guideline; refraction error; stem cell transplantation

Risk of Adverse Effects, Misdiagnosis, and Suboptimal Patient Care with the Use of Over-the-Counter Triamcinolone - Friedlander, S.L.; Tichenor, W.S.; Skoner, D.P. (Annals of Allergy, Asthma and Immunology, 2013)
Keywords: beclometasone; budesonide; ciclesonide; corticosteroid; flunisolide; fluticasone; herbaceous agent; itraconazole; mometasone furoate; non prescription drug; placebo; quinoline derived antiinfective agent; retinoic acid; ritonavir; triamcinolone; triamcinolone acetonide; allergic rhinitis; asthma; atopic dermatitis; bone density; bone metabolism; cataract; diagnostic error; drug antagonism; drug efficacy; drug monitoring; drug potentiation; drug safety; drug sensitivity; Food and Drug Administration; glaucoma; growth disorder; growth inhibition; growth rate; health care access; human; intraocular pressure; long term care; note; ossification; patient care; patient safety; priority journal; risk assessment; side effect; nasacort aq

Glaucoma: Present challenges and future trends - Bettin, P.; Di Matteo, F. (Ophthalmic Research, 2013)
The authors indicate four key issues which, in their opinion, represent the most stimulating challenges in the field of glaucoma today, and describe the present approaches and the developments that can be expected or advised in the near future: (1) Glaucoma is often undiagnosed or diagnosed too late. Accurate detection is crucial to correctly recognize and treat affected subjects, thus reducing the disability and the social burden of the disease. Is glaucoma screening advisable and cost-effective? What strategies can be implemented to achieve an earlier diagnosis? (2) What role can genetics play in glaucoma clinics? (3) What are the fundamentals and the limits of medical hypotensive and nonhypotensive treatment of glaucoma today, and what novelties could be introduced in the next few years? (4) What are the current and future options for glaucoma surgery? Should we aim at reducing aqueous production or at enhancing aqueous outflow? What are the success figures and the pros and cons of ab externo procedures with external filtration (trabeculectomy, nonpenetrating techniques and glaucoma drainage devices) and of ab externo techniques with internal filtration (viscocanalostomy and canaloplasty)? Will microinvasive procedures ever play a role in the treatment of the disease? These questions and the possible future developments in the management of glaucoma are discussed critically, based on the current clinical state of the art, on a review of the literature, and on an everyday experience in a busy university hospital glaucoma service. Copyright © 2013 S. Karger AG, Basel.
Keywords: acetylsalicylic acid; adenosine receptor stimulating agent; alpha adrenergic receptor stimulating agent; antihypertensive agent; apraclonidine; beta adrenergic receptor blocking agent; brimonidine; calcium channel blocking agent; cannabinoid 1 receptor; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; cyanocobalamin; cyclin dependent kinase inhibitor 2B; dapiprazole; fatty acid; latrunculin B; melatonin; memantine; metalloproteinase; miotic agent; mitomycin; myocilin; n methyl dextro aspartic acid receptor blocking agent; optineurin; palmidrol; pilocarpine; prostaglandin derivative; Rho kinase inhibitor; timolol; aqueous humor formation; aqueous humor outflow; cataract extraction; cataractogenesis; closed angle glaucoma; conjunctival hemorrhage; contact lens; cost effectiveness analysis; disease predisposition; drug dose regimen; drug efficacy; drug induced headache; drug tolerability; early diagnosis; eye blood flow; filtering operation; genetic association; geniculate body; glaucoma; glaucoma drainage implant; glaucoma surgery; human; hyperemia; hypersensitivity; hypertrichosis; intraocular pressure; iridotomy; iris disease; lethargy; long term care; loss of appetite; mass screening; medication compliance; meta analysis (topic); metal stent; miosis; myopia; nephrolithiasis; neuroprotection; nonhuman; nuclear magnetic resonance imaging; oculoplethysmography; open angle glaucoma; ophthalmic diode laser; ophthalmoscopy; optical coherence tomography; paresthesia; patient compliance; patient education; phacoemulsification; phase 1 clinical trial (topic); phase 3 clinical trial (topic); pigment disorder; postoperative complication; priority journal; pseudoexfoliation; punctal plug; quality of life; randomized controlled trial (topic); retina maculopathy; review; scanning laser ophthalmoscopy; scanning laser polarimetry; side effect; stereoscopic vision; trabeculectomy; trabeculoplasty; unspecified side effect; vision test; visual acuity; visual cortex

Adherence improvement in Dutch glaucoma patients: A randomized controlled trial - Beckers, H.J.M.; Webers, C.A.B.; Busch, M.J.W.M.; Brink, H.M.A.; Colen, T.P.; Schouten, J.S.A.G. (Acta Ophthalmologica, 2013)
Purpose: To study the effect of patient education and the TravAlert ®-Eyot® drop guider on intraocular pressure (IOP) and adherence in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT) monitored with the TravAlert® dosing aid. Methods: Multicentre, randomized, controlled clinical trial among 18 Dutch hospitals. Patients were randomized to one of the four study arms: (1) use of the dosing aid, (2) use of the dosing aid with the drop guider, (3) use of the dosing aid together with patient education or (4) use of the dosing aid and drop guider together with patient education. IOP was recorded at baseline and after 3 and 6 months. Data on adherence generated by the dosing aid were collected and studied at the end of the study. Results: Mean IOP dropped from 20.3 ± 5.7 mmHg at baseline to 16.3 ± 4.0 mmHg (right eye) after 6 months and from 20.2 ± 5.9 mmHg to 16.4 ± 4.1 mmHg (left eye). The mean adherence rate was 0.91 ± 0.1. IOP and adherence rate were not statistically different between the study arms. Patients with 'drug holidays' had a significantly higher mean IOP after 6 months. Patients who used the drop guider were less adherent. A lower adherence level was also associated with new patients with glaucoma and patients with a lower level of knowledge on glaucoma. Conclusion: Patient education is especially useful for new patients with glaucoma. The use of a drop guider does not improve adherence. Especially patients with 'drug holidays' are at risk for developing uncontrolled IOP levels. Copyright © 2012 Acta Ophthalmologica Scandinavica Foundation.
Keywords: NCT00603005; timolol plus travoprost; travoprost; adult; age distribution; aged; article; controlled study; educational status; female; human; intraocular hypertension; intraocular pressure; major clinical study; male; medication compliance; multicenter study; open angle glaucoma; ophthalmological equipment; patient attitude; patient compliance; patient education; patient satisfaction; priority journal; questionnaire; randomized controlled trial; self report; sex difference; visual impairment; Eyot; TravAlert

The cost of glaucoma care provided to medicare beneficiaries from 2002 to 2009 - Quigley, H.A.; Cassard, S.D.; Gower, E.W.; Ramulu, P.Y.; Jampel, H.D.; Friedman, D.S. (Ophthalmology, 2013)
Purpose: To estimate payments for glaucoma care among Medicare beneficiaries from 2002 to 2009. Design: Database study. Participants: Data from a 5% random sample of Medicare billing information from 2002 to 2009. Methods: Medicare beneficiaries, aged 65 years or older, with both Parts A and B fee-for-service (FFS) enrollment comprised the annual denominator. For each year, we included those with a defined glaucoma diagnostic code linked to a glaucoma visit, diagnostic test, or laser/surgical procedure. Open-angle, angle-closure, and other glaucoma were categorized separately. Claims were classified into glaucoma care, other eye care, and other medical care. Main Outcome Measures: Cost of glaucoma care in the Medicare Fee-for-Service Population. Results: In 2009, total glaucoma payments by Medicare were $37.4 million for this subset, for an overall estimated cost of $748 million, or 0.4% of an estimated cost of $192 billion for all Medicare FFS payments. Office visits comprised approximately one half, diagnostic testing was approximately one-third, and surgical and laser procedures were approximately 10% of glaucoma-related costs. Coded open-angle glaucoma (OAG) and OAG suspects accounted for 87.5% of glaucoma costs, whereas cost per person was highest in "other glaucoma." In 2009, <3% of patients with OAG underwent incisional surgery and approximately 5% had laser trabeculoplasty. Laser iridotomy was the highest cost category among patients with angle-closure glaucoma, whereas office visits was the highest cost category among the "other glaucoma" group. The total cost of nonglaucoma eye care for patients with glaucoma was 67% higher than their glaucoma care costs; these were chiefly costs for cataract surgery and treatment of retinal diseases. From 2002 to 2009, FFS glaucoma care costs calculated in 2009 dollars were stable and cost per person per year in 2009 dollars decreased from $242 to $228 (P = 0.01 by test for linear trend). Conclusions: Annual glaucoma care costs per person decreased in constant dollars from 2002 to 2009. Cataract and retinal eye care for patients with glaucoma substantially exceeded the cost of their glaucoma care each year. Visit payments represented the largest category of costs. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 by the American Academy of Ophthalmology.
Keywords: ranibizumab; aged; ambulatory care; article; cataract extraction; closed angle glaucoma; cost minimization analysis; diagnostic test; eye care; glaucoma; health care cost; human; iridotomy; laser surgery; medical fee; medicare; open angle glaucoma; outcome assessment; population research; priority journal; trabeculectomy; trabeculoplasty; lucentis

Novel topical ophthalmic formulations for management of glaucoma - Ibrahim, M.M.; Abd-Elgawad, A.-E.H.; Soliman, O.A.; Jablonski, M.M. (Pharmaceutical Research, 2013)
Purpose: Preparation of topical ophthalmic formulations containing brimonidine-loaded nanoparticles prepared from various biodegradable polymers - PCL, PLA and PLGA - for sustained release of brimonidine as a once daily regimen for management of glaucoma. Methods: Nanoparticles were prepared using spontaneous emulsification solvent diffusion method then characterized regarding their particle size, zeta potential, morphology and drug contents. Brimonidine-loaded nanoparticles were incorporated into eye drops, temperature-triggered in situ gelling system and preformed gel and characterized regarding their pH, viscosity, uniformity of drug contents, in vitro release study, in vitro cytotoxicity and in vivo intraocular pressure (IOP) lowering effects. Results: The results of optimized brimonidine-loaded PCL-, PLGA- and PLA-NPs respectively, are: particle sizes of 117.33 ± 4.58 nm, 125.67 ± 5.15 nm and 131.67 ± 3.79 nm; zeta potentials of -18.5 ± 2.87 mV, -21.82 ± 2.7 mV and -28.11 ± 2.21 mV; and encapsulation efficiencies of 77.97 ± 1.38%, 68.65 ± 3.35% and 73.52 ± 2.92%. TEM analyses revealed that all NPs have spherical shapes with dense core and distinct coat. In vitro release data showed a sustained release without any burst effect with Higuchi non-Fickian diffusion mechanism. Cytotoxicity studies revealed that all formulations are non-toxic. Also all formulations possessed a sustained IOP lowering effect compared to Alphagan® P eye drops. Conclusions: Our formulations showed prolonged management of glaucoma that should meet with better patient compliance as a once-daily formulation. © 2013 Springer Science+Business Media New York.
Keywords: brimonidine; dichloromethane; eye drops; hydroxypropylmethylcellulose; nanoparticle; phosphatidylcholine; poloxamer; polycaprolactone; polyglactin; polylactide; polyvinyl alcohol; u 104; unclassified drug; animal experiment; area under the curve; article; drug coating; drug cytotoxicity; drug distribution; drug dosage form comparison; drug efficacy; drug structure; drug synthesis; gel; glaucoma; human; human cell; in vitro study; in vivo study; intraocular pressure; mouse; nanoemulsion; nonhuman; particle size; patient compliance; pH measurement; preformulation; priority journal; process optimization; sustained release formulation; temperature; viscosity; zeta potential; alphagan p; alphagan; u 104; uk 14304

Preservative toxicity in glaucoma medication: Clinical evaluation of benzalkonium chloride-free 0.5% timolol eye drops - Rosin, L.M.; Bell, N.P. (Clinical Ophthalmology, 2013)
Timolol (generic name) is a frequently used medication for the control of glaucoma. Benzalkonium chloride (BAK) is a commonly used preservative in ophthalmic solutions with a broad range of antimicrobial activity; however, this nonspecificity can result in toxicity. Adverse effects attributed to BAK, including conjunctival inflammation and fibrosis, tear film instability, corneal cytotoxicity, anterior chamber inflammation, trabecular meshwork cell apoptosis, cataract development, macular edema, and even systemic effects, have been well documented. These effects can lead to ocular discomfort, poor intraocular pressure control, glaucoma surgery failure, and decreased patient compliance. BAK use in topical medications has decreased recently as newer and less toxic preservatives have become available. Yet these preservatives still exert some toxic effects, especially in patients with chronic eye disease who use multiple drops over extended periods of time. Thus, attempts to reduce overall preservative loads for patients are important, whether it be decreasing the amount of preservative, decreasing the total number of drops patients use, or eliminating preservatives entirely. A preservative-free formulation of timolol, TIMOPTIC® in OCUDOSE®, is available in unit-dose vials. Preservative-free unit-dose vials minimize toxic adverse effects and are a good option for patients with ocular surface disease, on long-term multidrop therapy, or who simply do not tolerate the effects of preservatives due to discomfort. © 2013 Rosin and Bell.
Keywords: antiglaucoma agent; benzalkonium chloride; timolol maleate; anterior eye chamber; cataract; cataract extraction; conjunctiva disease; cornea disease; cytotoxicity; drug choice; drug efficacy; drug hypersensitivity; drug packaging; drug penetration; drug safety; dry eye; eye discomfort; eye irritation; eye toxicity; filtering operation; glaucoma; human; intraocular hypertension; nonhuman; ocular surface disease; pathogenesis; patient comfort; patient compliance; physical chemistry; randomized controlled trial (topic); review; risk benefit analysis; tear film; toxicity testing; timoptic in ocudose

Patient-related and system-related barriers to glaucoma follow-up in a county hospital population - Lee, B.W.; Murakami, Y.; Duncan, M.T.; Kao, A.A.; Huang, J.-Y.; Lin, S.; Singh, K. (Investigative Ophthalmology and Visual Science, 2013)
Purpose. To identify the barriers to glaucoma follow-up and to assess how ethnicity influences the effect of such barriers among patients in a county hospital population. Methods. This cross-sectional study included 152 patients, 76 with poor clinic follow-up and 76 with good clinic follow-up, who were recruited at the San Francisco General Hospital glaucoma clinic as part of a case-control study. All subjects were required to be established patients with glaucoma initially seen and diagnosed in the clinic at least 1 year before enrollment. An oral questionnaire pertaining to the barriers to follow-up for glaucoma, as well as patient ethnicity, was administered to all participating subjects. The main outcome measure was the prevalence of significant barriers to follow-up, both overall and stratified by ethnicity. Results. The most prevalent barriers to follow-up included long clinic waiting times (75%), appointment scheduling difficulties (38%), the effect of other medical or physical comorbidities (29%), and difficulties related to medical interpretation (23%). While several barriers were cited as being important across different ethnicities, Latinos and Asian-Pacific Islanders were particularly affected by difficulties related to medical interpretation (P = 0.0001) and long waiting times in the clinic (P = 0.048). Conclusions. Understanding patient-reported barriers to glaucoma follow-up and their variation based on ethnicity may give providers insight as to why patients do not adhere to follow-up recommendations. Strategies to improve follow-up may include reduced clinic wait times, simplified appointment scheduling, and provision of appropriate education and counseling regardless of the patient's native language and ethnicity. © 2013 The Association for Research in Vision and Ophthalmology, Inc.
Keywords: adult; aged; article; comorbidity; controlled study; cross-sectional study; disease control; disease severity; ethnicity; female; follow up; glaucoma; health care access; health care cost; human; major clinical study; male; patient attitude; pilot study; prevalence; priority journal; questionnaire; treatment outcome

Severe refractory asthma: An update - Wener, R.R.L.; Bel, E.H. (European Respiratory Review, 2013)
Asthma is a heterogeneous disease in which adequate asthma control cannot be achieved in a substantial proportion despite currently available treatment possibilities. This subgroup has been defined as "severe refractory" asthma. Over the past years considerable progress has been made regarding a more exact definition of severe refractory asthma. A systematic approach to evaluate the asthma patient has been postulated. Further detailed classification into distinct phenotypes is ongoing to target the right treatment to the right patient. And, new therapeutic targeted treatment options are currently in development to provide possible new targets to improve disease state, symptoms and quality of life. This review will provide an update on the latest advancements with regard to all these domains. © ERS 2013.
Keywords: abediterol; amg 317; beta 2 adrenergic receptor stimulating agent; carmoterol; chemokine receptor CXCR2 antagonist; cyclosporine; daclizumab; etanercept; glucocorticoid; gold salt; golimumab; immunoglobulin E; indacaterol; interleukin 4 antibody; lebrikizumab; mepolizumab; methotrexate; navarixin; olodaterol; omalizumab; phosphodiesterase III inhibitor; phosphodiesterase IV inhibitor; potassium channel stimulating agent; proton pump inhibitor; reslizumab; tiotropium bromide; tralokinumab; unclassified drug; unindexed drug; vasoactive intestinal polypeptide derivative; vilanterol; adrenal cortex insufficiency; allergic asthma; altitude; asthma; bariatric surgery; bone density; bronchial thermoplasty; bronchodilatation; cardiovascular disease; cataract; comorbidity; corticosteroid induced osteoporosis; diabetes mellitus; disease classification; disease control; disease severity; drug fatality; drug megadose; ecchymosis; eosinophilia; eosinophilic asthma; eosinophilic asthma; forced expiratory volume; gastroesophageal reflux; glaucoma; human; hypertension; individualization; medical decision making; myopathy; nose disease; obesity; patient care; patient compliance; patient monitoring; phenotype; positive end expiratory pressure ventilation; practice guideline; quality of life; radiofrequency ablation; respiratory tract infection; review; side effect; skin disease; skin thinning; skin thinning; sleep disordered breathing; symptom; unspecified side effect; vasodilatation; body weight loss; amg 317; sch 527123

Tolterodine for the treatment of urge urinary incontinence - Elterman, D.S.; Chughtai, B.; Kaplan, S.A.; Barkin, J. (Expert Opinion on Pharmacotherapy, 2013)
Introduction: Overactive bladder (OAB) and its resultant urge urinary incontinence (UUI) are significant problems that medically, psychologically and financially affect people. The constellation of symptoms comprising OAB affects ∼ 16% of the adult population and its prevalence increases with aging. The typical class of medications used to treat OAB is antimuscarinics. Areas covered: OAB medications, with a focus on tolterodine for the treatment of UUI are reviewed. A thorough review of English language literature using EMBASE/Medline and PubMed has been performed. Expert opinion: Tolterodine provides a reasonable starting point when treating patients with OAB and UUI. Efficacy and tolerability are generally comparable between tolterodine and other newer antimuscarinics. Tolterodine is a good option as part of the algorithm in the treatment of OAB and UUI. © 2013 Informa UK, Ltd.
Keywords: cytochrome P450 2D6; diuretic agent; fesoterodine; fluoxetine; ketoconazole; long acting drug; moxifloxacin; oral contraceptive agent; oxybutynin; placebo; short acting drug; tolterodine; warfarin; water; abdominal pain; age distribution; anticholinergic effect; area under the curve; article; bladder pressure; closed angle glaucoma; constipation; detrusor muscle; dose response; drug blood level; drug contraindication; drug efficacy; drug formulation; drug hypersensitivity; drug induced headache; drug metabolism; drug safety; drug solubility; drug structure; drug tolerability; drug withdrawal; geriatric patient; heart rate; human; maximum plasma concentration; medication compliance; micturition; molecular weight; multicenter study (topic); patient compliance; pharmacodynamics; phase 1 clinical trial (topic); phase 2 clinical trial (topic); phase 3 clinical trial (topic); pKa; plasma concentration-time curve; postmarketing surveillance; practice guideline; QT interval; randomized controlled trial (topic); recommended drug dose; residual urine; steady state; torsade des pointes; treatment outcome; unspecified side effect; urge incontinence; urine retention; xerostomia

Rational use of topical corticosteroids - Carlos, G.; Uribe, P.; Fernández-Peñas, P. (Australian Prescriber, 2013)
Many dermatological conditions will respond to a topical corticosteroid. The clinical outcome will depend on making a correct clinical diagnosis and applying the right molecule in the most appropriate vehicle for the correct duration. Topical corticosteroids are classified by their strength, but the same molecule will have different effects depending on the vehicle. The patient's age and the affected area of skin are other important factors. If used correctly the adverse effects of topical corticosteroids are usually minimal. Systemic effects can occur with high doses.
Keywords: betamethasone dipropionate; betamethasone valerate; clobetasol propionate; clobetasone; corticosteroid; desonide; drug vehicle; emulsifying agent; hydrocortisone; hydrocortisone acetate; methylprednisolone aceponate; mometasone furoate; triamcinolone acetonide; acne; adrenal cortex insufficiency; age; article; clinical trial (topic); cream; diabetes mellitus; drug absorption; drug classification; drug efficacy; drug indication; drug penetration; drug potency; drug safety; drug use; drug withdrawal; glaucoma; human; hyperglycemia; hypopigmentation; hypothalamus hypophysis adrenal system; lactation; lotion; ointment; patient compliance; perioral dermatitis; pregnancy; prescription; rash; rosacea; side effect; skin atrophy; skin disease; tachyphylaxis; treatment duration; treatment response; unspecified side effect; vasoconstriction; wound healing impairment

Emerging therapies for the treatment of uveitis: Clinical trial observations - Metzinger, J.L.; Foster, C.S. (Clinical Investigation, 2013)
Uveitis, a leading cause of blindness in the USA and western Europe, can pose a challenge to ophthalmologists when considering treatment modality. Although once considered acceptable, corticosteroid monotherapy is no longer alone at the head of treatment options. Newer, more specific treatments, and medications translated from other divisions of medicine comprise the new wave of therapy employed by uveitis practitioners around the world, with and without regulatory approval. The purpose of this review is to examine the current status of clinical trial observations for newer treatments for uveitis. Innovative corticosteroid therapies and methods of delivery are described, in addition to novel calcineurin inhibitors, new biologic response modifiers, and other emerging therapies. Although very few therapies are approved for use explicitly in uveitis, the reported results of clinical trials are examined. A concise overview of the ongoing challenges in clinical research is discussed, from the perspective of the uveitis specialist, and the patient. Direction for the future of drug development and use is both exciting and dire, as these treatments are the only pathway for patients seeking to preserve vision. © 2013 Future Science Ltd.
Keywords: abatacept; adalimumab; alemtuzumab; canakinumab; citrate sodium; cyclosporine; dexamethasone; difluprednate; etanercept; everolimus; eye drops; fluocinolone acetonide; gevokizumab; golimumab; illuvien; infliximab; methotrexate; methylprednisolone; placebo; prednisolone acetate; prednisone; preservative; rapamycin; anakinra; rilonacept; rituximab; secukinumab; tocilizumab; triamcinolone; unclassified drug; unindexed drug; voclosporin; abdominal pain; acne; adjuvant therapy; allergic reaction; anaphylaxis; anemia; angina pectoris; ankylosing spondylitis; anterior eye chamber; arthralgia; backache; Behcet disease; blepharitis; blurred vision; bronchitis; cataract; cataract extraction; central macular thickness; chemosis; chill; clinical observation; clinical research; cohort analysis; conjunctival hemorrhage; conjunctival hyperemia; conjunctivitis; cornea transplantation; corticosteroid therapy; coughing; Crohn disease; Cushingoid syndrome; Cytomegalovirus; cytopenia; diabetic macular edema; diabetic retinopathy; diarrhea; digestive system perforation; disease course; dizziness; drug delivery system; drug efficacy; drug safety; dyspnea; electroosmosis; electrophoresis; electroporation; endophthalmitis; eye discomfort; eye inflammation; eye pain; eye surgery; eyelid edema; fatigue; fever; flu like syndrome; fluorescence angiography; follow up; Food and Drug Administration; gingiva hyperplasia; glaucoma; headache; health care quality; heart arrhythmia; heart failure; hepatitis B; herpes zoster; hirsutism; human

Influence of psychological health intervention on medical compliance and recurrence of patients with glaucoma - Guo, L.-H.; Li, H. (International Eye Science, 2013)
AIM: To estimate the influence of psychological health intervention on the medical compliance and recurrence of glaucoma patients. METHODS: Forty-eight patients with primary angle-closure glaucoma were enrolled and randomly classified into intervention group and control group. Patients in intervention group were treated with common surgery-drug treatment, mental health education and behavior therapy at the same time, and those in control group were treated with common surgery-drug treatment. After 2 years psychological health intervention, the patients were examined to determine their compliance and recurrence rates. RESULTS: The medical compliance of patients in intervention group was higher than that in control group. The recurrence rates of patients in intervention group were lower than that in control group. There were significant difference between two groups (χ2=11.429, P<0.01; χ2=14.667, P<0.01). CONCLUSION: Mental health education and behavior therapy could significantly increase the medical compliance of glaucoma patients and reduce the rates of recurrence.
Keywords: article; behavior therapy; clinical article; closed angle glaucoma; controlled study; health education; human; mental health care; patient compliance; psychological well-being; recurrent disease

Eye wise - Philpott, L. (Australian Journal of Pharmacy, 2013)
Keywords: antiglaucoma agent; eye drops; glucose; latanoprost; latanoprost plus timolol; omega 3 fatty acid; article; Australia; consumer attitude; diabetic retinopathy; drug marketing; drug safety; lack of drug effect; dry eye; employee attitude; eye care; eye examination; eye redness; glaucoma; glucose blood level; health education; health promotion; high risk patient; human; humidifier; information dissemination; lifestyle modification; medical information; optometry; patient compliance; pharmacist; pharmacist attitude; pharmacy (shop); age related macular degeneration; smoking; urbanization; visual impairment; xalacom; xalatan

Long-term supplementation with n-6 and n-3 PUFAs improves moderate-to-severe keratoconjunctivitis sicca: A randomized double-blind clinical trial - Sheppard Jr., J.D.; Singh, R.; McClellan, A.J.; Weikert, M.P.; Scoper, S.V.; Joly, T.J.; Whitley, W.O.; Kakkar, E.; Pflugfelder, S.C. (Cornea, 2013)
Purpose: Supplementation with gamma-linolenic acid (GLA) and omega-3 (n-3) polyunsaturated fatty acids (PUFAs) has been found to decrease the production of disease-relevant inflammatory mediators that are implicated in the pathogenesis of chronic dry eye. This study evaluated the effect of a supplement containing both GLA and n-3 PUFAs on signs and symptoms of moderate-to-severe keratoconjunctivitis sicca in postmenopausal patients. Methods: This multicenter, double-masked placebo-controlled clinical trial enrolled 38 patients (both eyes) with tear dysfunction who were randomized to supplemental GLA + n-3 PUFAs or placebo for 6 months. Disease parameters, including Ocular Surface Disease Index, Schirmer test, tear breakup time, conjunctival fluorescein and lissamine green staining, and topographic corneal smoothness indexes (surface asymmetry index and surface regularity index), were assessed at baseline and at 4, 12, and 24 weeks. The intensity of dendritic cell CD11c integrin and HLA-DR expression was measured in conjunctival impression cytologies. Results: The Ocular Surface Disease Index score improved with supplementation and was significantly lower than placebo (21 ± 4 vs. 34 ± 5) after 24 weeks (P = 0.05, n = 19 per group). The surface asymmetry index was significantly lower in supplement-treated subjects (0.37 ± 0.03, n = 15) than placebo (0.51 ± 0.03, n = 16) at 24 weeks (P = 0.005). Placebo treatment also significantly increased HLA-DR intensity by 36% 6 9% and CD11c by 34% 6 7% when compared with supplement treatment (n = 19 per group, P = 0.001, 24 weeks). Neither treatment had any effect on tear production, tear breakup time, or corneal or conjunctival staining. Conclusions: Supplemental GLA and n-3 PUFAs for 6 months improved ocular irritation symptoms, maintained corneal surface smoothness, and inhibited conjunctival dendritic cell maturation in patients with postmenopausal keratoconjunctivitis sicca. Copyrigt © 2013 Lippincott Williams & Wilkins.
Keywords: NCT00883649; gamma linolenic acid; HLA DR antigen; omega 3 fatty acid; placebo; adult; anorexia; antigen expression; article; clinical article; constipation; controlled study; dendritic cell; diarrhea; diet supplementation; disease severity; double blind procedure; drug withdrawal; dysgeusia; dyspepsia; facial expression; female; human; impression cytology; infection; keratoconjunctivitis sicca; keratometry; long term care; multicenter study; nausea; patient compliance; physical disease by body function; postmenopause; priority journal; randomized controlled trial; rash; Schirmer test; skin contusion; slit lamp; staining; treatment duration; visual acuity; vomiting

Selective proximal renal tubular involvement and dyslipidemia in two cousins with oculocerebrorenal syndrome of lowe - Topalog̈lu, R.; Ludwig, M.; Çelebi-Tayfur, A. (Turkish Journal of Pediatrics, 2013)
Oculocerebrorenal syndrome of Lowe (OCRL) is a rare, X-linked disorder characterized by congenital cataracts, neonatal or infantile hypotonia, seizures, cognitive impairment, and renal tubular dysfunction. In this article, we report two maternal cousins with OCRL with a hemizygous p.Ala788Asp mutation in exon 22 of the OCRL gene. They presented with diverse features of selective proximal renal tubular defect and high serum levels of total cholesterol, low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C).
Keywords: beta 2 microglobulin; cholesterol; creatinine; dipeptidyl carboxypeptidase inhibitor; enalapril; high density lipoprotein cholesterol; hydrochlorothiazide; low density lipoprotein cholesterol; phosphate; pravastatin; rosuvastatin; amino acid substitution; aminoaciduria; article; case report; cataract; cataract extraction; cholesterol blood level; clinical feature; cognitive defect; creatinine blood level; disease course; disease severity; dyslipidemia; exon; first-degree relative; gene; gene mutation; glaucoma; glomerulus filtration rate; hemizygote; human; hypercalciuria; hypercholesterolemia; infant; ion exchange chromatography; kidney proximal tubule; kidney tubule disorder; low birth weight; Lowe syndrome; male; mutational analysis; newborn; nystagmus; OCRL gene; patient compliance; phosphate urine level; proteinuria; urea nitrogen blood level; urinalysis

Psychometrics of a new questionnaire to assess Glaucoma adherence: The Glaucoma treatment compliance assessment tool - Mansberger, S.L.; Sheppler, C.R.; McClure, T.M.; VanAlstine, C.L.; Swanson, I.L.; Stoumbos, Z.; Lambert, W.E. (Transactions of the American Ophthalmological Society, 2013)
Purpose: To report the psychometrics of the Glaucoma Treatment Compliance Assessment Tool (GTCAT), a new questionnaire designed to assess adherence with glaucoma therapy. Methods: We developed the questionnaire according to the constructs of the Health Belief Model. We evaluated the questionnaire using data from a cross-sectional study with focus groups (n = 20) and a prospective observational case series (n=58). Principal components analysis provided assessment of construct validity. We repeated the questionnaire after 3 months for test-retest reliability. We evaluated predictive validity using an electronic dosing monitor as an objective measure of adherence. Results: Focus group participants provided 931 statements related to adherence, of which 88.7% (826/931) could be categorized into the constructs of the Health Belief Model. Perceived barriers accounted for 31% (288/931) of statements, cues-to-action 14% (131/931), susceptibility 12% (116/931), benefits 12% (115/931), severity 10% (91/931), and self-efficacy 9% (85/931). The principal components analysis explained 77% of the variance with five components representing Health Belief Model constructs. Reliability analyses showed acceptable Cronbach's alphas (>.70) for four of the seven components (severity, susceptibility, barriers [eye drop administration], and barriers [discomfort]). Predictive validity was high, with several Health Belief Model questions significantly associated (P <.05) with adherence and a correlation coefficient (R2) of.40. Test-retest reliability was 90%. Conclusion: The GTCAT shows excellent repeatability, content, construct, and predictive validity for glaucoma adherence. A multisite trial is needed to determine whether the results can be generalized and whether the questionnaire accurately measures the effect of interventions to increase adherence.
Keywords: eye drops; travoprost; adult; aged; article; clinical assessment tool; content validity; correlation coefficient; drug efficacy; eye pain; female; follow up; glaucoma; Glaucoma Treatment Compliance Assessment Tool; Health Belief Model; human; instrument validation; intraocular pressure; major clinical study; male; medication compliance; patient compliance; predictive validity; priority journal; prospective study; psychometry; questionnaire; reproducibility; risk benefit analysis; self concept; test retest reliability; treatment outcome; unspecified side effect; travatan

Latanoprost/timolol fixed combination for the treatment of glaucoma - Konstas, A.G.P.; Mocan, M.C.; Katsanos, A.; Voudouragkaki, I.C.; Irkec, M. (Expert Opinion on Pharmacotherapy, 2013)
Introduction: Glaucoma is a multifactorial optic neuropathy that can lead to progressive and irreversible loss of vision. Today there are > 60 million glaucoma patients worldwide, and this figure is rising due to aging. The aim of glaucoma therapy is to maintain the patient's visual function and quality of life by means of intraocular pressure (IOP) reduction, which currently constitutes the only evidence-based approach. Areas covered: Briefly discussed are selected, recent evidence on antiglaucoma fixed combinations. Then the efficacy and safety of the latanoprost/timolol fixed combination is comprehensively reviewed. Expert opinion: The latanoprost/timolol fixed combination can be a helpful stepwise therapeutic option in patients whose IOP is insufficiently controlled with monotherapy options. Future research is needed to better delineate the role and value of this medication in glaucoma therapy. © 2013 Informa UK, Ltd.
Keywords: benzalkonium chloride; bimatoprost plus timolol; brimonidine; dorzolamide; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; placebo; timolol; timolol plus travoprost; article; clinical practice; comparative study; conjunctival hyperemia; drug efficacy; drug safety; evening dosage; evidence based practice; eye irritation; follow up; glaucoma; herpes simplex keratitis; human; hypertrichosis; intraocular hypertension; intraocular pressure; iridocyclitis; long term care; meta analysis (topic); monotherapy; morning dosage; ocular surface disease; open angle glaucoma; patient compliance; phase 4 clinical trial (topic); quality of life; retina macula cystoid edema; side effect; skin pigmentation; virus reactivation; vision; xalacom

Comparison of adherence and persistence with bimatoprost 0.01% versus bimatoprost 0.03% topical ophthalmic solutions - Campbell, J.H.; Schwartz, G.; Labounty, B.; Kowalski, J.; Patel, V.D. (Current Medical Research and Opinion, 2013)
Objective: To compare patient adherence and persistence with bimatoprost 0.01%, a new formulation that offers equivalent intraocular pressure-lowering efficacy to bimatoprost 0.03% and improved tolerability, with that of the original bimatoprost 0.03% formulation. Methods: Pharmacy claims from a longitudinal database of prescription and medical claims for >115 million patients were analyzed. Patients with an initial (index) prescription for bimatoprost 0.01% or 0.03% between April and June 2011, and with no claim for ophthalmic prostaglandin or prostamide analogs during the preceding 18 months, were identified. Treatment adherence was expressed as the proportion of days covered (PDC) with study medication over the first 365 days after the index prescription. Treatment persistence over the first 12 months following the index prescription was assessed using Kaplan-Meier analyses, assuming a 30 day grace period for prescription refill. Treatment status (on/off study medication) was determined monthly for 12 months post-index. Results: In total, 6150 patients were assessed for treatment adherence and 7660 for persistence. Adherence was significantly better with bimatoprost 0.01% than bimatoprost 0.03% (mean PDC 0.540 vs. 0.438; p < 0.001). Significantly more patients had high adherence (PDC > 0.80) with bimatoprost 0.01% than 0.03% (29.1% vs. 17.3%; p < 0.001). Persistence was also significantly better with bimatoprost 0.01%, with 29.5% (95% confidence interval [CI]: 28.3%, 30.8%) versus 18.3% (95% CI: 16.8%, 19.9%) of patients remaining on continuous treatment for 12 months (p < 0.001). At 12 months, significantly more patients were 'on treatment' (continuing/restarting treatment) with bimatoprost 0.01% than 0.03% (48.8% vs. 33.9%; p < 0.001). Sensitivity analyses demonstrated similar findings in cohorts of ocular hypotensive treatment-naïve and elderly (≥65 years) patients. Conclusions: Bimatoprost 0.01% offers adherence and persistency advantages over bimatoprost 0.03% in patients requiring ocular hypotensive therapy. Study limitations included the observational design, lack of control for imbalances in patient characteristics, and assumption that prescription refill is synonymous with medication use. © 2013 Informa UK Ltd.
Keywords: bimatoprost; adult; aged; article; cohort analysis; comparative study; cross-sectional study; drug dose comparison; drug efficacy; drug tolerability; female; glaucoma; human; intraocular pressure; major clinical study; male; observational study; outcome assessment; patient compliance; prescription; retrospective study; topical treatment

Adherence, persistence and cost-consequence comparison of bimatoprost topical ocular formulations - Alany, R.G. (Current Medical Research and Opinion, 2013)
Keywords: bimatoprost; closed angle glaucoma; comparative study; conjunctival hyperemia; drug cost; drug formulation; geriatric patient; human; intraocular pressure; medication compliance; non insulin dependent diabetes mellitus; nursing home; open angle glaucoma; optic nerve lesion; patient compliance; prescription; pruritus; randomized controlled trial (topic); review; sleep disorder; visual field

Randomized, double-masked, placebo-controlled study to assess the ocular safety of mirabegron in healthy volunteers - Novack, G.D.; Lewis, R.A.; Vogel, R.; Sheth, N.; Swearingen, D.; Rasmussen, S.; Hantsbarger, G.; Martin, N.E. (Journal of Ocular Pharmacology and Therapeutics, 2013)
Purpose: This study assessed the effect of mirabegron on ocular safety in healthy volunteers. Methods: This was an 8-week, randomized, double-masked, placebo-controlled study. Participants: Consenting adults aged ≥18 years with a normal intraocular pressure (IOP, ≥10 to ≤21 mmHg) were eligible to enter the study. Of the 321 randomized subjects, 305 completed the study. Subjects were randomized 1:1 to a supratherapeutic dose of oral mirabegron 100 mg or placebo once daily for 56 days. The IOP was measured at screening, baseline, day 10, and day 56/end of treatment using Goldmann applanation tonometry. Visual acuity and biomicroscopy were also evaluated. The primary endpoint was the mean change from baseline in the IOP at 56 days or end of treatment with mirabegron versus placebo. Secondary outcome variables included change from baseline to day 10 in the IOP, and increases in the IOP of ≥6 mmHg and ≥10 mmHg in either eye from baseline to day 10 and day 56. Results: The mean (standard error, SE) IOP at baseline was 15.3 (0.16) mmHg for mirabegron and 15.4 (0.16) mmHg for placebo; values at day 56 were 15.0 (0.16) mmHg and 15.2 (0.17) mmHg, respectively. The adjusted mean IOP change from baseline to day 56 was -0.3 mmHg for mirabegron and -0.2 mmHg for placebo (-0.1 mmHg difference [95% confidence interval, CI, -0.4 to 0.3]). For the primary endpoint, mirabegron was noninferior to placebo, based on the prespecified limit of 1.5 mmHg. No statistically significant treatment effects on the IOP were seen at day 10. No subject discontinued due to increased IOP. Clinically significant increases from baseline in the IOP occurred rarely and only with placebo treatment. Changes in the visual acuity and biomicroscopy were not suggestive of a mirabegron effect. No treatment-emergent adverse event (AE) of glaucoma was reported. Conclusions: Mirabegron 100 mg orally once daily for 8 weeks of treatment does not increase the IOP, and was generally safe and well tolerated. © Copyright 2013, Mary Ann Liebert, Inc.
Keywords: NCT01284309; mirabegron; placebo; abnormal sensation; adult; aged; article; asthenopia; biomicroscopy; conjunctivitis; controlled study; coughing; dizziness; double blind procedure; drug blood level; drug effect; drug eruption; drug withdrawal; dry eye; eye pain; female; glaucoma; headache; human; hyperemia; intraocular pressure; iritis; lacrimation disorder; male; mediastinum disease; neurologic disease; normal human; nose obstruction; oropharynx pain; outcome assessment; partial blindness; patient compliance; patient safety; pruritus; randomized controlled trial; respiratory tract disease; sensory dysfunction; thorax disease; treatment duration; visual acuity

Vogt-Koyanagi-Harada disease: Presentation and implications in undocumented immigrants - Manizate, F.; Baksh, F.; Hassen, G.W.; Kalantari, H. (American Journal of Emergency Medicine, 2013)
Vogt-Koyanagi-Harada syndrome is an autoimmune disease involving pigmented tissue in the eyes, auditory system, skin, and central nervous system. It often presents as bilateral chronic granulomatous panuveitis. We report the case of a 32-year-old immigrant who presented to the emergency department asking for a second opinion for loss of vision and progressive hearing loss. We also will discuss the issue limited access to health care for a vulnerable population such as undocumented immigrants. © 2013 Elsevier Inc. All rights reserved.
Keywords: atropine; C reactive protein; prednisone; timolol; adult; article; autoimmune disease; case report; chemosis; clinical feature; cornea opacity; cost control; differential diagnosis; disease course; early intervention; emergency ward; Guatemala; headache; health care access; health care cost; health care policy; hearing impairment; Hispanic; human; undocumented immigrant; intraocular hypertension; laboratory test; malaise; male; primary health care; priority journal; prognosis; rare disease; uveitis; visual acuity; visual impairment; Vogt Koyanagi syndrome

Safety of ranibizumab in routine clinical practice: 1-year retrospective pooled analysis of four European neovascular AMD registries within the LUMINOUS programme - Holz, F.G.; Bandello, F.; Gillies, M.; Mitchell, P.; Osborne, A.; Sheidow, T.; Souied, E.; Figueroa, M.S.; Brand, C.; Koh, A.; Schmidt-Erfurth, U.; Sharma, N.; et al. (British Journal of Ophthalmology, 2013)
Purpose: Evaluation of 1-year safety profile of intravitreal ranibizumab 0.5 mg in neovascular agerelated macular degeneration (NV-AMD) within routine clinical practice. Methods: The LUMINOUS programme comprises a prospective observational study assessing ranibizumab 'real-world' safety and clinical effectiveness across licensed indications worldwide and an annual retrospective pooled safety analysis from completed NV-AMD ranibizumab registries. 1-year data from four European registries are available. This retrospective pooled safety analysis assessed 1-year incidence rates for safety events of particular interest (key ocular or systemic events possibly related to the injection procedure or vascular endothelial growth factor inhibition) together with treatment exposure. Patients were treated according to local protocols within the ranibizumab licence. Results: Data of 4444 patients from registries in Germany (n=3470), the Netherlands (n=243), Belgium (n=260) and Sweden (n=471) were retrospectively pooled. Between 70.4% and 84.4% of enrolled patients completed 1 year of follow-up. Most frequent overall ocular events of particular interest were retinal pigment epithelial tears (27 patients; <1%) and intraocular pressure-related events (12 patients; <0.3%). Most frequent non-ocular event of particular interest was stroke (19 patients; 0.4%); annual incidence of stroke was low across all registries (0.0-0.5%). Conclusions: Ranibizumab demonstrated favourable 1-year safety profile for NV-AMD in this routine clinical practice sample, consistent with previous reported trial data. Additional data from a larger patient population are needed to better describe the long-term safety profile of ranibizumab in routine clinical practice and further evaluate risk for infrequent but serious events in 'real-life' settings. The 5-year LUMINOUS prospective observational study will address this need.
Keywords: NCT01318941; bevacizumab; ranibizumab; aged; article; Belgium; brain hemorrhage; brain infarction; cataract; cerebrovascular accident; clinical practice; disease registry; drug efficacy; drug safety; drug withdrawal; endophthalmitis; Europe; eye inflammation; female; follow up; Germany; human; incidence; intraocular hypertension; major clinical study; male; Netherlands; patient compliance; priority journal; retina blood flow; retina detachment; age related macular degeneration; retina pigment epitheliopathy; retina tear; retrospective study; risk assessment; side effect; Sweden; vitreous hemorrhage; avastin

Seeing you through London 2012: eye care at the Paralympics. - Wilson, C.M.; Thomson, W.D.; D'Ath, P.J. (British journal of sports medicine, 2013)
The provision of eye care services for competitors and support teams is integral to the modern Olympic Games. The eye clinic for the London 2012 Paralympic Games employed a multidisciplinary team of eye care professionals using state-of-the-art instrumentation to provide the highest level of eye care. The detailed organisation of the eye care clinic at London 2012 is described in a companion paper which summarises the eye care clinic during the London 2012 Olympic Games. These two reports will aid in planning eye care clinics at future Games. This paper summarises the organisation of the eye clinic and provides outline audit data relating to eye conditions encountered during the Paralympic Games. A total of 870 patients representing 102 countries attended the eye clinic. 274 (31.5%) were competitors; the remainder were trainers and support staff. No serious ocular injuries resulted from competitor injury in the field of play during the Paralympic Games, although seven patients were referred urgently to hospital eye services for conditions including orbital cellulitis, retinal detachment, exudative macular degeneration, corneal ulcer, Stevens-Johnson syndrome and macular oedema. A total of 749 spectacles, 14 pairs of contact lenses and 7 low vision aids were dispensed. By combining excellent facilities and equipment with a multidisciplinary team of eye care professionals, we feel we provided the highest level of eye care, providing a legacy for future Games.
Keywords: adolescent; adult; ambulatory care; article; disabled sport; eye disease; eye injury; female; human; male; clinical audit; middle aged; Olympics; optometry; patient attitude; spectacles; sport injury; statistics; United Kingdom; utilization review; visual disorder; young adult

Seeing you through London 2012: eye care at the Paralympics - Wilson, C.M.; Thomson, W.D.; D'Ath, P.J. (British journal of sports medicine, 2013)
BACKGROUND: The provision of eye care services for competitors and support teams is integral to the modern Olympic Games. The eye clinic for the London 2012 Paralympic Games employed a multidisciplinary team of eye care professionals using state-of-the-art instrumentation to provide the highest level of eye care. The detailed organisation of the eye care clinic at London 2012 is described in a companion paper which summarises the eye care clinic during the London 2012 Olympic Games. These two reports will aid in planning eye care clinics at future Games. AIM: This paper summarises the organisation of the eye clinic and provides outline audit data relating to eye conditions encountered during the Paralympic Games. RESULTS: A total of 870 patients representing 102 countries attended the eye clinic. 274 (31.5%) were competitors; the remainder were trainers and support staff. No serious ocular injuries resulted from competitor injury in the field of play during the Paralympic Games, although seven patients were referred urgently to hospital eye services for conditions including orbital cellulitis, retinal detachment, exudative macular degeneration, corneal ulcer, Stevens-Johnson syndrome and macular oedema. A total of 749 spectacles, 14 pairs of contact lenses and 7 low vision aids were dispensed. CONCLUSIONS: By combining excellent facilities and equipment with a multidisciplinary team of eye care professionals, we feel we provided the highest level of eye care, providing a legacy for future Games.
Keywords: adolescent; adult; ambulatory care; sport injury; disabled sport; eye disease; eye injury; female; human; male; clinical audit; middle aged; patient attitude; spectacles; statistics and numerical data; United Kingdom; utilization; visual disorder; young adult

Analysis of 24-hour monitoring of intraocular pressure in 1055 eyes - Wang, B.; Dai, T.; Zhao, Y.; Gao, C.; Liu, J.; Chen, P. (Eye science, 2013)
PURPOSE: To investigate the clinical significance of 24-hour monitoring of intraocular pressure (IOP). METHODS: A total of 571 cases (1055 eyes) undergoing 24-hour monitoring of IOP in the Second People's Hospital of Zhengzhou between June 2012 and March 2013 were retrospectively analyzed. RESULTS: Among all 1055 eyes, 298 had suspected glaucoma (28.2%); 390 (37.0%) were diagnosed with glaucoma but received no treatment (312 with primary open angle glaucoma (POAG) and 78 with primary angle closure glaucoma (PACG)); 215 (20.4%) were diagnosed with glaucoma and received medical treatment; 132 (12.5%) underwent glaucoma filtration surgery; and there were 20 others. Through 24-hour IOP monitoring, 104 among 298 cases with suspected glaucoma were diagnosed with normal tension glaucoma (NTG), 110 with POAG, and 28 with the secondary glaucoma. Condition assessment and treatment plans were presented for 390 glaucoma cases receiving no treatment. Adjustment was made in the medical treatment of 138 eyes. Following glaucoma filtration surgery, 52 eyes received clinical advice on subsequent treatment. CONCLUSION: The simplified 24-hour IOP monitoring method is readily accepted by patients, which is of great significance for providing guidance on the diagnosis of glaucoma and the assessment of the efficacy of glaucoma surgery. However, one-time 24-hour IOP monitoring is not sufficiently efficacious to make a definite diagnosis of NTG. Therefore, long-term follow-up and repeated 24-hour IOP monitoring are required to diagnose NTG, along with a variety of related examinations.
Keywords: adult; aged; ambulatory monitoring; female; filtering operation; closed angle glaucoma; open angle glaucoma; human; intraocular pressure; low tension glaucoma; male; middle aged; oculoplethysmography; physiology; procedures; retrospective study; time

Factors affecting patient adherence to eye drop medication in a rural setting - Pugh-Jones, J.; Higman-James, D. (International Journal of Pharmacy Practice, 2013)
Introduction The effective management of glaucoma is dependent on good adherence to eye drop medication, since there is a direct link between poor control of intraocular pressure and deterioration of eye sight. Non-adherence to eye medication is estimated to be around 25% (1) which is similar to figures reported for other chronic conditions. Reasons for poor adherence to medicines are well recognised as multi-factorial, involving practical and perceptual issues. Living in a rural area may also pose additional practical barriers, but it is not clear how this influences patient adherence to treatment. The aim of the study was to identify the level of non-adherence and factors that influence adherence to eye-medication in a rural setting. Methods One-to-one interviews were carried out with seven healthcare professionals involved in the prescribing and supply process and three patients to identify the practical barriers to adherence to eye-medication. Thematic analysis of qualitative data were not included in reported results but informed the design of a questionnaire which quantified the extent to which patients experienced these issues. The setting was an eye-clinic in a rural area of Mid-WestWales. Following Health Board Ethics Committee approval, patients were invited to complete a researcher-administered study questionnaire while waiting for their out-patient appointment. This was divided into five sections: a) patient demographic details including distance from the clinic, b) self-reported adherence, c) level of information provided about administration d) views about the eye drop medication (based on a previously validated questionnaire2) and e) supply / access to medication. Results Of the 53 patients approached to take part in the study, 51 (96%) completed the study questionnaire. Most (80%) patients reported a good level of adherence (i.e. below a midpoint scale score of 21; 7 to 35 with a high score indicating low adherence) and this was not found to be related to distance from the clinic. A relationship was found between patients who had not been assessed for ability to administer their eye-drops and poor adherence (rho = -0.324, n = 51, p < 0.02). Similarly patients who identified barriers such as dexterity and ability to read labels, demonstrated a lower adherence (rho = 0.756, n = 51, p < 0.05). Only 45% (23/51) of patients said they would mention their eye-drops when asked about their medicines. The shape of the bottle (size and thickness) was an additional factor identified by patients as a barrier to adherence. Discussion Based on the findings of this small scale study, an improvement in the assessment process of patients' ability to administer their drops is essential. In rural settings, the pharmacists' role in this process, through medicines use review and education is key since some patients may not have access to this advice in the clinic. The growing trend towards delivery of medication direct to patients' homes raises further questions on the role that Community Pharmacy can play in supporting patients to use their eye-drop medication. The findings further support the need for pharmacists to prompt patients for information about eye medication as part of their drug-history taking. .
Keywords: eye drops; human; patient compliance; drug therapy; health care organization; patient; eye; hospital; questionnaire; pharmacist; rural area; outpatient; deterioration; professional standard; health; intraocular pressure; thematic analysis; health care personnel; scientist; thickness; anamnesis; pharmacy (shop); education; interview; glaucoma

The association between compliance with recommended follow-up and glaucomatous disease severity in a county hospital population - Ung, C.; Murakami, Y.; Zhang, E.; Alfaro, T.; Zhang, M.; Seider, M.I.; Singh, K.; Lin, S.C. (American Journal of Ophthalmology, 2013)
Purpose: To assess the association between insufficient follow-up and clinical parameters such as disease severity and medication use among glaucoma patients at a metropolitan county hospital. Design: Cross-sectional study. Methods: Two-hundred and six patients with established glaucoma were recruited from San Francisco General Hospital. Subjects were classified based on compliance with recommended follow-up examination intervals over the year preceding commencement of the study, as determined by patient medical records. Glaucoma severity was determined based on the American Academy of Ophthalmology Preferred Practice Patterns guidelines. Multivariate logistic regression analysis was used to assess the relationship between adherence with follow-up visits and disease severity. Results: After adjustment for the impact of potential confounding variables, subjects with severe glaucomatous disease were found to have been less adherent to their recommended follow-up than those patients with mild or moderate glaucomatous disease (adjusted OR 1.89, 95% CI 1.21-2.94; P =.01). Subjects who were on glaucoma medications were found to be less adherent to follow-up recommendations (adjusted OR 3.29, 95% CI 1.41-7.65, P =.01). Conclusion: Subjects with poor follow-up adherence were significantly more likely to have severe glaucomatous disease, suggesting that poor follow-up may contribute to disease worsening or, alternatively, those with more severe disease are less inclined to follow up at appropriate intervals. © 2013 Elsevier Inc. All rights reserved.
Keywords: adult; article; controlled study; disease severity; drug use; female; follow up; glaucoma; human; major clinical study; male; patient compliance; priority journal; treatment outcome

Direct cost and predictive factors for treatment in patients with ocular hypertension or early, moderate and advanced primary open-angle glaucoma: The CoGIS study in Germany - Lorenz, K.; Wolfram, C.; Breitscheidel, L.; Shlaen, M.; Verboven, Y.; Pfeiffer, N. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2013)
Background: The main objectives of this analysis were to assess the treatment costs and to identify major cost drivers and factors predicting direct costs in German patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG). Methods: This non-interventional cross-sectional study was conducted in two university hospitals and 13 ophthalmology practices in Germany regions (Bavaria, Rhineland-Palatinate, North Rhine-Westphalia, Hamburg and Mecklenburg-Western Pomerania) between May 2009 and January 2010 to assess resource utilisation in patients with OHT (ICD-10: 40.0) or POAG (ICD-10: 40.1) at early, moderate or advanced stages, according to the European Glaucoma Society classification Guidelines. Treatment patterns and direct costs were evaluated retrospectively for 5 years. Resource utilisation data (medication, hospitalisation, outpatient surgery, visits to ophthalmologists) were abstracted from the charts, and unit costs were applied to estimate direct costs per year (in Euros, 2009), calculated from the perspective of the statutory health insurance in Germany (Gesetzliche Krankenversicherung). Factors predicting costs were assessed in multivariate regression analysis. Results: One hundred and fifty-four patients (17.5 % OHT, 27.9 % early, 22.7 % moderate, and 31.8 % advanced POAG), on average 67 years old (SD 11) were included in the study. Average total annual direct costs per patient for OHT were €226 (SD 117), for early POAG €423 (SD 647), moderate €493 (SD 385) and advanced POAG €809 (SD 877). Glaucoma-related medications and hospitalisation represented the two major components of direct costs, increasing with the progression of glaucoma. In addition to treatment switches (p = 0.0001), factors predictive of an increase in total direct costs included the number of hospital interventions (p < 0.0001), disease-state changes since the start of treatment (p = 0.05), and current disease state (p = 0.05). Conclusions: Direct costs of treatment are higher in glaucoma compared to OHT and further increase in more severe glaucoma states. Additional treatment changes are major contributing factors to the increased treatment costs of glaucoma. If intraocular pressure can be controlled over the long term, progression to moderate and advanced states avoided, and patients remain on initial treatments, treatment costs could decline due to reduced and less expensive healthcare resource utilisation. © 2013 Springer-Verlag Berlin Heidelberg.
Keywords: adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; prostaglandin derivative; adult; ambulatory care; ambulatory surgery; article; clinical practice; controlled study; cross-sectional study; disease activity; disease classification; disease course; disease severity; drug cost; female; Germany; health care cost; health care utilization; hospital cost; hospitalization; human; ICD-10; intraocular hypertension; intraocular pressure; long term care; major clinical study; male; open angle glaucoma; ophthalmology; prediction; priority journal; regression analysis; retrospective study; university hospital

Neuroprotection of medical IOP-lowering therapy - Pfeiffer, N.; Lamparter, J.; Gericke, A.; Grus, F.H.; Hoffmann, E.M.; Wahl, J. (Cell and Tissue Research, 2013)
Intraocular pressure (IOP)-lowering therapy has been shown to arrest or retard the progression of optic neuropathy typical for glaucoma and can, thus, be described as neuroprotective. At present, six classes of medical therapy are employed, namely parasympathomimetics, alpha/beta-sympathomimetics, β-blockers, carbonic anhydrase inhibitors, α2-adrenergic receptor agonists and prostaglandin analogues. For several of these substances, some experimental evidence exists of a possible neuroprotective mechanism, beyond their IOP-lowering activity. β-Blockers are involved in the up-regulation of brain-derived neurotrophic factor (BDNF) and can decrease glutamate-mediated NMDA receptor activation. Not only systemic but also topical carbonic anhydrase inhibitors are able to increase retinal blood flow. α2-Adrenergic receptor agonists can up-regulate the formation of BDNF and anti-apoptotic factors. Prostaglandin analogues increase blood flow to the eye, possibly including the retina. To date, evidence for a neuroprotective effect independent of IOP regulation in human glaucoma is scarce and has only been shown to be likely for the α2-adrenergic receptor agonist, brimonidine. © 2013 Springer-Verlag Berlin Heidelberg.
Keywords: acetazolamide; epinephrine; adrenergic receptor stimulating agent; alpha 2 adrenergic receptor stimulating agent; apraclonidine; beta adrenergic receptor blocking agent; beta adrenergic receptor stimulating agent; betaxolol; bimatoprost; brain derived neurotrophic factor; brimonidine; carbachol; carbonate dehydratase inhibitor; carteolol; cholinergic receptor stimulating agent; clonidine; diclofenamide; dipivefrine; dorzolamide; latanoprost; metipranolol; pilocarpine; prostaglandin derivative; tafluprost; timolol; travoprost; unoprostone; aplastic anemia; aqueous humor; argon laser; asthma; bradycardia; bronchospasm; diuresis; dose response; excitotoxicity; eye blood flow; eyelash; glaucoma; heart rate; human; hyperemia; hypokalemia; hypotension; inflammation; intraocular hypertension; intraocular pressure; iris disease; low tension glaucoma; mechanical stress; myopia; neuroprotection; nonhuman; ocular hyperemia; ocular hyperemia; ocular surface disease; open angle glaucoma; optic disk; optic nerve disease; optic nerve injury; patient compliance; priority journal; pupil constriction; pupil constriction; pupil disease; retina blood flow; review; side effect; trabeculoplasty; upregulation; urolithiasis

Ocular Hypertension after Pediatric Cataract Surgery: Baseline Characteristics and First-Year Report - Lin, H.; Chen, W.; Luo, L.; Zhang, X.; Chen, J.; Lin, Z.; Qu, B.; Zhan, J.; Zheng, D.; Zhong, X.; Tian, Z.; Liu, Y. (PLoS ONE, 2013)
Monitoring intraocular pressure (IOP) is essential for pediatric cataract treatment but always difficult due to lack of cooperation in young children. We present the baseline characteristics and the first-year results of a long-term prospective cohort study, which are aimed to determine the relationship of the incidence of ocular hypertension (OH) in children after cataract surgery during the first-year period and the risk of developing late-onset glaucoma. Children were included with the following criteria: they were≤10 years old and scheduled to undergo cataract surgery with/without intraocular lens implantation; they were compliant with our follow-up protocol, which included monitoring IOP using a Tono-Pen under sedation or anesthesia. Incidence of OH, peak OH value, OH onset time and OH duration within a 12-month period following surgery were measured. In brief, 206 patients (379 eyes) were included and OH developed in 66 of 379 (17.4%) eyes. The mean follow-up period was 14.0±3.2 months (median, 12 months; range, 10-16 months). Moreover, 33 of 196 (16.8%) aphakic eyes and 33 of 183 (18.0%) IOL eyes were diagnosed with OH. The peak OH onset times were at 1-week (34/66, 51.5%) and 1-month (14/66, 21.2%) appointments postsurgery. The peak IOP value in the OH eyes was 29.9±7.5 mmHg (median, 29 mmHg; range, 21-48 mmHg). The duration of OH was 30.9±31.2 days (median, 30 days; range, 3-150 days). OH recurred in 13 eyes with a history of OH diagnosed within 1 month postsurgery (13/54, 24.1%), which needed temporary or long term use of antiglaucoma medications. In conclusion, the incidence of OH in children after cataract surgery was 17.4% during the first-year period. Children who have suffered elevated IOP in the first year after cataract surgery should be followed closely to determine if there is an increased risk of developing late-onset glaucoma. © 2013 Lin et al.
Keywords: antiglaucoma agent; brimonidine; brinzolamide; carteolol; eye drops; pranoprofen; steroid; article; cataract extraction; child; cohort analysis; disease duration; drug withdrawal; female; follow up; glaucoma; human; incidence; intraocular hypertension; intraocular pressure; lens implant; major clinical study; male; patient compliance; pediatric surgery; postoperative period; preschool child; prospective study; risk assessment; school child

Management of asthma in the elderly patient - Melani, A.S. (Clinical Interventions in Aging, 2013)
A significant number of older asthmatics, more often than in previous ages, have poorly controlled asthma, leading to increased morbidity and mortality. On the other hand, current guidelines suggest that most asthmatics can obtain achievement and maintenance of disease control and do not include sections specific to the management of asthma in the elderly so that it is more evident the contrast between poor control of asthma in the elderly and the lack of specific guidance from guidelines on asthma management in older asthmatics. Inhaled corticosteroids are the cornerstone for older asthmatics, eventually with add-on inhaled long-acting beta-agonists; inhaled short acting beta-agonists can be used as rescue medications. Triggers exacerbating asthma are similar for all ages, but inhaled viruses and drug interactions have greater clinical significance in the elderly. Older asthmatics have an increased likelihood of comorbidities and polypharmacy, with possible worsening of asthma control and reduced treatment adherence. Physicians and older asthmatics probably either do not perceive or accept a poor asthma control. We conclude that specific instruments addressed to evaluate asthma control in the elderly with concomitant comorbidities and measurements for improving self-management and adherence could assure better disease control in older asthmatics. © 2013 Melani, publisher and licensee Dove Medical Press Ltd.
Keywords: antiasthmatic agent; beclomethasone dipropionate; beta adrenergic receptor stimulating agent; budesonide; ciclesonide; corticosteroid; cyclosporin derivative; flunisolide; fluticasone; fluticasone furoate; formoterol; dry powder inhaler; indacaterol; ipratropium bromide; leukotriene receptor stimulating agent; long acting drug; macrolide; methotrexate; mometasone furoate; montelukast; omalizumab; prednisolone; soft mist inhaler; roflumilast; salbutamol; short acting drug; tacrolimus; theophylline; tiotropium bromide; triamcinolone; unclassified drug; unindexed drug; vilanterol; add on therapy; adrenal insufficiency; age; aged; anaphylaxis; asthma; bronchial thermoplasty; bronchoscopy; cataract; comorbidity; diabetes mellitus; disease control; disease exacerbation; drug dose comparison; drug interaction; drug megadose; exercise; gastritis; gastrointestinal symptom; glaucoma; human; hypertension; injection site reaction; low drug dose; metered dose inhaler; morbidity; mortality; muscle weakness; osteoporosis; patient care; patient compliance; peptic ulcer; polypharmacy; practice guideline; psychosis; review; skin contusion; unspecified side effect; virus; handihaler; respimat

Therapeutic uses of prostaglandin F2α analogues in ocular disease and novel synthetic strategies - Dams, I.; Wasyluk, J.; Prost, M.; Kutner, A. (Prostaglandins and Other Lipid Mediators, 2013)
The pharmacological management of glaucoma and ocular hypertension has significantly changed over the last 18 years with the introduction of PGF 2α analogues, more specifically latanoprost (6), travoprost (8), bimatoprost (10) and tafluprost (12). Prostanoids are currently the first-line medicines among ocular antihypertensive drugs in terms of efficacy, safety, patient compliance and medical economy. Their ability to effectively reduce intraocular pressure with once-per-day dosing, ocular tolerability comparable to timolol and general lack of systemic adverse effects have made them the mainstay of pharmacological therapy for glaucoma and ocular hypertension all over the world. The present review reports a novel, convergent and highly diastereoselective method for the synthesis of PGF2α analogues from the structurally advanced prostaglandin phenylsulfone (5Z)-(+)-15 and new ω-chain synthons. The biochemistry, clinical efficacy and side effects of four commercially available PGF2α analogues, currently used as first-line agents for reducing intraocular pressure in patients with glaucoma or ocular hypertension, are also discussed. © 2012 Elsevier Inc. All rights reserved.
Keywords: bimatoprost; fluprostenol; latanoprost; nonsteroid antiinflammatory agent; promethazine; prostaglandin F2 alpha; prostanoid; tafluprost; timolol; travoprost; unoprostone; unoprostone isopropyl ester; alopecia; behavior; blood vessel permeability; conference paper; drug efficacy; drug marketing; drug safety; eye disease; glaucoma; hair loss; health care cost; human; hyperemia; hyperpigmentation; intraocular hypertension; intraocular pressure; leisure; low level laser therapy; miosis; movement (physiology); nonhuman; open angle glaucoma; patient compliance; retina macula cystoid edema; skin discoloration; structure activity relation; trichiasis; lumigan; rescula; taflotan; travatan; xalatan

Development and validation of a predictive model for nonadherence with once-daily glaucoma medications - Chang, D.S.; Friedman, D.S.; Frazier, T.; Plyler, R.; Boland, M.V. (Ophthalmology, 2013)
Objective: To develop and validate a predictive model to estimate the probability of being nonadherent to topical glaucoma medications. Design: Prospective cohort study. Participants: Patients being treated with once-daily prostaglandin eye drops. Methods: A predictive model for nonadherence was developed from the Travatan Dosing Aid (TDA) study (n = 196) using stepwise logistic regression. The performance of the TDA-derived model was assessed using a separate cohort of subjects from the Automated Dosing Reminder Study (ADRS; n = 407). The assessment was based on regression coefficients, discrimination, and calibration. We also developed a scoring system from the TDA-derived model to simplify the estimation of risk for clinical use. Main Outcome Measures: Usage of drops was monitored electronically for 3 months in both studies. Adherence was calculated as the percentage of days on which a dose was taken within 4 hours of the average dosing time for that patient. Nonadherence was defined as taking ≤75% prescribed doses within a window starting 2 weeks after the baseline visit until 2 weeks before the follow-up visit. Results: Six factors, including younger age, black race, worse general health status, shorter duration of glaucoma medication therapy, lower self-reported adherence, and admitting to not following doctors' orders, were associated with being nonadherent and were included in the predictive model. The coefficients for the TDA-derived and the ADRS-derived predictive models were similar. The risk scoring system developed from the TDA study had good discrimination (area under the receiver operating characteristic curve of 0.80) and calibration (Hosmer-Lemeshow goodness-of-fit test, P = 0.102) when applied to the ADRS population. Conclusions: The TDA-derived predictive model for nonadherence performed well in an independent population. A risk scoring system was developed using demographic data and patient responses to 4 questions to provide an estimate of the probability of being nonadherent. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology.
Keywords: antiglaucoma agent; prostaglandin; adult; aged; article; cohort analysis; female; follow up; glaucoma; human; major clinical study; male; patient compliance; phase 1 clinical trial (topic); priority journal; prospective study; risk assessment; scoring system; self report; treatment duration; validation study

High-Risk Populations for Vision Loss and Eye Care Underutilization: A Review of the Literature and Ideas on Moving Forward - Elam, A.R.; Lee, P.P. (Survey of Ophthalmology, 2013)
Much work has been done to highlight and understand the significant disparities in the use of eye care services, but they continue to exist. We review the existing literature on utilization in high-risk populations to provide a context for understanding what "high-risk" means, to understand the utilization patterns among high-risk populations, and to highlight barriers to appropriate eye care utilization. We also discuss potential approaches to reduce these disparities. © 2013 Elsevier Inc.
Keywords: corticosteroid; African American; age distribution; article; awareness; cardiovascular risk; cataract; comorbidity; cultural factor; denial; diabetes mellitus; diabetic retinopathy; disease severity; doctor patient relationship; educational status; ethnic difference; European American; eye care; eye examination; fear; finance; follow up; glaucoma; health belief; health care access; health care availability; health care cost; health care delivery; health care planning; health care utilization; health education; health literacy; health program; health promotion; health service; high risk population; Hispanic; human; hypermetropia; immigration; knowledge; language; lifestyle; medicare; myopia; open angle glaucoma; patient attitude; practice guideline; prevalence; priority journal; age related macular degeneration; risk factor; self report; social status; social support; trust; visual impairment

Comparison of the efficacy and safety of fixed combination travoprost/timolol and dorzolamide/ timolol in patients with primary open-angle glaucoma and ocular hypertension - Babić, N.; Andreić, V.; Miljković, A.; Grković, D.; Jovanović, P. (Srpski arhiv za celokupno lekarstvo, 2013)
INTRODUCTION: Combining two medications in one bottle may improve compliance by reducing the time required to administer drops and the frequency of the total number of medication bottles. OBJECTIVE: To compare the efficacy of reduced intraocular pressure (IOP) and safety of fixed combination travoprost 0.004%/timolol 0.5% vs. fixed combination dorzolamide 2%/timolol 0.5% in patients with primary open-angle glaucoma or ocular hypertension. METHODS: Prospective randomized clinical study included 60 patients divided into 2 groups. Follow-up was done at day 14 and 45 and month 3. IOP measurements were taken at each follow-up examination at 8 am, 10 am and 4 pm. RESULTS: Both fixed combinations reduced IOP significantly compared to initial values at all follow-ups (p < 0.001). Mean pooled IOP at all visits and time points was slightly lower in the travoprost/timolol group compared with the dorzolamide/timolol group (16.13 mmHg vs. 16.15 mmHg). Mean IOP reduction from baseline ranged from -7.46 mmHg to -9.92 mmHg in the travoprost/timolol group and from -6.93 mmHg to -8.93 mmHg for the dorzolamide/timolol group. Mean (+/- standard error of the mean) reduction in diurnal LOP from baseline to 3rd month was 8.96 +/- 2.79 in the travoprost/timolol group versus 8.07 +/- 2.91 in patients receiving dorzolamide/timolol fixed combination (p = 0.196). The most frequent treatment-related adverse events were conjunctival hyperemia in the travoprost/timolol group, and dry eye and foreign body sensation in the dorzolamide/timolol group. CONCLUSION: Travoprost/timolol fixed combination was slightly more effective than dorzolamide/timolol fixed combination in reducing mean diurnal IOP. Travoprost/timolol group resulted in an IOP reduction for up to 1.07 mmHg higher than dorzolamide/timolol group. Both fixed combinations were well tolerated and safe.
Keywords: antihypertensive agent; cloprostenol; dorzolamide plus timolol; drug combination; sulfonamide; thiophene derivative; timolol; travoprost; analogs and derivatives; controlled study; drug combination; open angle glaucoma; human; intraocular hypertension; patient compliance; prospective study; randomized controlled trial

Glaucoma - King, A.; Azuara-Blanco, A.; Tuulonen, A. (BMJ (Online), 2013)
Keywords: antiglaucoma agent; eye drops; prostaglandin; blindness; cataract extraction; clinical feature; closed angle glaucoma; cost effectiveness analysis; disease classification; disease course; drug safety; eye photography; genetic association; glaucoma; human; intraocular hypertension; intraocular pressure; iridectomy; laser surgery; low level laser therapy; open angle glaucoma; patient compliance; priority journal; review; screening test; trabeculectomy; trabeculoplasty; unspecified side effect; vision test; visual acuity

Editorial (Journal of Current Glaucoma Practice, 2013)
Keywords: sorbate potassium; timolol; timolol maleate; vasculotropin inhibitor; Ahmed valve; clinical practice; comorbidity; congenital glaucoma; correlation analysis; editorial; eye burning; genetic counseling; glaucoma; glaucoma surgery; gonioscopy; gravity; human; in vivo study; intraocular hypotension; intraocular pressure; iridotomy; lacrimation; lens implantation; materials testing; molecular biology; molecular diagnosis; molecular mechanics; multicenter study (topic); Nigeria; observational study; open angle glaucoma; ophthalmic argon laser; ophthalmic neodymium YAG laser; pathogenesis; patient compliance; phacoemulsification; postoperative period; prospective study; retrospective study; risk assessment; sclerectomy; side effect; trabeculoplasty; treatment outcome; visual acuity

A survey of attitudes of glaucoma subspecialists in England and Wales to visual field test intervals in relation to NICE guidelines - Malik, R.; Baker, H.; Russell, R.A.; Crabb, D.P. (BMJ Open, 2013)
Objectives: To establish the attitudes of glaucoma specialists to the frequency of visual field (VF) testing in the UK, using the NICE recommendations as a standard for ideal practice. Design: Interview and postal survey. Setting: UK and Eire Glaucoma Society national meeting 2011 in Manchester, UK, with a second round of surveys administered by post. Participants: All consultant glaucoma specialists in England and Wales were invited to complete the survey. Primary and secondary outcome measures: (1) Compliance of assigned follow-up VF intervals with NICE guidelines for three hypothetical patient scenarios, with satisfactory treated intraocular pressure and (a) no evidence of VF progression; (b) evidence of VF progression and (c) uncertainty about VF progression, and respondents were asked to provide typical follow-up intervals representative of their practice; (2) attitudes to research recommendations for six VF in the first 2 years for newly diagnosed patients with glaucoma. Results: 70 glaucoma specialists completed the survey. For each of the clinical scenarios a, b and c, 14 (20%), 33 (47%) and 28 (40%) responses, respectively, fell outside the follow-up interval recommended by NICE. Nearly half of the specialists (46%) agreed that 6 VF tests in the first 2 years was ideal practice, while 16 (28%) said this was practice 'not possible', with many giving resources within the NHS setting as a limiting factor. Conclusions: The results from this survey suggest that there is a large variation in attitudes to follow-up intervals for patients with glaucoma in the UK, with assigned intervals for VF testing which are, in many cases, inconsistent with the guidelines from NICE.
Keywords: follow up; glaucoma; health care survey; health personnel attitude; human; interview; intraocular pressure; medical specialist; outcome assessment; postal mail; practice guideline; protocol compliance; review; United Kingdom; visual field

Targeting the A3adenosine receptor for glaucoma treatment (Review) - Pnina, F.; Shira, C.; Bar-Yehuda, S. (Molecular Medicine Reports, 2013)
Glaucoma is a worldwide disease and the second leading cause of blindness. Current treatments are associated with a number of side-effects and poor compliance, due to the requirement for treatment administration several times a day. These treatments typically aim to lower intraocular pressure (IOP); however, they are unable to protect retinal ganglion cells (RGCs) from undergoing apoptosis, which is the main cause of vision loss. A 3adenosine receptor (A3AR) agonists have been found to protect normal cells from undergoing apoptosis via the downregulation of death signals. Furthermore, A3AR agonists have been reported to have several ophthalmological effects, including the prevention of ganglion cell apoptosis in vitro and in vivo and anti-inflammatory effects in experimental models of autoimmune uveitis. CF101, an orally bioavailable A3AR agonist, has been analyzed in dry eye syndrome phase II clinical trials and was identified to be safe and well tolerated. The anti-inflammatory effect of CF101 was shown to significantly improve corneal staining, tear meniscus and tear break-up time in dry eye patients. In addition, CF101 was found to decrease IOP in patients. The safety and efficacy of CF101, together with its suitability for oral administration, indicates that it has potential as a candidate drug for the treatment of glaucoma. Copyright © 2013 Spandidos Publications Ltd. All rights reserved.
Keywords: piclidenoson; adenosine A3 receptor; adenosine A3 receptor agonist; apoptosis inducing factor; caspase 3; caspase 9; cytochrome c; nitric oxide; timolol; tumor necrosis factor; tumor necrosis factor alpha receptor; antiinflammatory activity; apoptosis; aqueous humor flow; article; autoimmune uveitis; drug efficacy; drug safety; drug tolerability; dry eye; glaucoma; human; in vitro study; intraocular pressure; membrane permeability; nerve cell; neuroprotection; nonhuman; oxidative stress; pathogenesis; patient compliance; phase 2 clinical trial (topic); protein expression; pseudoexfoliation; retina ganglion cell; visual impairment; Wnt signaling

Current and future pharmacological treatments for diarrhea-predominant irritable bowel syndrome - Camilleri, M. (Expert Opinion on Pharmacotherapy, 2013)
Introduction: Diarrhea-predominant irritable bowel syndrome (IBS-D) affects about one-third of patients with IBS, which is observed in about 12% of people across five continents. The ultimate goal in this field is to identify the underlying cause of symptoms in order to individualize education of the patient, and to provide optimal treatment of this highly prevalent condition. Areas covered: This review addresses the pharmacological treatments for IBS-D under three categories: drugs for IBS-D (i.e., the 5-HT3 antagonist, alosetron); drugs approved for other indications that are used in IBS-D (e.g., opioid agonists; other 5-HT3 antagonists; serotonergic psychoactive agents; bile acid binders; 5-ASA compounds; probiotics and non-absorbable antibiotics); as well as development of drugs that are likely to impact the management of IBS-D in the future (e.g., drug absorbents; TPH1 inhibitors; mast cell stabilizers; centrally acting benzodiazepines). The final section addresses key findings: regulatory roadblocks; weaknesses in the current research in this field so far and opportunities to address unmet needs including restoration of normal intestinal barrier function or permeability, and suppression within the intestines of local immune activation that is thought to trigger abnormal motor, sensory and secretory functions in IBS-D. Expert opinion: While symptomatic treatment of diarrhea is effective, there is a need for new treatments for the IBS-D complex. Greater understanding of the mechanisms in IBS-D has led to promising approaches to develop more efficacious therapies. © 2013 Informa UK, Ltd.
Keywords: alosetron; aminosalicylic acid; amitriptyline; asimadoline; ast 120; codeine; colesevelam; colestyramine; cromoglycate disodium; desipramine; diphenoxylate; doxepin; duloxetine; fluphenazine; imipramine; ketotifen; loperamide; lx 1031; mebeverine; mesalazine; nortriptyline; placebo; probiotic agent; ramosetron; rifaximin; tofisopam; trimipramine; unclassified drug; abdominal pain; bladder dysfunction; blood brain barrier; colon motility; constipation; diarrhea; drug efficacy; drug safety; gastrointestinal transit; genetic variability; glaucoma; human; intestinal secretion; intestine function; irritable colon; ischemic colitis; low drug dose; meta analysis (topic); nonhuman; palliative therapy; patient compliance; patient satisfaction; pharmacogenetics; phase 2 clinical trial (topic); phase 3 clinical trial (topic); quality of life; randomized controlled trial (topic); recommended drug dose; review; risk management; tachycardia

Comparison of resource utilization in the treatment of open-angle glaucoma between two cities in Finland: Is more better? - Hagman, J. (Acta Ophthalmologica, 2013)
Keywords: antiglaucoma agent; article; biogeographic region; city; comparative study; drug cost; evidence based medicine; eye photography; Finland; health care cost; health care planning; health care utilization; Health Related Quality of Life questionnaire; human; major clinical study; open angle glaucoma; practice guideline; priority journal; quality of life; questionnaire; resource allocation; retrospective study; visual field

Author reply - Colby, K.; Pavan-Langston, D. (Ophthalmology, 2013)
Keywords: aciclovir; ganciclovir; trifluridine; anterior eye segment; astigmatism; blepharitis; differential diagnosis; disease predisposition; eye infection; health care cost; herpes simplex; herpes simplex keratitis; human; letter; patient compliance; practice guideline; priority journal; randomized controlled trial (topic); topical treatment

Medication (Re)fill adherence measures derived from pharmacy claims data in older Americans: A review of the literature - Sattler, E.L.P.; Lee, J.S.; Perri III, M. (Drugs and Aging, 2013)
Medication nonadherence is a significant public health problem that affects the health and well-being of older Americans while burdening the US healthcare system. Pharmacy claims data have gained importance in deriving objective medication (re)fill adherence measures; however, little is known about application of such measures in older Americans. The objective of this study was to assess the types and characteristics of pharmacy claims-derived medication (re)fill adherence measures used in older Americans. A comprehensive literature search strategy was employed to identify all articles using pharmacy claims data to measure (re)fill adherence to prescription medications in older Americans aged 65+ years. Included were articles reporting original research studies conducted and published in the USA in English between 1 January 2000 and 1 November 2012. The basic search used multiple key terms indicating adherence, combined with the term "medication" and the term "pharmacy claims or administrative claims." Due to the variety of measure names used in the literature, a more specific search was added to repeat the basic search for 29 previously used medication (re)fill adherence measure names. Articles identified through the database search were manually reviewed to select only articles meeting the inclusion criteria. The search resulted in a total of 36 articles. Information on medication (re)fill measurements were extracted and summarized. The 36 articles used 20 differently named measures under the three main concepts: medication adherence, persistence, and discontinuation. Measures of medication adherence cumulatively assessed the proportion of time at which medications were (not) filled over a predefined observation period (e.g., medication possession ratio). Measures of medication persistence assessed the continuity of medication filling over a specified time period, while medication discontinuation measures focused on termination of medication (re)fills. Overall, almost two thirds of all identified articles used a single medication (re)fill adherence measure. Among them, 77 % used a medication possession measure. The term "medication possession ratio" (MPR) was used most frequently (65 %), followed by the "proportion of days covered" (PDC; 30 %). No single measure can be generally recommended for the use in older Americans. The challenges in using pharmacy claims-based medication (re)fill adherence measures in older Americans include a lack of consensus terminology and algorithms among measures of the same concepts, insufficient transparency of individual measure operationalization, and inadequate consideration of unique characteristics of the older population, such as temporary nursing home care. Although medication (re)fill adherence measures may be well suited for measuring medication adherence in older Americans, little guidance is available on how to use them in this population. Further efforts need to be given to the development and standardization of pharmacy claims-based medication (re)fill measures that are specifically tailored toward use in older Americans. © 2013 Springer International Publishing Switzerland.
Keywords: alendronic acid; amlodipine plus benazepril; angiotensin receptor antagonist; anticonvulsive agent; antiglaucoma agent; antihypertensive agent; antilipemic agent; antiparkinson agent; beta adrenergic receptor blocking agent; bisphosphonic acid derivative; calcitonin; calcium channel blocking agent; corticosteroid; digoxin; dipeptidyl carboxypeptidase inhibitor; donepezil; galantamine; hydroxymethylglutaryl coenzyme A reductase inhibitor; insulin; muscarinic receptor blocking agent; nonsteroid antiinflammatory agent; oral antidiabetic agent; paroxetine; phenobarbital; phenytoin; proton pump inhibitor; raloxifene; risedronic acid; rivastigmine; unindexed drug; Alzheimer disease; anxiety disorder; article; billing and claims; chronic lung disease; corticosteroid therapy; drug withdrawal; dyslipidemia; epilepsy; heart failure; heart infarction; hormonal therapy; human; hypertension; medicare; medication compliance; non insulin dependent diabetes mellitus; open angle glaucoma; osteoporosis; overactive bladder; Parkinson disease; patient compliance; pharmacy (shop); priority journal; senescence; treatment refusal

The long-term safety of antiepileptic drugs - Gaitatzis, A.; Sander, J.W. (CNS Drugs, 2013)
Antiepileptic drugs (AEDs) are used by millions of people worldwide for the treatment of epilepsy, as well as in many other neurological and psychiatric conditions. They are frequently associated with adverse effects (AEs), which have an impact on the tolerability and success of treatment. Half the people who develop intolerable AEs discontinue treatment early on after initiation, while the majority of people will continue to be exposed to their effects for long periods of time. The long-term safety of AEDs reflects their potential for chronic, cumulative dose effects; rare, but potentially serious late idiosyncratic effects; late, dose-related effects; and delayed, teratogenic or neurodevelopmental effects. These AEs can affect every body system and are usually insidious. With the exception of delayed effects, most other late or chronic AEs are reversible. To date, there is no clear evidence of a carcinogenic effect of AEDs in humans. While physicians are aware of the long-term AEs of old AEDs (the traditional liver enzyme-inducing AEDs and valproate), information about AEs of new AEDs (such as lamotrigine, levetiracetam, oxcarbazepine, topiramate or zonisamide), particularly of their teratogenic effects, has emerged over the years. Sporadic publications have raised issues about AEs of the newer AEDs eslicarbazepine, retigabine, rufinamide, lacosamide and perampanel but their long-term safety profiles may take years to be fully appreciated. Physicians should not only be aware of the late and chronic AEs of AEDs but should systematically enquire and screen for these according to the individual AED AE profile. Care should be taken for individuals with comorbid conditions that may render them more susceptible to specific AEs. Prevention and appropriate management of long-term AED AEs is expected to improve adherence to treatment, quality of life and control of epilepsy. © 2013 Springer International Publishing Switzerland.
Keywords: acetazolamide; anticonvulsive agent; carbamazepine; cyanocobalamin; eslicarbazepine; ethosuximide; etiracetam; felbamate; folic acid; gabapentin; lacosamide; lamotrigine; midazolam; oxcarbazepine; perampanel; phenobarbital; phenytoin; pregabalin; primidone; retigabine; rufinamide; stiripentol; tiagabine; topiramate; valproic acid; vigabatrin; zonisamide; acne; alopecia; amenorrhea; aplastic anemia; atherosclerosis; bladder function; carcinogenicity; cognition; comorbidity; complex regional pain syndrome type I; B12 deficiency; drug safety; drug tolerability; drug tolerance; Dupuytren contracture; female infertility; fibromatosis; frozen shoulder; gingiva hypertrophy; glaucoma; hirsutism; human; hyperhomocysteinemia; hyperlipidemia; hyperthermia; hypertrichosis; impotence; liver toxicity; long term care; male infertility; nephrolithiasis; obesity; oligomenorrhea; osteomalacia; osteopenia; osteoporosis; patient compliance; patient education; Peyronie disease; postnatal development; pregnancy; priority journal; pseudolymphoma; quality of life; reproductive health; review; rickets; semen abnormality; side effect; skin discoloration; suicide; sweating; teratogenicity; testosterone blood level; visual field defect; vitamin D deficiency; body weight gain; body weight loss

Patent watch - Harrison, C. (Nature Reviews Drug Discovery, 2013)
Keywords: brimonidine; brimonidine plus timolol; generic drug; peginterferon; ribavirin; timolol maleate; drug approval; drug dose regimen; drug efficacy; drug use; glaucoma; hepatitis C; intraocular pressure; note; patent; patient compliance; priority journal

Glaucoma Severity and Medication Adherence in a County Hospital Population - Ung, C.; Zhang, E.; Alfaro, T.; Murakami, Y.; Zhang, M.; Seider, M.I.; Lin, S.C.; Singh, K. (Ophthalmology, 2013)
Objective: To assess the association between disease severity and adherence with glaucoma medications in a county hospital population. Design: Cross-sectional study. Participants: A total of 126 patients diagnosed with glaucoma receiving intraocular pressure (IOP)-lowering medication were recruited from the San Francisco General Hospital Ophthalmology Clinic. Methods: Subjects completed an oral questionnaire to assess demographic information, knowledge of glaucoma, and perceptions of glaucoma medication adherence. Glaucoma disease severity was classified according to the American Academy of Ophthalmology's Preferred Practice Pattern guidelines. Medication adherence was measured for each patient by obtaining pharmacy refill data and calculating medication possession ratio (MPR), that is, the ratio of total days' supply of medication during a 365-day period. Adherence was measured retrospectively over the 18-month period before study entry. Subjects with an MPR >80% were considered adherent. Main Outcome Measure: Medication adherence. Results: Subjects with mild or moderate glaucoma were more likely to be nonadherent to their prescribed glaucoma medications than those with severe disease (adjusted odds ratio [OR], 1.54; 95% confidence interval [CI], 1.03-2.31; P = 0.04). Age, gender, race, education level, years of glaucoma, number of medications, and glaucoma diagnosis were not found to be statistically significantly associated with adherence. Conclusion: Patients with severe glaucoma were more likely to adhere to their topical IOP-lowering medication regimen than those with milder glaucomatous disease. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. © 2013 American Academy of Ophthalmology.
Keywords: alpha adrenergic receptor stimulating agent; antihypertensive agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin; adult; article; closed angle glaucoma; cross-sectional study; disease severity; female; glaucoma; human; intraocular pressure; low tension glaucoma; major clinical study; male; medication compliance; open angle glaucoma; patient compliance; prescription; priority journal; public hospital

Authors' response: Generic medications in ophthalmology - Connor, A.J.; Fraser, S. (British Journal of Ophthalmology, 2013)
Keywords: latanoprost; health survey; human; letter; clinical audit; open angle glaucoma; ophthalmology; patient compliance; prescription; priority journal; questionnaire; xalatan

Intraocular pressure changes during sexual activity - Mansouri, K.; Medeiros, F.A.; Weinreb, R.N. (Acta Ophthalmologica, 2013)
Keywords: bimatoprost; brinzolamide; aged; alcohol consumption; ambulatory monitoring; case report; clinical trial; contact lens sensor; female; Goldmann applanation tonometer; human; intraocular pressure; intraocular pressure measuring device; letter; open angle glaucoma; priority journal; prospective study; sensor; sexual behavior; signal detection; water loading (test); wine; lumigan; SENSIMED Triggerfish

The cost of glaucoma care provided to a sample of medicare beneficiaries from 2002-2009 - Quigley, H.; Cassard, S.; Gower, E.; Ramulu, P.; Jampel, H.; Friedman, D. (Investigative Ophthalmology and Visual Science, 2013)
Purpose: To estimate payments for glaucoma care among Medicare beneficiaries from 2002 to 2009. Methods: Data from a 5% random subsample of Medicare billing information from the years 2002 through 2009 were collected from the carrier, outpatient hospital, inpatient hospital and beneficiary summary files. Medicare beneficiaries with both Parts A and B, fee for service enrollment for > 1 month during the year, who had one of a defined set of glaucoma diagnostic codes were included if they had one glaucoma visit, glaucoma diagnostic test, or glaucoma laser/surgical procedure. Groups coded as open angle, angle closure, or other glaucoma were categorized separately. Claims were classified into glaucoma care, other eye care and other medical care. Results: In 2009, overall glaucoma payments were $37.4 million for the 5% sample, for an overall estimated cost of $748.4 million, or 0.4% of all Medicare payments. Office visits comprised nearly one-half of glaucoma-related costs, diagnostic testing was about onethird, and surgical and laser procedures were about 10% of costs each. Coded OAG and OAG suspects accounted for 87.5% of glaucoma costs, while cost per person was highest in other glaucoma, followed by ACG, then OAG. Fewer than 3% of OAG patients were estimated to undergo surgery and about 5% had laser trabeculoplasty in 2009. Payments for ACG patients were headed by laser iridotomy (35% of their total). Other glaucoma patients had the highest proportion of costs devoted to surgery (26% of their total), particularly tube-shunt surgeries. The non-glaucoma eye care for glaucoma patients was 67% higher than that for glaucoma care, chiefly related to cataract surgery and diagnosis/treatment of retinal diseases. From 2002 to 2009, glaucoma care costs rose 30% (p<0.001 by test for linear trend) and the cost per person per year rose from $197 to $228 (p<0.01 by test for linear trend), due to increased reimbursement for visits, an increased number of OAG suspects, more higher-level visits, and more laser and surgical procedures. Conclusions: Payments for glaucoma were less than 1/200th of all Medicare payments, increasing from 2002-2009 at less than the rate of general or medical inflation. Cataract and retinal eye care for glaucoma patients substantially exceeded the cost of their glaucoma care. Visit charges represent the largest category of costs.
Keywords: adult; aging; ambulatory care; cataract extraction; clinical research; conference abstract; controlled study; diagnosis; economics; eye care; glaucoma; hospital patient; human; iridotomy; laser; medical care; medicare; outpatient; reimbursement; retina disease; surgery; surgical technique; trabeculoplasty; workforce

Assessment of intervisit IOP control in eyes with advanced glaucoma - Patel, P.; Pritz, N.; Fechtner, R.; Khouri, A. (Investigative Ophthalmology and Visual Science, 2013)
Purpose: The Advanced Glaucoma Intervention Study (AGIS) provided evidence more than a decade ago that low intraocular pressure (IOP) was associated with reduced progression of visual field defects. The aim of this study was to evaluate the extent of intervisit control of IOP with current treatments of patients with advanced glaucoma. Methods: Medical records of consecutive patients with a diagnosis of advanced primary open angle glaucoma (POAG) at New Jersey Medical School between 06/2012 and 11/2012 were reviewed. Inclusion: POAG with documented cup-to-disc ratio > 0.8 and visual field abnormalities in both hemifields and/or loss within 5° of fixation in at least one hemifield as tested with standard automated perimetry, >9 office visits. Exclusion: Glaucoma other than POAG, mild to moderate POAG, <9 office visits. Data on IOP, ocular medications, lens status, and ophthalmic surgeries (incisional and laser) were collected. IOP was categorized into one of four groups (Excellent <14, Good 14-17.5, Fair 18-21, Poor >21 mmHg; consistent with AGIS). Effect of lens status and glaucoma surgery was analyzed. Percentages, means, paired t-tests, and chi-square analyses were used. Results: 4 93 time points were collected for 50 eyes (28 patients). Mean age was 65 years (range: 46 to 88 years). The numbers of time points that fell within the various categories were: Excellent 173/493 (35%), Good 179/493 (36%), Fair 75/493 (15%), Poor 66/493 (13%). When further grouped into time points < or > 18 mmHg, glaucoma surgery and lower mean number of medications were statistically significantly higher in time points with IOP <18 mmHg. The number of time points < 18 mmHg was higher for pseudophakic eyes, but this did not reach statistical significance (Table 1). Conclusions: In eyes with advanced POAG, IOP control below 18 mmHg was achieved in about 70% of office visits, and was more often seen in eyes after glaucoma surgery. Rigorous IOP control remains a challenge in advanced POAG more than a decade after AGIS recommendations.
Keywords: adult; aged; ambulatory care; chi square test; clinical article; complication; conference abstract; congenital malformation; controlled study; eye surgery; female; glaucoma surgery; human; intervention study; intraocular pressure; laser; low drug dose; male; medical record; medical school; New Jersey; open angle glaucoma; perimetry; statistical significance; visual field defect

Bevacizumab and triamcinolone acetonide for choroidal neovascularization due to age-related macular degeneration unresponsive to antivascular endothelial growth factors - Veritti, D.; Sarao, V.; Lanzetta, P. (Journal of Ocular Pharmacology and Therapeutics, 2013)
Purpose: To evaluate the safety and efficacy of a combined approach using an antivascular endothelial growth factor (VEGF) agent (bevacizumab) and a steroid (triamcinolone acetonide) for treating choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) unresponsive to anti-VEGF monotherapy. Methods: Retrospective case series. We analyzed 25 eyes with CNV due to AMD who received a combination of intravitreal bevacizumab (1 mg) and triamcinolone (4 mg). Results were assessed at 7 days, 1, 3, 6, 9, and 12 months by best-corrected visual acuity (BCVA) measurement, fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT). Retreatment with intravitreal bevacizumab or combination therapy was considered at investigator discretion at every follow-up visit. Results: A mean BCVA improvement of 0.18 (95% CI: 0.05; 0.3) logMAR was reported between baseline and the 12-month measurement (P<0.01). An opposite trend toward progressive loss of BCVA, from 1.08 to 1.31 logMAR, had been observed in the 6 months before starting the combination therapy, in spite of regular treatment with anti-VEGFs (P<0.0001). OCT measurements showed a 139-μm (95% CI: 76; 203) decrease in mean central retinal thickness (P<0.01). On average, patients required 1.8 additional treatments. Five (20%) cases of intraocular pressure elevation were successfully treated with medications. Conclusions: Combination therapy with intravitreal bevacizumab and triamcinolone acetonide proved to be a safe and effective option for CNV unresponsive to anti-VEGF monotherapy. The combined treatment reversed the preoperative trend toward losing vision, and a significant anatomic improvement was seen by OCT. © Copyright 2013, Mary Ann Liebert, Inc. 2013.
Keywords: bevacizumab; triamcinolone acetonide; adult; aged; ambulatory care; article; central retinal thickness; clinical article; drug efficacy; drug safety; female; follow up; human; indocyanine green angiography; intraocular hypertension; male; monotherapy; off label drug use; optical coherence tomography; retina fluorescein angiography; age related macular degeneration; retreatment; subretinal neovascularization; treatment duration; visual acuity

Seeing you through London 2012: eye care at the Olympics. - D'Ath, P.J.; Thomson, W.D.; Wilson, C.M. (British journal of sports medicine, 2013)
Provision of eye care services for competitors and their support teams has become an integral part of the modern Olympic Games. To describe the organisation of the eye clinic at London 2012 over a 4-week period and provide outline audit data. The clinic employed multidisciplinary eye care professionals and utilised state-of-the-art instrumentation to provide the highest level of eye care. A total of 1406 patients from 154 countries attended the clinic over the Olympic Games, of which, 276 were competitors. All individuals received a comprehensive refractive and ocular health examination. Minor ocular injuries, glaucoma, diabetic retinopathy and macular degeneration were among the conditions detected and managed. Most patients attended the clinic to have their refractive status checked: 973 spectacles and 50 pairs of contact lenses were dispensed. It is hoped that this account of the provision of eye care at London 2012 will assist with the planning of this service at future events.
Keywords: adolescent; adult; aged; ambulatory care; article; athlete; female; history; human; male; middle aged; ophthalmology; outpatient department; patient attitude; spectacles; sport; sports medicine; statistics; United Kingdom; utilization review; vision test; visual disorder

Efficacy and tolerability between an olmesartan/amlodipine fixed-dose combination and an amlodipine double dose in mild to moderate hypertension - Lin, T.-H.; Tsai, C.-D.; Pan, J.-P.; Hou, C.J.-Y.; Hsia, C.-H.; Tsai, J.-P.; Lai, W.-T. (Kaohsiung Journal of Medical Sciences, 2013)
Fixed-dose combinations (FDCs) are one of the options for improving blood pressure (BP) goal attainment. We enrolled 141 patients and evaluated the efficacy and safety between a fixed dose of olmesartan/amlodipine (OA) and a double dose of amlodipine (DA) for treating mild to moderate hypertension after amlodipine monotherapy failure. After at least 2 weeks of monotherapy failure, the patients were randomized to receive either OA or DA for 8 weeks. We compared the systolic blood pressure (SBP)-lowering efficacy of the OA and DA using both an office BP and an ambulatory blood pressure monitoring (ABPM) device. The intent-to-treat analysis found that the early (2nd week) and final visit (8th week) SBP reductions were significantly greater in those patients receiving OA (n = 70) than DA (n = 71) (17.57 ± 15.49 vs. 10.46 ± 13.36 and 24.89 ± 14.09 vs. 17.03 ± 13.27 mmHg, p = 0.002 and 0.001, respectively). Among those using ABPM, the patients with 8-week OA had a greater SBP-lowering effect in comparison with those on DA (14.08 ± 10.74 vs. 6.32 ± 10.21, p = 0.018). Both treatment strategies were well tolerated. This study showed that an OA FDC is more effective than DA in reducing SBP for mild to moderate hypertension after the failure of amlodipine monotherapy.Copyright © 2012, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.
Keywords: amlodipine; amlodipine plus olmesartan; adult; aged; anemia; antihypertensive therapy; anxiety; arthralgia; article; blood pressure monitor; blood pressure monitoring; bronchitis; cataract; cellulitis; cholesteatoma; chondromalacia; comparative study; conjunctivitis; constipation; controlled study; contusion; dermatophytosis; diastolic blood pressure; disease severity; dizziness; drug efficacy; drug induced headache; drug safety; drug tolerability; lack of drug effect; dyspnea; edema; enteritis; female; gastroenteritis; glaucoma; gout; headache; heart palpitation; Helicobacter infection; human; hypertension; hyperthyroidism; hyperuricemia; hypokalemia; insomnia; intention to treat analysis; intervertebral disk disease; lacrimation; liver disease; major clinical study; male; monotherapy; multicenter study; musculoskeletal disease; musculoskeletal stiffness; nausea; neck pain; nocturia; open study; papular rash; patient compliance; periodontitis; peripheral edema; positional vertigo; prospective study; randomized controlled trial; reflux esophagitis; rhinopharyngitis; sialoadenitis; side effect; skin tumor; sleep disorder; systolic blood pressure; tendinitis; thorax pain; treatment duration; upper respiratory tract infection; urolithiasis; vertigo; visual field defect

Better value eye care for the 21st century: The population approach - Malik, A.N.J.; Cassels-Brown, A.; Wormald, R.; Gray, J.A.M. (British Journal of Ophthalmology, 2013)
Health services globally and in the UK face challenges from increasing need and rising expectations to inequalities and financial constraints. The UK government has recently published a Public Health Framework for the first time. This has included preventable sight loss as an outcome measure for the nation's public health reflecting increasing recognition of eye health issues in the broader public health agenda. This presents a real opportunity to improve eye care services at a population level. However, the chief executive of the National Health Service (NHS) has set his own challenge to the NHS to find $20 billion in efficiency savings in the next 3 years in order to maintain services within the available healthcare budget. We have reviewed national routine healthcare data in order to understand the current financial expenditure, activity and outcomes in ophthalmology. Our results have found a wide variation in expenditure in healthcare and activity across the country. We discuss a population based, value-orientated approach to dealing with healthcare issues which will provide a sustainable framework for the future.
Keywords: dorzolamide plus timolol; latanoprost; ranibizumab; article; clinical competence; cost benefit analysis; cost control; diabetic macular edema; drug cost; early diagnosis; evidence based medicine; eye care; eye disease; eye surgery; financial management; glaucoma; government; health care access; health care cost; health care delivery; health care disparity; health care financing; health care need; health care quality; health program; human; national health service; ophthalmology; outcome assessment; patient referral; patient safety; population research; priority journal; public health; quality adjusted life year; age related macular degeneration; social status; trend study; United Kingdom; cosopt; xalatan

The neuropathies of vasculitis - Collins, M.P.; Arnold, W.D.; Kissel, J.T. (Neurologic Clinics, 2013)
Vasculitic neuropathy can occur as an isolated entity (nonsystemic vasculitic neuropathy) but more commonly evolves in the setting of primary systemic vasculitides or secondary vasculitides related to infections, drugs, or connective tissue disorders. Vasculitic neuropathies are usually but not always painful and tend to produce sensory motor or sensory symptoms. Patients with purely motor or small-fiber dysfunction are unlikely to have vasculitis. Deficits are typically multifocal or asymmetric, but distal symmetric polyneuropathy occurs uncommonly. Evaluation requires laboratory tests, electrodiagnostic studies, and nerve or nerve/muscle biopsy. This article reviews classification, clinical presentation, diagnostic evaluation, and management of peripheral nerve vasculitis. © 2013 Elsevier Inc.
Keywords: azathioprine; C reactive protein; capsaicin; carbamazepine; cidofovir; corticosteroid; cyclophosphamide; foscarnet; gabapentin; ganciclovir; hepatitis B surface antigen; immunoglobulin; lidocaine; methotrexate; mycophenolate mofetil; neutrophil cytoplasmic antibody; prednisone; pregabalin; rituximab; serotonin noradrenalin reuptake inhibitor; tramadol; tricyclic antidepressant agent; valganciclovir; valproic acid; acne; action potential; analgesia; anterior horn cell; antigen antibody complex; antigen presenting cell; antiviral therapy; arthralgia; atherosclerosis; Behcet disease; blood vessel injury; bone density; cataract; CD4+ T lymphocyte; CD8+ T lymphocyte; Churg Strauss syndrome; Cogan syndrome; corticosteroid therapy; cranial neuropathy; cryoglobulinemia; dermatomyositis; disease activity; electrodiagnosis; electromyography; enteritis; eosinophilic granuloma; fatigue; fracture; giant cell arteritis; glaucoma; glomerulus basement membrane; granulomatosis; granulomatous vasculitis; helper cell; hepatitis B; hepatitis C; hirsutism; human; hyperglycemia; hypertension; hypokalemia; immune complex deposition; immunosuppressive treatment; immunotherapy; insomnia; intestine perforation; kidney failure; macrophage; maintenance therapy; microscopic polyangiitis; mixed connective tissue disease; mononeuropathy; monotherapy; muscle biopsy; myalgia; myelinated nerve; myopathy; nerve biopsy; nerve conduction; nerve potential; neuropathic pain; neuropathy; non insulin dependent diabetes mellitus; occupational therapy; osteoporosis; outcome assessment; pancreatitis; patient compliance; physiotherapy; plasmapheresis; polyarteritis nodosa; polyneuropathy; polyradiculoneuropathy; priority journal; protein cerebrospinal fluid level; randomized controlled trial (topic)

Adherence to therapy among diabetes patients in a Niger delta referral center - Suleiman, I.A.; Siasia, W.O.; Egbesu, I.E. (Value in Health, 2013)
OBJECTIVES: Information on adherence among diabetes patient is rare in Bayelsa State, Niger Delta. The objective of the study was to determine the rate of adherence to therapy among diabetes mellitus patients. METHODS: It was a cross sectional survey with the use of an interviewer-administered questionnaire. A 4-item Morisky self-reported adherence scale in addition to other self-developed, validated and pretested questionnaires were used. This was administered to 263 patients receiving treatment at the Outpatient Department of the hospital after seeking and obtaining their consent between June and August 2012 on clinic days. Questions related to demographics, medication history, adherence rate, etc., were included. In addition, the respective case notes (263) of the same set of patients were examined, and relevant data extracted (such as blood glucose level). Data was appropriately analysed using SPSS. Descriptive statistics were used in presentation of results. RESULTS: Majority of the 210 patients (80.0%) were taking both metformin and glibenclamide tablets. About 60 percent, 156 (59.3%), of patients were adjudged adherent with prescribed medications on the 4-item Morisky scale of adherence with a score of 1.22±0.2, which differs significantly from the non-adherent group with a score of 3.34±0.87. (p<0.0001). However, overall adherences to all aspects of diabetes management were poorer as only 80 (30.5%) had normal fasting blood glucose level of less than 6.1mmol/l after at least five visits to the hospital. Only 42 (16.0%) patients self monitor their glucose level. The most frequently reported factor affecting adherence is high cost of drug therapy, 118 (44.8%), and forgetfulness, 99 (37.6%). Most of the patients, 201 (76.4%), have developed one complication or the other such as hypertension and glaucoma. CONCLUSIONS: There is poor adherence to anti-diabetic therapy among the patients. Financial constraint was found to be the most important factor affecting optimal adherence to therapy.
Keywords: glucose; glibenclamide; metformin; patient compliance; diabetic patient; human; Niger; patient; drug therapy; hospital; diabetes mellitus; questionnaire; glucose blood level; diet restriction; statistics; tablet; therapy; glaucoma; hypertension; outpatient department

Persistence with glaucoma therapy in a lrage health organization in israel - Goldshtein, I.; Levkovitch-Verbin, H.; Shalev, V.; Zigman, N.; Chodick, G. (Value in Health, 2013)
OBJECTIVES: To investigate treatment patterns of glaucoma and persistence to therapy in a large health organization (HMO) in Israel. METHODS: A retrospective cohort study, conducted using the electronic medical databases of Maccabi Healthcare Services, a 2 million member HMO in Israel. The study population consisted of all patients who were newly diagnosed with glaucoma between 2003 and 2010 at MHS. Collected data included personal characteristics and demographics, relevant surgical procedures, prescribed and dispensed antiglaucoma medications, and caregiver characteristics. We investigated quality of care indices including routine ophthalmologist follow up, performance of tonometry tests, as well as persistence to treatment by drug type. Persistence was analyzed by proportion of days covered by drugs during follow up time, ignoring overlaps due to overuse and simultaneous combination of several types of eye drops. RESULTS: A total of 11,512 incident glaucoma patients, who were diagnosed between 2003 and 2010 were identified. One quarter of these patients remained naïve through the follow-up period, additional 20% were non-adherent with therapy (covered less than 20% of the follow up time), and only 13% exhibited high persistence (covered at least 80% of the follow-up period). The most common physician was ophthalmologist both at treatment initiation (70% of initial prescriptions were ophthalmologist vs. 7% by general practitioner) and ongoing prescriptions (48% ophthalmologist vs. 22% by general practitioner). CONCLUSIONS: The current study demonstrates the potential use of automated medical databases to characterize treatment patterns of glaucoma, illustrate the great variety of drug therapies, and describe adherence to treatment in the community. The increased comorbidity and mortality among these patients has important implication for health authorities for prevention and delivery of health-care services.
Keywords: eye drops; therapy; health care organization; Israel; glaucoma; human; follow up; patient; health service; data base; prescription; general practitioner; drug therapy; physician; tonometry; population; cohort analysis; health; mortality; caregiver; comorbidity; community; patient compliance; surgical technique; prevention; health care delivery; health maintenance organization

Nanoparticle diffusion in the bovine vitreous - Park, K. (Journal of Controlled Release, 2013)
Keywords: collagen fibril; drug carrier; hyaluronic acid; nanocarrier; nanoparticle; polyglactin; polystyrene; polyvinyl alcohol; vasculotropin inhibitor; adhesion; cow; diabetic macular edema; diabetic retinopathy; diffusion; drug delivery system; drug efficacy; drug transport; eye disease; flow kinetics; gene targeting; gene therapy; glaucoma; human; intraocular drug administration; liquefaction; motion; nonhuman; note; particle size; patient attitude; patient compliance; priority journal; retina; age related macular degeneration; viscosity; vitreous body

Review: Timing of office visits can be a powerful tool to improve adherence in the treatment of dermatologic conditions - Heaton, E.; Levender, M.M.; Feldman, S.R. (Journal of Dermatological Treatment, 2013)
Background: Poor adherence to treatment is a significant problem throughout medicine and particularly in the treatment of dermatologic conditions with topical medications, which present unique barriers to adherence. Purpose: We reviewed the literature to assess whether timing of office visits can be used to improve adherence. Methods: Studies examining adherence and office visits were identified using two search engines. PubMed was searched using the terms "medication adherence" OR "medication compliance" AND "visits." A Web of Science® cited reference search was performed to identify articles referencing the paper "On White-Coat Effects and the Electronic Monitoring of Compliance" by Alvan R. Feinstein, MD. Results: Fifteen studies were identified, three of which were on dermatologic conditions. Thirteen studies found a positive correlation between adherence and office visits. Three of these studies demonstrated increased adherence with increased visit frequency. One study reported adherence was unaffected by office visits. Limitations: Our review was limited in that none of the studies identified looked at the effect timing of office visits had on adherence in the long term. Conclusions: Strategic scheduling of office visits can be a valuable tool to improve adherence, particularly in the management of dermatologic conditions, and may help spare patients unnecessary exposure to more toxic systemic therapies. © 2013 Informa Healthcare USA on behalf of Informa UK Ltd.
Keywords: enalapril; isradipine; lopinavir plus ritonavir; pilocarpine; prednisone; triamcinolone; ambulatory care; article; atopic dermatitis; chronic obstructive lung disease; clinical trial (topic); correlation analysis; dermatitis; epilepsy; glaucoma; human; Human immunodeficiency virus infection; hypertension; Medline; patient compliance; priority journal; psoriasis; randomized controlled trial (topic); sickle cell anemia; skin disease

Racial differences in primary open-angle glaucoma: More than meets the eye - Racette, L.; Ozobu Jr, L. (Expert Review of Ophthalmology, 2013)
Keywords: biogeography; biomedicine; blindness; cell degeneration; cornea thickness; diet; eye blood flow; genetic code; genetic trait; geographic distribution; health care access; health care cost; health care delivery; health care planning; health care policy; health care practice; health disparity; health status; help seeking behavior; human; intraocular pressure; Black person; open angle glaucoma; optic disk; optic nerve disease; optic nerve fiber; perfusion pressure; population research; public health problem; race difference; retina ganglion cell; review; risk factor; social aspect; social status; United States; visual impairment

Strengthening institutional capacity for glaucoma care in Sub-Saharan Africa - Damji, K.F. (Middle East African Journal of Ophthalmology, 2013)
Keywords: Africa; cornea thickness; glaucoma; health care access; health care financing; health care management; health care policy; health care quality; human; information technology; intraocular pressure; knowledge; leadership; learning environment; medical education; medical information; medical research; priority journal; public health problem; public health service; review; risk factor

Teleglaucoma: Improving access and efficiency for glaucoma care - Kassam, F.; Yogesan, K.; Sogbesan, E.; Pasquale, L.R.; Damji, K.F. (Middle East African Journal of Ophthalmology, 2013)
Teleglaucoma is the application of telemedicine for glaucoma. We review and present the current literature on teleglaucoma; present our experience with teleglaucoma programs in Alberta, Canada and Western Australia; and discuss the challenges and opportunities in this emerging field. Teleglaucoma is a novel area that was first explored a little over a decade ago and early studies highlighted the technical challenges of delivering glaucoma care remotely. Advanced technologies have since emerged that show great promise in providing access to underserviced populations. Additionally, these technologies can improve the efficiency of healthcare systems burdened with an increasing number of patients with glaucoma, and a limited supply of ophthalmologists. Additional benefits of teleglaucoma systems include e-learning and e-research. Further work is needed to fully validate and study the cost and comparative effectiveness of this approach relative to traditional models of healthcare.
Keywords: comparative effectiveness; conference paper; geographic distribution; glaucoma; health care access; health care cost; health care delivery; health care practice; health care system; health program; human; information processing; learning; medical information; medical research; ophthalmology; priority journal; teleglaucoma; telemedicine; telemonitoring

Patterns of presentations at a free eye clinic in an urban state hospital - Hassan, M.B.; Olowookere, S.A.; Adeleke, N.A.; Akinleye, C.A.; Adepoju, E.G. (Nigerian Journal of Clinical Practice, 2013)
Background: Provision of affordable eye care is one of the cardinal programs of the Osun State Government of Nigeria. Objective: The objective of this study was to assess the pattern of eye diseases presenting in a secondary health care facility based at Osogbo the State Capital. Materials and Methods: We reviewed the hospital records of all patients that were cared for at the eye clinic of the State Hospital, Osogbo, Osun State, Nigeria from January 2009 to December 2010. Results: A total of 1018 patients were attended to at the eye clinic during the period of review. Mean age of these patients was 49.4 ± 23.2 years. There were 408 (40.1%) males and 610 (59.9%) females with a female-male ratio of 1.5 : 1. Most of them were traders (28.1%) and married (32.1%). Vernal conjunctivitis (21.1%), cataract (14%), glaucoma (11.1%), and refractive errors (20.7%) were the main eye diagnoses. Conclusion: Preventable causes of blindness were quite common among the patients. There is a need for community education to reduce the prevalence of these diseases in the general population.
Keywords: adolescent; adult; aged; ambulatory care; article; eye disease; female; health care planning; health service; hospital; human; male; middle aged; Nigeria; statistics; utilization review

Management of asthma in school age children on therapy (MASCOT): A randomised, double-blind, placebocontrolled, parallel study of efficacy and safety - Lenney, W.; McKay, A.J.; Tudur Smith, C.; Williamson, P.R.; James, M.; Price, D. (Health Technology Assessment, 2013)
Background: Asthma affects one in eight children in the UK. National management guidelines have been available for many years but, unlike in adults, studies in children have been few, with their methodologies often based on inappropriate adult models. Sound medical evidence in support of the national guidelines for asthma management in children is lacking. The MASCOT study has been developed to address this need. Objectives: To determine whether adding salmeterol or montelukast to low-dose inhaled corticosteroids (ICSs) can reduce the number of exacerbations requiring treatment with oral corticosteroids in children with uncontrolled asthma. Design: A randomised, double-blind, placebo-controlled trial with a 4-week run-in period on a fluticasone propionate inhaler (100 μg twice daily) with inhaler technique correction. Patients who met the post run-in period eligibility criteria were randomised in the ratio of 1: 1: 1 and were followed for 48 weeks. Setting: Secondary care hospitals based in England and Scotland with recruitment from primary and secondary care. Participants: Children aged 6-14 years with asthma requiring frequent short-acting beta-2 agonist relief, with symptoms of asthma resulting in nocturnal wakening and/or asthma that has interfered with usual activities. Interventions: Three groups were compared: (1) inhaled fluticasone propionate 100 μg twice daily plus placebo tablet once daily; (2) inhaled fluticasone propionate 100 μg and salmeterol 50 μg twice daily (combination inhaler) plus placebo tablet once daily; and (3) inhaled fluticasone propionate 100 μg twice daily plus montelukast 5-mg tablet once daily. Main outcome measures: The primary outcome was the number of exacerbations requiring treatment with oral corticosteroids over 48 weeks. Secondary outcome measures included quality of life as measured by the Paediatric Asthma Quality of Life Questionnaire with Standardised Activities [PAQLQ(S)] and the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ); time from randomisation to first exacerbation requiring treatment with a short course of oral corticosteroids; school attendance; hospital admissions; amount of rescue beta-2 agonist therapy prescribed; time from randomisation to treatment withdrawal (because of lack of efficacy or side effects); lung function at 48 weeks (as assessed by spirometry); cost-effectiveness; adverse events. Results: The study was closed prematurely because of poor recruitment and the target sample size of 450 was not achieved. In total, 898 children were screened to enter the trial, 166 were registered for the 4-week run-in period and 63 were randomised (group 1: 19, group 2: 23, group 3: 21), with 38 contributing data for the primary outcome analysis. There were no significant differences between groups for any of the outcomes. Adverse events were similar between the groups except for nervous system disorders, which were more frequently reported on fluticasone plus montelukast. Conclusions: Based on the results of the MASCOT study it is not possible to conclude whether adding salmeterol or montelukast to ICSs can reduce the number of exacerbations requiring treatment with oral corticosteroids in children with uncontrolled asthma. © Queen's Printer and Controller of HMSO 2013.
Keywords: ISRCTN03556343; beta 2 adrenergic receptor stimulating agent; corticosteroid; fluticasone propionate; montelukast; placebo; salbutamol; salmeterol xinafoate; abdominal pain; adrenal suppression; aggression; agitation; alanine aminotransferase blood level; anaphylaxis; anaphylaxis; angioneurotic edema; anxiety disorder; arousal; arthralgia; article; aspartate aminotransferase blood level; asthenia; asthma; behavior change; bone density; breast disease; bronchitis; bronchospasm; cataract; cholestatic hepatitis; connective tissue disease; contusion; cost effectiveness analysis; Cushing syndrome; Cushingoid syndrome; depression; diarrhea; dizziness; drowsiness; drug cost; drug efficacy; drug eruption; drug hypersensitivity; drug induced headache; drug safety; drug withdrawal; dyspepsia; dysphonia; dyspnea; ear disease; edema; erythema nodosum; eye disease; fatigue; follow up; fracture; gastrointestinal disease; glaucoma; growth retardation; hallucination; health care cost; heart arrhythmia; atrial fibrillation; heart palpitation; heart ventricle extrasystole; hoarseness; hospital admission; hospital care; human; hyperglycemia; hypesthesia; hypokalemia; immunopathology; infection; infestation; inner ear disease; insomnia; irritability; lung function test; malaise; mediastinum disease; mental disease; multicenter study (topic); muscle cramp; musculoskeletal disease; myalgia; nausea; neurologic disease; nightmare; Paediatric Asthma Caregivers Quality of Life Questionnaire; Paediatric Asthma Quality of Life Questionnaire with Standardised Activities; parallel design; paresthesia; patient compliance; pharyngitis; pneumonia; primary medical care; pruritus; quality of life; questionnaire

Hybrid dendrimer hydrogel/poly(lactic-Co-glycolic acid) nanoparticle platform: An advanced vehicle for topical delivery of antiglaucoma drugs and a likely solution to improving compliance and adherence in glaucoma management - Yang, H.; Leffler, C.T. (Journal of Ocular Pharmacology and Therapeutics, 2013)
Glaucoma therapy typically begins with topical medications, of which there are 4 major classes in common use in the United States: beta-Adrenergic antagonists, alpha-Agonists, carbonic anhydrase inhibitors, and prostaglandin analogs. Unfortunately, all 4 classes require at least daily dosing, and 3 of the 4 classes are approved to be administered 2 or 3 times daily. This need for frequent dosing with multiple medications makes compliance difficult. Longer-Acting formulations and combinations that require less frequent administration might improve compliance and therefore medication effectiveness. Recently, we developed an ocular drug delivery system, a hybrid dendrimer hydrogel/poly(lactic-co-glycolic acid) nanoparticle platform for delivering glaucoma therapeutics topically. This platform is designed to deliver glaucoma drugs to the eye efficiently and release the drug in a slow fashion. Furthermore, this delivery platform is designed to be compatible with many of the glaucoma drugs that are currently approved for use. In this article, we review this new delivery system with in-depth discussion of its structural features, properties, and preclinical application in glaucoma treatment. In addition, future directions and translational efforts for marketing this technology are elaborated. © 2013, Mary Ann Liebert, Inc.
Keywords: brimonidine; dendrimer; drug vehicle; hybrid dendrimer hydrogel/poly(lactic co glycolic acid) nanoparticle platform; macrogol; nanoparticle; polyamidoamine; polyglactin; timolol; unclassified drug; cross linking; drug delivery system; drug release; drug solution; glaucoma; human; hydrogel; patient compliance; review

Anterior eye segment drug delivery systems: Current treatments and future challenges - Molokhia, S.A.; Thomas, S.C.; Garff, K.J.; Mandell, K.J.; Wirostko, B.M. (Journal of Ocular Pharmacology and Therapeutics, 2013)
New technologies for delivery of drugs, such as small molecules and biologics, are of growing interest among clinical and pharmaceutical researchers for use in treating anterior segment eye disease. The challenge is to deliver effective drugs at therapeutic concentrations to the targeted ocular tissue with minimal side effects. To achieve this, a better understanding of the unmet needs, what is required of the various methods of delivery to achieve successful delivery, and the potential challenges of anterior segment drug delivery is necessary and the primarily aim of this review. This review covers the various physiological and anatomical barriers that exist for effective delivery to the targeted tissue of the eye, the pathological conditions of the anterior segment, and the unmet needs for treatment of these ocular diseases. Second, it reviews the novel delivery technologies that have the potential to maintain and/or improve the drug's therapeutic index and improving both patient adherence for chronic therapy and potential patient outcomes. This review bridges the pharmaceutical and clinical research/challenges and provides a detailed overview of anterior segment drug delivery accomplishments thus far, for researchers and clinicians. © 2013, Mary Ann Liebert, Inc.
Keywords: NCT01180062; aciont; agents acting on the eye; amino acid; antihistaminic agent; artificial tear; beta adrenergic receptor blocking agent; bevacizumab; cation; corticosteroid; cyclosporine; dexamethasone; egp 437; eye drops; fluorescein isothiocyanate dextran; ketotifen fumarate; lacisert; latanoprost; macrogol; ABC transporter subfamily B; nonsteroid antiinflammatory agent; nucleoside; pilocarpine; poly(methyl methacrylate); prostaglandin derivative; steroid; toddd; unclassified drug; vasoconstrictor agent; zonula occludens protein; allergic conjunctivitis; amnion; anterior eye segment; blurred vision; bradycardia; cataract; cataract extraction; cell membrane; clinical trial (topic); conjunctiva; conjunctival hyperemia; contact lens; drug bioavailability; drug delivery system; drug formulation; dry eye; eye disease; eye inflammation; eye irritation; eyelid edema; foreign body reaction; gap junction; gel; glaucoma; human; hyperemia; hypersensitivity; hypertension; in vitro study; in vivo study; intraocular pressure abnormality; iontophoresis; iritis; lipophilicity; liquid; medical device; microelectromechanical system; nonhuman; ointment; patient compliance; photophobia; postoperative inflammation; punctal plug; Leporidae; rectouterine pouch; review; silicone prosthesis; suspension; trabecular meshwork; aciont; egp 437; toddd; Cylindrical Smartplug; Eyegate; LX201

[Glaucoma dynamics in patients who followed monitoring and treatment instructions and in those who didn't]. - Kunin, V.D.; Redid, A.A. (Vestnik oftalmologii, 2013)
Clinical course of different stages of primary open-angle glaucoma (POAG) is studied in 216 patients (432 eyes) who followed monitoring and treatment instructions during 13 years and in those who didn't. In patients who did not follow recommendations glaucoma progression was found in 99,4% of patients with initial disease, in 48,7% of cases with advanced stage and in 50% of patients with the end stage of the disease. Patients who followed recommendations of general ophthalmologists and glaucomatologists showed stable course of glaucoma process in 1 patient (0,6%) with initial stage, in 51,3% of patients with advanced stage and in 50% of patients with the end stage of the disease.
Keywords: antihypertensive agent; article; attitude to health; disease course; drug effect; female; health care; human; intraocular pressure; male; methodology; middle aged; open angle glaucoma; organization and management; outcome assessment; pathophysiology; patient compliance; physiologic monitoring; psychological aspect; risk factor; statistics; visual system examination

Patient acceptance and attitude toward an alternative method of subconjunctival injection for the medical treatment of glaucoma - Chong, R.S.; Su, D.H.W.; Tsai, A.; Jiang, Y.; Htoon, H.M.; Lamoureux, E.L.; Aung, T.; Wong, T.T. (Journal of Glaucoma, 2013)
PURPOSE:: Nonadherence to glaucoma medications may be a major cause of treatment failure. We examined the acceptance of glaucoma patients toward a possible new route of administering glaucoma medication by subconjunctival injection. PATIENTS AND METHODS:: Patients were recruited from specialist glaucoma clinics on a voluntary basis. Trained interviewers administered a 30-item questionnaire and an information sheet with details of an alternative subconjunctival injection route involving injections at 3-month intervals. Outcome measures regarding acceptance of the new procedure, social situational factors, disease factors, and treatment factors were assessed. RESULTS:: A total of 151 patients participated in this study. Of the 151 patients 112 (74.2%) were willing to have their glaucoma medication given by the new method of subconjunctival injection, 101 of 112 (90.2%) were willing to accept it at the same cost as their present medication, and 87 of 101 (86.1%) were willing to accept it even at a higher cost. These patients tended to be on a greater number of medications (P=0.006), and medicating more frequently in a day (P=0.003). Nine of 10 (90%) patients who were admitted to nonadherence were willing to accept subconjunctival injections at 3-month intervals in place of their topical medication. CONCLUSIONS:: Our study found that 74% of glaucoma patients were willing to accept an alternative form of glaucoma treatment through 3-monthly subconjunctival injections. A large proportion of patients who were admitted to nonadherence to topical medication were willing to consider this alternative method of medication. Our findings are helpful when developing patient-acceptable drug-delivery regimes, which may alleviate the need for daily medication. Copyright © 2013 by Lippincott Williams & Wilkins.
Keywords: antiglaucoma agent; aged; article; controlled study; cost; female; glaucoma; human; interview; major clinical study; male; patient attitude; patient compliance; priority journal; questionnaire; treatment outcome

Health literacy and glaucoma - Muira, K.W.; Christensenc, L.; Bosworth, H.B. (Current Opinion in Ophthalmology, 2013)
Patients with chronic eye diseases such as glaucoma and limited health literacy skills are vulnerable to poor visual outcomes. Attention to health literacy may improve the care and outcomes of these patients. © 2013 Wolters Kluwer Health.
Keywords: diabetic patient; functional status; glaucoma; glycemic control; health literacy; human; mental health; National Eye Institute Visual Function Questionnaire; patient care; patient compliance; priority journal; review; self care; social status; verbal communication; visual impairment; word recognition

Nanotechnology and glaucoma: Little particles for a big disease - Pita-Thomas, D.W.; Goldberg, J.L. (Current Opinion in Ophthalmology, 2013)
We review the recent advances in nanoparticle-based glaucoma therapy with a focus on drug delivery to the eye, as well as novel applications including gene therapy. © 2013 Wolters Kluwer Health.
Keywords: alginic acid; alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; chitosan; eye drops; gold nanoparticle; heat shock protein; microsphere; nanoparticle; anterior eye segment; aqueous humor; bronchospasm; central corneal thickness; clinical trial (topic); cornea epithelium; disease course; drug bioavailability; drug half life; endocytosis; epithelium; fatigue; gene mutation; gene therapy; glaucoma; human; hypotension; intraocular pressure; nanotechnology; nerve fiber degeneration; optic nerve; patient compliance; pigment epithelium; posterior eye segment; priority journal; retina ganglion cell; retina ischemia; review; subretinal neovascularization; tight junction; viral gene delivery system; visual impairment; xerostomia

Effect of beclomethasone nasal spray on intraocular pressure in ocular hypertension or controlled glaucoma - Yuen, D.; Buys, Y.M.; Jin, Y.-P.; Alasbali, T.; Trope, G.E. (Journal of Glaucoma, 2013)
Purpose: To evaluate the effect of 6 weeks administration of beclomethasone nasal spray on intraocular pressure (IOP) in patients with ocular hypertension or controlled primary open-angle glaucoma. Patients and Methods: Randomized double-masked controlled trial. Patients were randomized to twice daily beclomethasone versus placebo saline nasal spray. There were a total of 4 study visits: baseline and weeks 2, 4, 6 after starting the spray. Each study visit was at the same time within a 1-hour time window. Primary outcome measure was IOP. Secondary measures included visual acuity, anterior segment changes, patient reported side effects, and compliance. Study endpoint was 6 weeks from the start of treatment or an IOP increase of >20% from baseline. A sample size calculation suggested that 8 patients in each arm would be sufficient to detect a difference of 3.2mm Hg with a power of 80%. Results: Nineteen consecutive consenting patients completed the study - 9 in the steroid arm and 10 in the placebo arm. There were no statistically significant differences between groups in baseline characteristics, IOP at each study visit, or change in IOP from baseline at any time point. At 6 weeks, the change in mean IOP from baseline was +0.50±1.52 versus +0.70±1.44 mm Hg in the steroid and saline nasal spray groups, respectively (P=0.77). Conclusions: Patients with ocular hypertension and primary openangle glaucoma showed no evidence of IOP elevation after 6 weeks use of beclomethasone nasal spray. Copyright © 2013 by Lippincott Williams & Wilkins.
Keywords: NCT00775489; beclometasone; placebo; sodium chloride; adult; anterior eye segment; article; clinical article; controlled study; double blind procedure; drug effect; female; human; intraocular hypertension; intraocular pressure; male; open angle glaucoma; patient compliance; priority journal; randomized controlled trial; treatment outcome; visual acuity

Editorial: Special issue on health informatics and personalized medicine - Poon, C.C.Y.; Wang, M.D.; Bonato, P.; Fenstermacher, D.A. (IEEE Transactions on Biomedical Engineering, 2013)
The increasingly aging population, prevalence of chronic diseases and rising costs have brought about some unique healthcare challenges to our global society. In response to these unmet healthcare needs, researchers are actively seeking for innovative solutions that target for 1) prevention of diseases and 2) personalized diagnosis and treatment. It is envisaged that by taking preventive measures for health monitoring and diagnosing and treating patients with a personalized approach at an early stage of disease development, healthcarewill be more cost effective and sustainable. Engineers, computer scientists, as well as information and communication technologists all have their respective unique roles in this future health model. The authors provide an overview of the advancements in information and communication technologies (ICT), and explain how some innovative health solutions can now be delivered to individuals at a relatively low cost. © 2012 IEEE.
Keywords: ambulatory monitoring; Bayesian learning; biomedical engineering; cardiovascular disease; cost effectiveness analysis; decision making; disease course; early diagnosis; electrocardiogram; electroencephalogram; electronic medical record; feedback system; glaucoma; health care cost; health care need; health care planning; health status; atrial fibrillation; human; intraocular pressure; medical informatics; medical technology; P wave; personalized medicine; photoelectric plethysmography; preoperative care; prevalence; R wave; review; robotics; T wave; virtual reality

Adding to complexity: Comorbidity in paediatric rheumatic disease - Smith, E.M.D.; Foster, H.E.; Beresford, M.W. (Rheumatology (United Kingdom), 2013)
Novel therapies including biologic agents offer paediatric rheumatologists significant opportunity to improve long-term prognosis for children with rheumatic disease. However, comorbidities related to the diseases themselves and their treatments pose specific challenges to be overcome. Prompt recognition and appropriate management will improve quality of life, effectiveness of treatment and overall prognosis. In this review, we discuss key areas of comorbidity frequently encountered in paediatric rheumatology including cardiovascular, renal, genito-urinary and visual comorbidity, bone health, drug-related issues and the influence of rheumatic disease on growth and puberty. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
Keywords: apolipoprotein B; atorvastatin; B cell activating factor; bisphosphonic acid derivative; calcitonin; calcium; cholesterol; corticosteroid; CXCL13 chemokine; etanercept; glucocorticoid; hydroxymethylglutaryl coenzyme A reductase inhibitor; methotrexate; monocyte chemotactic protein 1; orosomucoid; placebo; RANTES; vascular cell adhesion molecule 1; vitamin D; antigen antibody complex; arterial wall thickness; arthritis; atherosclerosis; atherosclerotic plaque; autoimmune hepatitis; bone; bone density; bone mass; bone mineral; bone turnover; capillaroscopy; cataract; childhood disease; common variable immunodeficiency; comorbidity; complement activation; diet supplementation; disease course; disease duration; drug megadose; endothelial dysfunction; fracture; glaucoma; Graves disease; growth; growth disorder; growth rate; growth retardation; human; hyperlipidemia; hypertension; immobilization; impaired glucose tolerance; inflammation; insulin dependent diabetes mellitus; life expectancy; mortality; mouth pain; nausea and vomiting; ossification; osteopenia; osteoporosis; patient compliance; priority journal; puberty; quality of life; review; rheumatic disease; rheumatology; standardized mortality ratio; stomach pain; sunlight; uveitis; visual acuity; vitamin supplementation

Medical record validation of self-reported eye diseases and eye care utilization among older adults - Maclennan, P.A.; Mcgwin Jr., G.; Searcey, K.; Owsley, C. (Current Eye Research, 2013)
Purpose: Vision impairment is an important public health concern. Accurate information regarding visual health and eye care utilization is essential to monitor trends and inform health policy interventions aimed at addressing at-need populations. National surveys provide annual prevalence estimates but rely on self-report. The validity of self-reported information regarding eye disease has not been adequately explored. Methods: This cross-sectional study compared self-report of eye care utilization and eye disease with information obtained from medical records. The study population was 2001 adults aged 70 years and older who completed the Behavioral Risk Factor Surveillance System's Visual Impairment and Access to Eye Care Module. Cohen's kappa (κ) was used to assess agreement. Results: Agreement between self-report and medical records was substantial for eye care utilization (κ = 0.64) and glaucoma (κ = 0.73), moderate for macular degeneration (κ = 0.40) and diabetic retinopathy (κ = 0.47) and slight for cataracts (κ = 0.18). Self-report tended to overestimate the number of subjects who visited an eye care provider in the previous year, and underestimated the prevalence in all but one (glaucoma) of the four eye diseases evaluated. Conclusions: Though agreement was substantial for self-report of eye care utilization, results of the current study suggest that national estimates based on self-report overestimate eye care utilization. © 2013 Informa Healthcare USA, Inc.
Keywords: aged; article; behavioral risk factor surveillance system; cataract; cross-sectional study; diabetic retinopathy; eye care; eye disease; female; glaucoma; health care utilization; human; major clinical study; male; medical information; medical record; priority journal; macular degeneration; self report; validity; visual impairment

Peep into policy, politics, parliament - Ratnarajan, G.; Wormald, R. (Perspectives in Public Health, 2013)
Keywords: blindness; cataract; decision making; electronic medical record; expectation; glaucoma; health care access; health care cost; health care personnel; health care policy; health service; human; national health service; note; ophthalmology; optometry; patient transport; politics; prevalence; primary medical care; professional practice; refraction error

Noncompliance with glaucoma medication in Korean patients: A multicenter qualitative study - Park, M.H.; Kang, K.-D.; Moon, J. (Japanese Journal of Ophthalmology, 2013)
Purpose: To investigate the common side effects of topical antiglaucoma medication, factors affecting compliance, and the utilization of herbal medicine for glaucoma treatment in South Korea. Patients and methods: A cross-sectional multicenter hospital-based study. In-depth interviews using a structured questionnaire were conducted with 581 individuals diagnosed with glaucoma. Additional eligibility requirements were: all participants were diagnosed with glaucoma in one or both eyes and prescribed eye drops at least one month before the start of the study, and were in a suitable condition for an interview. The frequency of response for each category in the interview questionnaire was analyzed. Results: Conjunctival injection, a stinging sensation, and blurred vision were the most frequently reported side effects, among which blurred vision was the most unbearable. Patient knowledge of glaucoma was the only factor associated with the patient's self-evaluation of compliance. Forgetfulness was the most common reason for nonadherence. Only 2.9 % of patients were taking herbal medicine. Conclusions: Physicians should address a patient's complaint of blurred vision resulting from medication. Complete initial explanation of the consequences of nonadherence and of the potential vision loss from glaucoma are critical elements in improving patient adherence in Asian populations. © 2012 Japanese Ophthalmological Society.
Keywords: antiglaucoma agent; ginseng extract; herbaceous agent; abnormal sensation; adult; article; blurred vision; conjunctiva disease; conjunctival drug administration; conjunctival drug administration; cross-sectional study; drug cost; drug induced disease; drug induced headache; drug self administration; drug utilization; dyspnea; ethnic group; eye disease; eyelash overgrowth; eyelash overgrowth; eyelid skin darkening; eyelid skin darkening; eyewax; eyewax; female; glaucoma; heart palpitation; herbal medicine; human; injection site stinging; interview; itchy sensation; itchy sensation; Korean; major clinical study; male; multicenter study; patient attitude; patient compliance; prescription; priority journal; self evaluation; side effect; skin manifestation; social status; South Korea; structured questionnaire; taste; work schedule

Adherence to ocular hypotensive therapy: Patient health education needs and views on group education - Waterman, H.; Brunton, L.; Fenerty, C.; Mottershead, J.; Richardson, C.; Spencer, F. (Patient Preference and Adherence, 2013)
Background: In this study the authors sought both to understand the health education needs of patients with glaucoma, with particular regard to adherence to glaucoma treatment, and to examine these patients' views of group education. Methods: Using a health promotion approach to health education, 27 qualitative interviews with new and established patients receiving glaucoma treatment were conducted. Health promotion is defined as a way of strengthening people's capacities to control and optimize their own health. The interviews were transcribed and were then analyzed thematically. Results: Nine categories of health education needs were identified from the transcripts: (1) to understand glaucoma; (2) to understand their diagnosis or understand the difficulties in giving a diagnosis; (3) to understand the implications of eye drops, their side effects, and how to renew the eye drops; (4) to feel confident to put in eye drops; (5) to put the condition into perspective - to know how to manage their risk; (6) to be able to ask questions of clinicians; (7) to be able to navigate the health care system; (8) to understand and be able to manage own adherence behavior; and (9) to know where to access other sources of information. The majority of patients had something positive to say about group education, and about half of the patients said they would attend group education if they were offered the opportunity. Conclusion: A health promotion approach identified a wide range of patient-centered health education needs regarding adherence to glaucoma treatment. Group education will be attractive to some patients. Clinicians could use the health education needs identified in this study to guide the development of either individual or group-based educational intervention to improve adherence to glaucoma treatment. However, clinicians need to be aware that when developing a group intervention, attention will need to be given to making the education relevant to the circumstances of each patient. © 2013 Waterman et al, publisher and licensee Dove Medical Press Ltd.
Keywords: eye drops; adult; aged; article; clinical article; education; eye redness; female; glaucoma; group education; health care system; health promotion; human; interview; male; medical information; patient attitude; patient compliance; patient education; risk management; thematic analysis

Patient satisfaction: The name of the game? - White, A.; Goldberg, I. (Clinical and Experimental Ophthalmology, 2013)
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; eye drops; prostaglandin derivative; awareness; drug information; drug labeling; drug tolerability; editorial; glaucoma; human; monotherapy; patient compliance; patient education; patient participation; patient preference; patient satisfaction; quality of life; questionnaire; rating scale; Treatment Impact Patient Satisfaction Scale; treatment outcome; unspecified side effect; vision

Improving compliance with eye drop medications. - Pastor, S.; Harbin, T. (Missouri medicine, 2013)
Keywords: eye drops; article; glaucoma; human; devices; mobile phone; patient compliance; reminder system

Patterns of adherence behaviour for patients with glaucoma - Cate, H.; Bhattacharya, D.; Clark, A.; Holland, R.; Broadway, D.C. (Eye (Basingstoke), 2013)
Aims and purposeAdherence to long-term treatment regimens for primary open-angle glaucoma holds a challenge for both clinicians and patients. The study aims were to (i) establish the magnitude of travoprost non-adherence using an Electronic Adherence Monitor (EAM), (ii) compare electronic with patient self-reported adherence, and (iii) explore the application of a previously reported method of graphically presenting adherence data to a larger cohort over a longer monitoring period.MethodsA cohort study of patients using travoprost for glaucoma or ocular hypertension was conducted. All participants used an EAM and adherence data were collected prospectively for 2 months. Self-reported adherence was obtained using the Morisky Medication Adherence Scale (MMAS); patients also reported frequency of missed doses. Potential predictors of adherence were collected via a structured interview. EAM-recorded interdose intervals were plotted graphically.ResultsOf 100 patients invited to participate, 98 consented and EAM data were collected successfully from 88 participants. The median EAM adherence score for the cohort was 88.9% (interquartile range: 71.2, 92.2). When dichotomised (≥80%: adherent; <80%: non-adherent), EAM identified 36.7% as non-adherent and MMAS 12.2%. EAM data were used to classify five types of adherence behaviour including a category representing levels of ≥97% maintained by 21% of participants.ConclusionEAM revealed good adherence to glaucoma monotherapy but poor agreement with patient self-reported adherence. An adherence category of persistent and exceptionally high adherence to travoprost over a 2-month period was identified. © 2013 Macmillan Publishers Limited All rights reserved 0950-222X/13.
Keywords: travoprost; adult; aged; article; female; follow up; human; major clinical study; male; open angle glaucoma; patient compliance; patient monitoring; prospective study; self report; structured interview; treatment outcome

Comparison of resource utilization in the treatment of open-angle glaucoma between two cities in Finland: Is more better? - Hagman, J. (Acta Ophthalmologica, 2013)
Introduction: Glaucoma is a progressive optic neuropathy associated with neural rim loss of the optic disc and the retinal nerve fibre layer typically causing visual field (VF) deterioration. Generally, glaucomatous lesions in the eye and in the visual field progress slowly over the years. In population-based cross-sectional studies, the percentage of unilateral or bilateral visual impairment varied between 3-12%. In screening studies, 0.03-2.4% of patients have been found to suffer visual impairment. Glaucoma has previously been associated with substantial healthcare costs and resource consumption attributable to the treatment of the disease. The disease also causes reduction in health-related quality of life (HRQoL) in patients with glaucoma. Objective and Methods: This study compares patients with diagnosed open-angle glaucoma from two geographically different regions in Finland. A total of 168 patients were examined, 85 subjects from an area with higher per patient treatment costs (Oulu) and 83 patients from a region with lower per patient treatment costs (Turku). All patients had a history of continuous glaucoma medication use for a period of 11 years. For each patient, the total direct costs from glaucoma treatment were calculated and the total amount of resource consumption was determined from registries and patient records. Each patient underwent a clinical examination with visual field assessment and fundus photography. These data were used to determine the current stage of disease for each patient. Health-related quality of life questionnaire (15D) was used in determining each patient's subjective HRQoL score. Results: When applying the current diagnostic criteria for open-angle glaucoma, a total of 40% of patients did not to display any structural or functional damage suggesting glaucoma after 11 years of continuous medical treatment and follow-up. Patients with higher glaucoma stage (worse disease) were found to have statistically higher treatment costs compared with those at lower disease stages. Resource consumption was also greater in the patients in higher glaucoma stage. Patients in the Oulu district consumed more resources, and glaucoma treatment was more expensive than in the Turku area. The total treatment cost in Oulu and Turku was 6010 € and 4452 €, respectively, for the whole 11-year period. There was no statistically significant difference in quality-of-life scores between the two areas. No difference was noted between the higher-spending and lower-spending areas in this respect. However, when the population was analysed as a whole, patients with higher glaucoma stage were found to have lower vision-based 15D scores compared with those at lower disease stages. This observation was made also at both districts independently. Conclusions: Major cost source in open-angle glaucoma treatment is medication, up to 74% of annual costs. In addition, it seems that higher resource consumption and higher treatment costs do not increase the patients' HRQoL as assessed by the 15D instrument. © 2013 Acta Ophthalmologica Scandinavica Foundation.
Keywords: antiglaucoma agent; adult; aged; article; central corneal thickness; controlled study; disease severity; drug cost; evidence based medicine; eye photography; female; Finland; follow up; glaucoma staging system; health care cost; health care utilization; human; intraocular pressure; major clinical study; male; open angle glaucoma; perimetry; priority journal; quality of life; resource allocation; sclerectomy; scoring system; trabeculectomy; visual acuity

Vogt-Koyanagi-Harada disease in first nations and metis of northern Alberta - Ehmann, D.; Tennant, M.T.S.; Somani, R.; Rudnisky, C.J. (Canadian Journal of Ophthalmology, 2013)
Objective: The objective of this article was to describe the incidence, clinical characteristics, and visual outcomes of Vogt- Koyanagi-Harada disease in First Nations and Metis individuals. Design: A retrospective chart review. Participants: Nineteen First Nation and Metis Canadian residents in Northern Alberta. Methods: Electronic records for a 17-year period (1994-2010) were reviewed. Charts were reviewed for age, sex, length of followup, location of primary residence, diagnostic criteria at presentation, disease stage at presentation, duration of symptoms before presentation, ocular and extraocular manifestations at presentation, treatments, compliance, and complications. The time to an eye reaching 20/40, 20/200, and a halving of the baseline visual angle was plotted using Kaplan-Meier methodology. Results: Of 19 First Nations and Metis individuals identified, 84.2% were female, and the average age at presentation was 30.8 years. The most common presenting symptom and sign were blurred vision (89.5%) and anterior segment inflammation (89.5%), respectively. Fifteen (78.9%) patients had extraocular manifestations, the most common being alopecia (26.3%) and cerebrospinal fluid pleocytosis (26.3%). All patients were initially treated with corticosteroids; immunomodulatory therapy was used for 2 (10.5%) patients. Twelve (63.2%) patients experienced ocular complications; 47.4% of patients had difficulty with treatment compliance and attending follow-up appointments. The median time to achieve 20/40 vision was shorter for compliant patients compared with noncompliant patients (P = 0.048). Conclusions: The features of Vogt-Koyanagi-Harada disease in First Nations and Metis Canadians are most similar to series of South Asian and Hispanic patients. Compliant patients were found to achieve 20/40 vision significantly sooner than noncompliant patients. © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Keywords: brimonidine; corticosteroid; cyclosporine; dorzolamide; dorzolamide plus timolol; latanoprost; methotrexate; timolol; adult; alopecia; anterior eye segment; article; blurred vision; cataract; cerebrospinal fluid; child; clinical article; disease duration; epiretinal membrane; female; follow up; gastrointestinal hemorrhage; glaucoma; headache; human; immunosuppressive treatment; incidence; inflammation; keratopathy; lumbar puncture; male; medical record review; meningism; patient compliance; pleocytosis; retina macula cystoid edema; subretinal neovascularization; suicidal ideation; tinnitus; vision; visual acuity; vitiligo; Vogt Koyanagi syndrome

Are generic topical prostanoids the way forward in the care of glaucoma patients? - Yes - Titcomb, L.C. (Eye (Basingstoke), 2013)
Keywords: bimatoprost; generic drug; latanoprost; tafluprost; travoprost; cost control; drug bioavailability; drug cost; drug efficacy; drug packaging; drug safety; drug substitution; glaucoma; human; intraocular pressure; medication compliance; multiple drug dose; note; ophthalmologist; patient care; patient compliance; personal experience; prescription; primary medical care; United Kingdom; xalatan

Are generic topical prostanoids the way forward in the care of glaucoma patients? - No - Dubois, V.D.J.-P. (Eye (Basingstoke), 2013)
Keywords: eye drops; latanoprost; timolol; general practitioner; glaucoma; health care cost; human; medication compliance; note; outpatient care; patient care; patient compliance; pharmacist; prescription; tonometry; unspecified side effect; xalatan

A study to assess the feasibility of undertaking a randomized controlled trial of adherence with eye drops in glaucoma patients - Richardson, C.; Brunton, L.; Olleveant, N.; Henson, D.B.; Pilling, M.; Mottershead, J.; Fenerty, C.H.; Spencer, A.F.; Waterman, H. (Patient Preference and Adherence, 2013)
Background: Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals. This feasibility study evaluated the measures to be used for a future randomized controlled trial assessing the effects of group-based education on adherence with eye drops. Methods: People diagnosed with glaucoma within the previous 12months attending a regional ophthalmology clinic in the North West of England were recruited. A two-session education program delivered one week apart had been devised as part of a previous project. A combined adult learning and health needs approach to education was taken. Outcomes measured were knowledge of glaucoma, self-report of adherence, illness perception, beliefs about medicines, patient enablement, and general health (Short Form-12). Adherence was also measured objectively using a Medical Events Monitoring System device. Results: Twenty-six participants consented to undertake the educational program and 19 produced analyzable data. Knowledge of glaucoma, illness perception, beliefs about medicine, and patient enablement all showed statistically significant improvements after education. Mean adherence with eye drops was maintained above 85% before and for 3 months after attendance at the educational program. Self-report exaggerated adherence by at least 10% when compared with the objective Medical Events Monitoring System data, and in fact the kappa agreement was zero. Conclusion: All questionnaires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was considered to be an objective surrogate measure for adherence with eye drops. A multicenter, randomized, controlled equivalence trial of group versus individualized education using adherence as the primary outcome is the next step. © 2013 Richardson et al.
Keywords: antihypertensive agent; eye drops; adult; aged; article; controlled study; feasibility study; female; glaucoma; health belief; health care delivery; health care need; health care practice; health education; health program; health status; human; intraocular hypotension; major clinical study; male; medication compliance; patient compliance; patient education; randomized controlled trial (topic); self report; Short Form 12; study design; treatment outcome; United Kingdom

Ahmed valve, suture-less implantation: A new approach to an easier technique - García-Delpech, S.; Sanz-Marco, E.; Martinez-Castillo, S.; López-Prats, M.J.; Udaondo, P.; Salom, D.; Díaz-Llopis, M. (Journal of Glaucoma, 2013)
PURPOSE:: Tissue adhesives have been used in ophthalmology instead of sutures to minimize the operating time. This case series investigated the effectiveness and safety of use of cyanoacrylate in Ahmed valve implantation through pars plana for refractory glaucoma. PATIENTS AND METHODS:: Seventeen eyes of 17 patients with refractory glaucoma underwent Ahmed valve scleral suture-less implantation through pars plana with a cyanoacrylate suture of the plate. Refractory glaucoma was defined as intraocular pressure (IOP) ≥21 mm Hg with antiglaucoma eye drops, good adherence to treatment, and no previous glaucoma surgery. IOP control and development of complications were evaluated during the follow-up (mean follow-up, 13.23 mo, 6 to 28 mo). RESULTS:: IOP control, defined as IOP≤21 mm Hg with or without antiglaucoma eye drops, was achieved in 82.2% of patients, and 58.8% were able to eliminate antiglaucoma eye drops. Mean surgical time was 9.76±2.60 and 6±0.81 minutes in patients with previous vitrectomy (4 cases). Postoperative complications included transiently increased IOP, transient hyphema, early postoperative hypotony (4 cases), and tube block by the vitreous (2 cases): 1 resolved by Nd:YAG and the other by second vitrectomy. No cases of tube or plate extrusion, plate migration, choroidal or retinal detachment, or vitreous hemorrhage were observed. CONCLUSIONS:: These results are promising and demonstrate a safe and effective alternative to the traditional scleral suture. Our data suggest that Ahmed valve implantation through pars plana with cyanoacrylate is a safe and effective method for refractory glaucoma. Further studies are needed to confirm our observation. Copyright © 2012 by Lippincott Williams & Wilkins.
Keywords: antiglaucoma agent; bimatoprost; brimonidine; cyanoacrylate; cyclopentolate; prednisolone acetate; suture material; timolol; tissue adhesive; tobramycin; adult; aged; Ahmed valve; article; ciliary disk; clinical article; drug dose reduction; dysesthesia; female; glaucoma; glaucoma drainage implant; human; hyphema; intraocular hypotension; intraocular pressure; male; operation duration; patient compliance; patient safety; postoperative complication; priority journal; prosthesis complication; refractory glaucoma; sclera; surgical approach; surgical technique; sutureless implantation; trabeculectomy; treatment outcome; visual acuity; vitrectomy

Managed care implications of age-related ocular conditions - Cardarelli, W.J.; Smith, R.A. (American Journal of Managed Care, 2013)
The economic costs of age-related ocular diseases and vision loss are increasing rapidly as our society ages. In addition to the direct costs of treating age-related eye diseases, elderly persons with vision loss are at significantly increased risk for falls and fractures, experiencing social isolation, and suffering from an array of comorbid medical conditions compared with individuals with normal vision. Recent studies estimate the total economic burden (direct and indirect costs) of adult vision impairment in the United States at $51.4 billion. This figure is expected to increase as the baby boomer generation continues to age. While a number of highly effective new therapies have caused a paradigm shift in the management of several major age-related ocular diseases in recent years, these treatments come at a substantial cost. This article reviews the economic burdens and treatment-related costs of 4 major ocular diseases of aging - glaucoma, age-related macular degeneration, diabetic retinopathy, and dry eye disease - and the implications for managed care.
Keywords: aflibercept; artificial tear; bevacizumab; cyclosporine; latanoprost; prostaglandin; ranibizumab; triamcinolone; vasculotropin; awareness; baby boomer; comorbidity; cost control; cost effectiveness analysis; diabetic macular edema; diabetic retinopathy; diseases; dry eye; early intervention; eye disease; Food and Drug Administration; glaucoma; health care cost; health care policy; health insurance; health service; home health agency; human; intraocular pressure; job performance; managed care; managed care organization; medical care; medicare; medication compliance; nursing home; open angle glaucoma; optical coherence tomography; patient; patient compliance; photodynamic therapy; prescription; priority journal; productivity; quality adjusted life year; reimbursement; age related macular degeneration; retrospective study; review; social isolation; symptom; United States; visual acuity; visual disorder; visual impairment

Morning dosing of once-daily glaucoma medication is more convenient and may lead to greater adherence than evening dosing - Ford, B.A.; Gooi, M.; Carlsson, A.; Crichton, A.C. (Journal of Glaucoma, 2013)
PURPOSE:: To determine if adherence and convenience of once-daily glaucoma medication is greater in the morning or the evening. DESIGN:: Prospective, randomized crossover treatment trial. PATIENTS AND METHODS:: Thirty patients newly diagnosed with glaucoma or ocular hypertension requiring intraocular pressure (IOP) reduction were started on travoprost eye drops and randomized to either morning or evening administration for 1 month. They were then crossed over to the opposite dosing schedule for the following month. Adherence was monitored using an automated dosing aid. MAIN OUTCOME MEASURES:: Adherence was compared between morning versus evening dosing and first versus second month dosing. Demographic characteristics were obtained, treatment effect was measured, and patients completed a post-study questionnaire regarding the convenience of the 2 dosing regimens. RESULTS:: Patient adherence overall was good (89.3%). There was no statistically significant difference (P=0.07) in adherence between morning dosing (90.9%) and evening dosing (87.3%). Adherence in the first month (91.7%) was superior to the second month (86.5%). There was no significant difference in IOP response between morning and evening dosing. Patients found morning dosing more convenient than evening dosing. CONCLUSIONS:: Early adherence to treatment with a prostaglandin analogue is good, but patients prefer morning administration to evening administration. This may lead to greater adherence with morning administration, particularly among men. Adherence decreases from the first to second month after initiation of treatment. IOP response to this treatment is not significantly affected by morning versus evening administration. Copyright © 2013 by Lippincott Williams & Wilkins.
Keywords: travoprost; adult; aged; article; automation; clinical article; controlled study; crossover procedure; drug dose regimen; evening dosage; female; glaucoma; human; intraocular hypertension; intraocular pressure; male; morning dosage; patient compliance; priority journal; questionnaire; randomized controlled trial; therapy effect

Sociodemographic factors and utilization of eye care services: Is there an association with patients presenting to a tertiary referral hospital in acute angle-closure? - Sandhu, S.; Van Wijngaarden, P.; Nguyen, D.Q.; O'Hare, F.; Sandhu, N.; Wang, J.J.; Crowston, J.G. (Clinical and Experimental Ophthalmology, 2013)
Background: The aim of this study is to examine the relationship between sociodemographic factors and utilization of eye care services in patients presenting in acute angle-closure (AAC). Design: A hospital-based retrospective, case-control study. Participants: Fifty-five patients consecutively presenting to the emergency department of the Royal Victorian Eye and Ear Hospital with AAC (cases), and 43 patients consecutively referred to the outpatient department for prophylactic laser peripheral iridotomy (controls) over a 3-year period. Methods: Standardized telephone questionnaires. Main Outcome Measures: Comparisons were made for sociodemographic factors, utilization of eye care services and provision of information on glaucoma and premonitory symptoms of AAC. Results: No significant differences across a range of socioeconomic and demographic factors were found. Fewer cases reported having attended an eye care professional ever (P=0.02), or in the 12months preceding their acute hospital attendance (P=0.002), and had less awareness of angle closure glaucoma (P=0.001). Logistic regression modelling demonstrated premonitory symptoms of AAC (odds ratio 3.96, [95% confidence interval 1.52-10.32], P<0.001) and a period of greater than 12months since the last eye examination (odds ratio 3.89, [95% confidence interval 1.64-9.21]) were significantly associated with the risk of AAC. Conclusions: No significant differences in socioeconomic or demographic parameters between cases and controls were identified. Control subjects had a history of more frequent and recent access to eye care services than cases. The finding that more than one-third of patients presenting with AAC had consulted an eye care provider in the preceding year suggests that a significant proportion of individuals at risk of AAC remain undetected. © 2012 The Authors Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.
Keywords: acute angle closure glaucoma; adult; article; awareness; closed angle glaucoma; controlled study; emergency ward; eye care; eye examination; female; health care utilization; hospital based case control study; human; major clinical study; male; outpatient department; questionnaire; retrospective study; social status; symptomatology; telemonitoring; tertiary health care

The United Kingdom glaucoma treatment study: A multicenter, randomized, placebo-controlled clinical trial: Design and methodology - Garway-Heath, D.F.; Lascaratos, G.; Bunce, C.; Crabb, D.P.; Russell, R.A.; Shah, A. (Ophthalmology, 2013)
Objective: Elevated intraocular pressure (IOP) is a major risk factor for the deterioration of open-angle glaucoma (OAG); medical IOP reduction is the standard treatment, yet no randomized placebo-controlled study of medical IOP reduction has been undertaken previously. The United Kingdom Glaucoma Treatment Study (UKGTS) tests the hypothesis that treatment with a topical prostaglandin analog, compared with placebo, reduces the frequency of visual field (VF) deterioration events in OAG patients by 50% over a 2-year period. Design: The UKGTS is a randomized, double-masked, placebo-controlled, multicenter treatment trial for OAG. Participants: Five hundred sixteen newly diagnosed (previously untreated) patients with OAG were recruited prospectively at 10 centers between 2007 and 2010. Methods: Patients were assigned by concealed telephone allocation to treatment with a prostaglandin analog (latanoprost 0.005%) or placebo. The observation period was 2 years, with subjects monitored by VF testing, quantitative imaging, optic disc photography, and tonometry at 11 visits. Data were acquired according to novel protocols optimized for the analysis of deterioration velocity. The sample size was determined for a 2-sided error of α = 0.05 to detect the difference between 24% and 11% in incident deterioration over a 24-month follow-up at 90% power and assuming a 25% attrition rate. Main Outcome Measures: The primary outcome was time to VF deterioration within 24 months. Secondary outcomes included the deterioration velocity of VF and quantitative imaging measures and the relationship between these velocities and risk factors for deterioration. Results: The study design enabled a short trial with a 2-year observation period and provided data that can be used to assess the feasibility of further shortening trial duration with the progression velocity of VF and structural imaging measurements as outcomes. Conclusions: The UKGTS is the first randomized, placebo-controlled trial to evaluate the efficacy of medical treatment in reducing VF deterioration in OAG. The measurement of deterioration velocity and inclusion of quantitative imaging has the potential to reduce the number of patients and duration required for subsequent clinical trials. This trial also will quantify risk factors for deterioration, enabling more precise risk profiling of patients and the development of patient management protocols. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology.
Keywords: ISRCTN96423140; latanoprost; placebo; article; controlled study; disease course; double blind procedure; drug formulation; follow up; human; imaging system; intraocular pressure abnormality; major clinical study; multicenter study; open angle glaucoma; patient compliance; patient monitoring; photography; priority journal; randomized controlled trial; risk factor; sample size; teleconsultation; tonometry; treatment outcome; treatment planning; United Kingdom; unspecified side effect; visual field

Surgical outcomes in childhood uveitic glaucoma - Bohnsack, B.L.; Freedman, S.F. (American Journal of Ophthalmology, 2013)
Purpose: To evaluate surgical outcomes and to describe a strategy for pediatric uveitic glaucoma. Design: Retrospective case series. Methods: The clinical practice of a single surgeon identified 36 patients with juvenile uveitic glaucoma (diagnosed before 18 years of age) who underwent 1 or more intraocular pressure (IOP)-lowering surgical procedures. The first eye operated on was included in the analysis. The main indication for success was IOP of less than 21 mm Hg with controlled inflammation, without further IOP-lowering surgery or devastating complication. Results: Patients with uveitic glaucoma associated with juvenile idiopathic arthritis (n = 20), idiopathic uveitis (n = 9), other (n = 6) were included. Mean age ± standard deviation at initial glaucoma surgery was 11.1 ± 4.4 years with a follow-up of 5.6 ± 4.8 years (range, 0.2 to 16.4 years). Goniotomy was the initial surgical procedure in 31 (86%) eyes. Fifteen eyes did not require further IOP-lowering surgery. Sixteen eyes had additional IOP-lowering surgery: second goniotomy (n = 9), glaucoma drainage device (n = 6), and trabeculectomy (n = 1). By Kaplan-Meier survival analysis, the first versus the first or second goniotomy were successful at 10 years in 48% (95% confidence interval, 28% to 65%) versus 69% (95% confidence interval, 47% to 84%). Goniotomy failure was noncorrelative with phakic status or presence of preoperative synechiae. Five eyes (14%) had initial glaucoma drainage device implantation because of closed angles. Visual acuity was similar between initial and final examinations (0.37 ± 0.48 logarithm of the minimal angle of resolution units [Snellen 20/47] vs 0.28 ± 0.34 logarithm of the minimal angle of resolution units [Snellen 20/38]). IOP was reduced (33.0 ± 8.0 mm Hg vs 12.6 ± 4.5 mm Hg; P <.0001), as was number of glaucoma medications (3.2 ± 1.1 vs 1.2 ± 1.3; P <.0001). Eyes undergoing cataract removal after successful glaucoma surgery maintained IOP control. Glaucoma was controlled and vision was preserved in 33 (92%) eyes. Conclusions: Refractory juvenile uveitic glaucoma was managed successfully by goniosurgery and glaucoma drainage device implantation. Cataract removal can be accomplished successfully, provided IOP and uveitis are well controlled before surgery. © 2013 Elsevier Inc.
Keywords: adolescent; adult; article; cataract extraction; child; clinical article; clinical practice; controlled study; disease association; eye injury; eye surgery; female; follow up; glaucoma; glaucoma surgery; goniotomy; human; infant; intermediate uveitis; interstitial nephritis; intraocular pressure; juvenile rheumatoid arthritis; male; outcome assessment; patient compliance; phakic intraocular lens; preschool child; priority journal; retina detachment; retrospective study; sarcoidosis; school child; surgeon; survival time; trabeculectomy; treatment failure; treatment indication; treatment outcome; uveitic glaucoma; uveitis; vision

The epidemiology of microbial keratitis with silicone hydrogel contact lenses - Stapleton, F.; Keay, L.; Edwards, K.; Holden, B. (Eye and Contact Lens, 2013)
It was widely anticipated that after the introduction of silicone hydrogel lenses, the risk of microbial keratitis would be lower than with hydrogel lenses because of the reduction in hypoxic effects on the corneal epithelium. Large-scale epidemiological studies have confirmed that the absolute and relative risk of microbial keratitis is unchanged with overnight use of silicone hydrogel materials. The key findings include the following: (1) The risk of infection with 30 nights of silicone hydrogel use is equivalent to 6 nights of hydrogel extended wear; (2) Occasional overnight lens use is associated with a greater risk than daily lens use; (3) The rate of vision loss due to corneal infection with silicone hydrogel contact lenses is similar to that seen in hydrogel lenses; (4) The spectrum of causative organisms is similar to that seen in hydrogel lenses, and the material type does not impact the corneal location of presumed microbial keratitis; and (5) Modifiable risk factors for infection include overnight lens use, the degree of exposure, failing to wash hands before lens handling, and storage case hygiene practice. The lack of change in the absolute risk of disease would suggest that exposure to large number of pathogenic organisms can overcome any advantages obtained from eliminating the hypoxic effects of contact lenses. Epidemiological studies remain important in the assessment of new materials and modalities. Consideration of an early adopter effect with studies involving new materials and modalities and further investigation of the impact of second-generation silicone hydrogel materials is warranted. © 2013 Lippincott Williams & Wilkins.
Keywords: Acanthamoeba keratitis; bacterial keratitis; conference paper; contact lens; cornea epithelium; disease duration; disease severity; health care cost; high risk population; human; hydrogel; incidence; patient compliance; priority journal; risk factor; silicone hydrogel contact lens; therapy delay; visual impairment

Advancement and tribulations in ocular drug delivery - Dave, V.; Sharma, S.; Yadav, S.; Paliwal, S. (International Journal of Drug Delivery, 2012)
Development of new drug candidates and novel delivery techniques for treatment of ocular diseases has recently accelerated. The field of ocular drug delivery is one of the most interesting and challenging endeavors facing the pharmaceutical scientist for past 10-20 years. In ophthalmic formulation to the eye like solutions, suspensions, and ointments are available in the market shows drawbacks such as increased precorneal elimination, blurred vision and high variability in efficiency. The major setback associated with the conventional dosage forms is the bioavailability of drug. In the last three decades to improve the bioavailability by common to adding viscosity-enhancing agents or mucoadhesive polymers into dosage formulations. To prevail over to conventional dosage formulations there were non-conventional technologies such as lipososme, niosome, microspheres, nanoparticle, implant, gene therapy and ocular inserts could be developed in pharmaceutical market. In this article, we have summarized the different types of commonly used ophthalmic formulations and compared the conventional formulations with the advanced formulation in many respects like their applicability, acceptance, characteristics and utility. "Ocular drug delivery is one of the most interesting and challenging endeavours facing the pharmaceutical scientist...The anatomy, physiology and biochemistry of the eye render this organ exquisitely impervious to foreign substances...The challenge to the formulator is to outwit the protective barriers of the eye without causing permanent tissue damage...The ancient ophthalmic solutions, suspensions and ointment dosage forms are clearly no longer sufficient to combat some present virulent diseases...".
Keywords: epinephrine; carbomer; carboxymethylcellulose; dexamethasone; dipivefrine; ganciclovir; gentamicin; hydroxypropylcellulose; microRNA; microsphere; pilocarpine; polyglactin; polylactic acid; prednisolone acetate; prodrug; small interfering RNA; biodegradability; cardiovascular disease; cell encapsulation; controlled release formulation; Cytomegalovirus retinitis; drug absorption; drug bioavailability; drug delivery system; drug hypersensitivity; drug implant; drug research; drug stability; drug tolerance; dry eye; eye burning; eye irritation; eye pain; eye redness; eye swelling; gene targeting; human; intraocular hypertension; liposomal delivery; microencapsulation; nanopharmaceutics; nonhuman; nonviral gene delivery system; ocular pruritus; patient compliance; photosensitivity; macular edema; review; risk benefit analysis; scleral plug; visual disorder; Ocusert; Posurdex; Vitasert

Tafluprost once daily for treatment of elevated intraocular pressure in patients with open-angle glaucoma - Liu, Y.; Mao, W. (Clinical Ophthalmology, 2012)
Glaucoma is a leading cause of visual loss worldwide. Current antiglaucoma therapy focuses on lowering intraocular pressure to a safe level. In recent years, prostaglandin analogs have become the first-line agents for treating open angle glaucoma. Tafluprost, which was first reported in 2003, is a novel prostaglandin analog, and has been shown to be a potent ocular hypotensive agent in a number of preclinical and clinical studies. Also, its unique preservative-free formulation helps to decrease preservative-associated ocular disorders and improve patient compliance. In this review, studies from 2003 to 2012 focusing on the structure, metabolism, efficacy, and safety of tafluprost are summarized. These studies suggested that application of tafluprost once daily is a safe and effective treatment for patients with open angle glaucoma. © 2013 Liu and Mao, publisher and licensee Dove Medical Press Ltd.
Keywords: bimatoprost; dorzolamide; latanoprost; prostaglandin derivative; prostaglandin F2 alpha derivative; tafluprost; timolol; travoprost; unoprostone; adipose tissue; application site irritation; blood pressure; cell survival; clinical effectiveness; concentration response; conjunctiva disease; cornea disease; cytotoxicity test; dose response; drug absorption; drug effect; drug efficacy; drug metabolism; drug penetration; drug potency; drug potentiation; drug safety; drug substitution; drug tolerability; drug withdrawal; eye blood flow; eye disease; eye toxicity; heart rate; human; hyperemia; intraocular hypertension; intraocular pressure abnormality; iris disease; neuroprotection; nonhuman; open angle glaucoma; orbit; patient compliance; pruritus; retina ganglion cell; review; side effect; single drug dose; treatment duration; trend study; unspecified side effect; afp 168

Economic burden of glaucoma in Rivers State, Nigeria - Adio, A.O.; Onua, A.A. (Clinical Ophthalmology, 2012)
Background: Primary open angle glaucoma is reported to blind 150,000 people in the Nigerian population and over 7000 in Rivers State, and requires constant follow-up. Compliance is a challenge, given that most inhabitants live below the poverty line. This study was performed to determine how Nigerian patients are affected economically by the disease. Methods: Consecutive adult patients attending the eye clinic of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria, with a diagnosis of primary open angle glaucoma and on outpatient antiglaucoma treatment in the first 6 months of 2006, were recruited for the study. The lowest paid government worker was on USD50 (N7500.00) per month and the gross domestic product per capita was USD1150 for the period under review. Results: We enrolled 120 consecutive patients of mean age 52.7 ± 10.4 years, with a male to female ratio of 2:3. The most common occupations were in the civil service (n = 56, 46.7%). All participants were on topical antiglaucoma treatment. The average cost of medical antiglaucoma medication was N6000 (USD40) per month. Computed to include indirect costs, including medical laboratory tests, transportation, and care by patient escorts, an average sum of USD105.4 (N15,810) was spent by each patient per month. Most of the patients (73.3%) were responsible for their own treatment costs. No patient accepted the cheaper option of surgery (USD275.4, N41,310). Eighty of the patients (66.7%) visited our eye clinic monthly. Direct and indirect loss to the economy was USD3,064587 per annum from those already blind. This was in addition to the USD 4.1 million being spent yearly on medical treatment by those who were visually impaired by glaucoma. Conclusion: Middle-income earners spent over 50% of their monthly income and low-income earners spend all their monthly earnings on treatment for glaucoma. This situation often resulted in noncompliance with treatment and hospital follow-up visits. To reduce the economic burden of glaucoma, trabeculectomy performed by experienced surgeons should be offered as first-line treatment for glaucoma in this country, rather than medical therapy. © 2012 Adio and Onua, publisher and licensee Dove Medical Press Ltd.
Keywords: antiglaucoma agent; adult; aged; blindness; drug cost; female; glaucoma; glaucoma surgery; health care cost; health care utilization; health economics; human; major clinical study; male; Nigeria; occupation; review; visual impairment

Navigating the storm that is contributing to health disparities - Higginbotham, E.J. (Archives of Ophthalmology, 2012)
Keywords: influenza vaccine; aging; cultural anthropology; editorial; eye photography; glaucoma; health care access; health care cost; health care quality; human; influenza vaccination; open angle glaucoma; priority journal; residency education; seasonal influenza; visual field

Clinical pharmacists' partnership with hospices drives an evolution of PBM services - Protus, B.M.; Kimbrel, J.M.; Gonzalez, J. (Formulary, 2012)
Hospice and palliative care organizations provide end-of-life care to more than 1.5 million patients each year. Pharmacists have become an integral part of the hospice interdisciplinary team approach to patient-centered care. While the role of the pharmacist in the healthcare continuum continues to expand, specialized practice settings, such as hospice, continue to demand more clinical services from pharmacists. This article discusses 3 primary service domains that encompass the aspects of pharmacist involvement in hospice and palliative care: medication utilization, therapeutics, and clinical education. These domains highlight the enhanced partnership that can exist between hospice and palliative care organizations and pharmacy benefits management companies.
Keywords: atropine; haloperidol; hyoscyamine; lorazepam; morphine; anorexia; anxiety disorder; article; blood pressure regulation; clinical education; cost effectiveness analysis; delirium; depression; distress syndrome; dyspnea; edema; glaucoma; gout; health care management; health care utilization; heart failure; hospice; human; insomnia; lung congestion; medicaid; medication therapy management; nausea; pain; palliative therapy; patient care; pharmacist; public-private partnership; respiratory tract disease; responsibility; spiritual care; terminal care

Applications of novel vesicular drug delivery system as ocular drug vehicles: A review - Modi, K.A.; Shelat, P.K. (International Journal of Pharmaceutical Sciences and Research, 2012)
The eye is the most easily reachable organ available for topical drug delivery of local as well as interiorly acting drugs. Ideal drug delivery system aims to provide loading and maintenance dose of drug while being within therapeutic limits at the desired site of action for the desired period of time. In the treatment of ocular disease, the site of action is very narrow and undesired side effects may cause serious injuries to eye tissues. Thus, ideal ocular drug delivery should be site specific, controlled release and non-irritating. Many drugs (more than 85%) belong to BCS class IV exhibiting poor solubility and permeability. Moreover; the precorneal losses like tear secretion, naso-lachrymal drainage and less permeability of corneal tissue causes only 1% absorption of instilled dose. These limitations lead to increased loading dose and dosing frequency to maintain minimum therapeutic level for action which ultimately causes over exposure of drug to eye and leads to serious side effects. Due to these hurdles of conventional drug delivery system, the vesicular drug delivery system is gaining more popularity day by day as they offer improved permeability and altered bioavailability of drug. These formulations mainly include liposome and niosome made up of phospholipids and non-ionic surfactants respectively. They are non-antigenic, biodegradable and non-irritating. The present article reveals the key-work done on vesicular drug delivery system as potential ocular drug delivery system and justifies the need for further research on vesicular drug delivery system as ocular vehicles.
Keywords: acetazolamide; aciclovir; chitosan; chitosan derivative; chloramphenicol; ciprofloxacin; clodronic acid; cyclopentolate; dihydrostreptomycin; fluconazole; ganciclovir; gentamicin; idoxuridine; levofloxacin; liposome; methotrexate; n trimethylchitosan chloride; niosome; nonionic surfactant; ofloxacin; penicillin G; phosphatidylcholine; phospholipid; pilocarpine; tacrolimus; tilisolol; triamcinolone acetonide; unclassified drug; antigenicity; bacterial keratitis; biocompatibility; biodegradability; blepharoconjunctivitis; blepharoconjunctivitis; candidal keratitis; candidal keratitis; conjunctivitis; controlled drug release; cornea; cytomegalovirus infection; drug absorption; drug bioavailability; drug coating; drug delivery system; drug dosage form comparison; drug efficacy; drug exposure; drug formulation; drug penetration; drug research; drug retention; drug safety; drug solubility; drug stability; drug uptake; encapsulation; eye irritation; glaucoma; herpes simplex; herpes simplex keratitis; human; hydrogel; hydrophilicity; keratomycosis; lacrimal duct; lacrimation; liposomal delivery; molecular weight; nonhuman; particle size; patient compliance; review; surface charge; uveoretinitis; vesicular drug delivery system; viral eye infection

Protocol for a randomised controlled trial to estimate the effects and costs of a patient centred educational intervention in glaucoma management. - Cate, H.; Bhattacharya, D.; Clark, A.; Fordham, R.; Notley, C.; Broadway, D.C. (BMC ophthalmology, 2012)
Poor glaucoma education is thought to be a causative factor of non-adherence to glaucoma therapy. However, the multi-factorial nature of non-adherent behaviour may explain the failure of purely educational interventions to achieve significant improvement in adherence. Behaviour Change Counselling (BCC) allows both the imparting of information and assessment of patient ambivalence to medication use and may elicit behaviour change in order to achieve better adherence. The chronic and complex nature of glaucoma means that patient non-adherence to glaucoma therapy does not easily correlate with measureable objective clinical endpoints. However, electronic medication monitoring offers an objective method of measuring adherence without reliance on clinical endpoints. The study is a randomised controlled trial (RCT) with glaucoma (open angle) or ocular hypertension patients attending a glaucoma clinic and prescribed travoprost. The study will determine whether additional glaucoma education using BCC is beneficial and cost effective in improving adherence with glaucoma therapy. An 8-month follow-up period, using an electronic adherence monitoring device (Travalert dosing aid, TDA), will indicate if the intervention is likely to be sustained in the longer term. Additionally, a cost-effectiveness framework will be used to estimate the cost benefit of improving adherence. The development of a novel intervention to deliver glaucoma education using BCC required practitioner training and fidelity testing. Five practitioners were successfully trained to become Glaucoma Support Assistants able to deliver the BCC intervention. The research group had prior clinical and investigative experience in this setting, and used multiple strategies to design a method to address the study objectives. This RCT, using BCC to improve adherence to ocular hypotensive therapy, to our knowledge is the first within this disease area. Using a variety of adherence measures allows examination of the known inaccuracies of patient self-report with respect to glaucoma medication. The novel BCC component has undergone fidelity testing using BECCI and the BCC template will ensure conformity to a standardised intervention. Current Controlled Trials: ISRCTN89683704.
Keywords: ISRCTN89683704; antihypertensive agent; cloprostenol; drug derivative; travoprost; article; clinical protocol; cognitive therapy; controlled clinical trial; controlled study; cost benefit analysis; economics; follow up; human; intraocular hypertension; methodology; open angle glaucoma; patient compliance; patient education; randomized controlled trial

Corneal ulceration in a LASIK patient due to vitamin a deficiency after bariatric surgery - Donaldson, K.E.; Fishler, J. (Cornea, 2012)
Purpose: To review the case of a 41-year-old woman who underwent bariatric surgery in 2000. She subsequently underwent laser in situ keratomileusis (LASIK) surgery in 2008 and complained of dry eye since the LASIK surgery. In November 2010, she was diagnosed with a corneal melt and was treated with aggressive lubrication, followed by eventual amniotic membrane placement and a tarsorrhaphy. She then presented for consultation at the Bascom Palmer Eye Institute when she developed a corneal infiltrate. She was diagnosed with fungal keratitis with corneal xerosis. At that time, vitamin A levels were measured and were less than 2 μ/dL. The patient admitted noncompliance with nutritional supplements. Methods: Case report. Results: The patient was treated with aggressive lubrication and natamycin. Vitamin supplements were restarted, and the patient experienced dramatic improvement in symptoms with resolution of the infection. A central corneal scar with corneal thinning remains. The patient underwent a penetrating keratoplasty for visual rehabilitation. Conclusions: Patient education with emphasis on compliance with nutritional supplements is essential after bariatric surgery. Consider vitamin A deficiency in the differential diagnosis of dry eye after LASIK surgery. Copyright © 2012 by Lippincott Williams and Wilkins.
Keywords: bacitracin; gentamicin; natamycin; retinol; vancomycin; adult; amniotic membrane placement; bandage contact lens; bariatric surgery; case report; conjunctival biopsy; consultation; cornea disease; cornea scar; cornea ulcer; corneal melt; corneal melt; corneal thinning; Curvularia; diet supplementation; disease severity; drug dose reduction; dry eye; eye care; female; hospital admission; human; keratomileusis; keratomycosis; keratoplasty; lubrication; patient compliance; penetrating keratoplasty; postoperative period; priority journal; rehabilitation care; retinol deficiency; review; tarsorhaphy; vitamin blood level; vitamin supplementation

Effectiveness of a short message reminder in increasing compliance with pediatric cataract treatment: A randomized trial - Lin, H.; Chen, W.; Luo, L.; Congdon, N.; Zhang, X.; Zhong, X.; Liu, Z.; Chen, W.; Wu, C.; Zheng, D.; Deng, D.; Ye, S.; et al. (Ophthalmology, 2012)
Objective: Regular follow-up is essential to successful management of childhood cataract. We sought to assess whether a mobile phone short message service (SMS) for parents of children with cataract could improve follow-up adherence and the proportion of procedures performed in timely fashion. Design: Randomized, controlled trial. This trial is registered with ClinicalTrials.gov, NCT01417819. Participants: We included 258 parent-child pairs involved in the Childhood Cataract Program of the Chinese Ministry of Health. Methods: Participants were randomized (1:1) to a mobile phone SMS intervention or standard follow-up appointments. All participants were scheduled to attend <4 follow-up appointments according to the protocol. Parents in the intervention group received SMS automated reminders before scheduled appointments. The control group parents did not receive SMSs or any alternative reminder of scheduled appointments. Regular ocular examinations and analyses were performed by investigators masked to group allocation; however, study participants and the manager in charge of randomization and sending SMSs were not masked. Main Outcome Measures: Number of follow-up appointments attended, additional surgeries, laser treatments, changes in eyeglasses prescription, and occurrence of secondary ocular hypertension. Results: Among parent-child participants, 135 were randomly assigned to the SMS intervention and 123 to standard appointments. Attendance rates for the SMS group (first visit, 97.8%; second, 91.9%; third, 92.6%; fourth, 83%) were significantly higher than those for the control group (first visit, 87.8%; second, 69.9%; third, 56.9%; fourth, 33.3%). The increase in attendance rate for total number of follow-up visits with SMS reminders was 47.2% (relative risk [RR] for attendance, 1.47; 95% confidence interval [CI], 1.16-1.78; P = 0.003). The number needed to remind (NNR) to gain 1 additional visit by 1 child was 3 (95% CI, 1.8-4.2). A total of 247 clinical interventions were carried out in the SMS group and 134 in the control group (RR, 1.68; 95% CI, 1.37-1.99; P = 0.007). The NNR to result in 1 additional clinical intervention was 5 (95% CI, 3.5-6.5). Conclusions: The SMS reminders significantly improved follow-up adherence in pediatric cataract treatment. Using readily available mobile phone resources may be an effective and economic strategy to improve management of childhood cataract in China. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. © 2012 American Academy of Ophthalmology.
Keywords: NCT01417819; adult; article; cataract; clinical effectiveness; controlled study; eye examination; female; follow up; human; intraocular hypertension; low level laser therapy; major clinical study; male; mobile phone; patient compliance; priority journal; randomized controlled trial; reminder system; short message service reminder; spectacles

Post-trabeculectomy topical bevacizumab preventing bleb failure: A preliminary study - Bhasker, S.K.; Saxena, S.; Singh, K. (Journal of Ocular Biology, Diseases, and Informatics, 2012)
This study aims to evaluate the efficacy and safety of post-trabeculectomy topical bevacizumab, in preventing bleb failure. A total of 11 females and 12 males were enrolled for the study. After a complete ophthalmic evaluation, the patients underwent trabeculectomy. Full ophthalmic examination was done the next day, which included visual acuity, intraocular pressure (IOP), and bleb morphology. Next, two drops of bevacizumab [0.25 mg (0.01 ml)] were instilled over the wound area with a tuberculin (1 ml) syringe. Pressure was applied at the medial canthus to prevent it from going into the lacrimal passage. Similar postoperative procedures were repeated at 1, 2, 3, and 4 weeks. So in all, five instillations of bevacizumab were completed. Later, the patients were followed at 1-month interval for 6 months. Target IOP was achieved in all eyes and was maintained during the study period of 6 months without any anti-glaucoma medication. Average IOP before trabeculectomy was 27.27±8.92 mmHg, which decreased postoperatively to 8.77±0.97 mmHg at 3 months and 9.27±1.16 mmHg at 6 months. This drop in IOP was statistically significant on both occasions (p=0.00). A nice low filtering bleb was formed after the surgery, and it remained the same during the study period. The other parameters like cup-to-disc ratio and visual field did not change during the 6 months of study as expected because glaucoma is a slow progressive disease. Modulating the wound at multiple sites by bevacizumab (inflammation, proliferative, and remodeling stages) can lead to success of trabeculectomy. © Springer Science+Business Media New York 2013.
Keywords: antiglaucoma agent; bevacizumab; absence of side effects; adult; aged; article; bleb failure; clinical article; conjunctiva disease; drug efficacy; drug safety; female; follow up; human; intraocular pressure; male; middle aged; open angle glaucoma; optic disk cup; patient compliance; postoperative period; preoperative evaluation; priority journal; trabeculectomy; treatment outcome; visual acuity; visual field; visual system examination; wound healing; avastin

Cost-effective glaucoma care in the managed care setting - Vold, S.D. (Journal of Managed Care Medicine, 2012)
Glaucoma is a major cause of vision loss that can be prevented with treatment. Early detection and treatment of ocular hypertension and eye damage can prevent progression. Although treatment of glaucoma has traditionally been medical, evolving minimally invasive surgical procedures result in good outcomes and avoid the issue of adherence problems seen with medications.
Keywords: antiglaucoma agent; eye drops; African American; article; blindness; cost effectiveness analysis; cost of illness; disease control; disease predisposition; disease severity; early diagnosis; eye care; glaucoma; high risk population; human; intraocular hypertension; intraocular pressure abnormality; low tension glaucoma; managed care; minimally invasive surgery; open angle glaucoma; optic nerve lesion; outcome assessment; patient compliance; postoperative complication; risk assessment; risk factor; trabeculectomy; visual field defect

Adherence to treatment for glaucoma in patients at a community pharmacy - Barris Blundell, D. (Pharmaceutical Care Espana, 2012)
Aims: To determine the degree of adherence to treatment for glaucoma and/or ocular hypertension and describe the medication used for glaucoma in patients at a community pharmacy. Methods: A descriptive study carried out over 4 months (January-April 2012) at a community pharmacy in Benalmádena (Málaga) with the patients who came in for their glaucoma and/or ocular hypertension medication. Those who agreed to take part in the study were given a survey which included: patient details, details of medicines and indirect methods to assess compliance (self-reporting of compliance according to Haynes-Sackett and the Morisky-Green test). Results: Thirty six patients were included. Adherence to the treatment was 66.7% self-reported compliance and 50% according to the Morisky-Green test. The most-dispensed pharmacological group was that of prostaglandin analogues at 36.1% as monotherapy and 27.8% as part of polytherapy. 27.8% of the patients used more than one medication, while 72.2% used monotherapy for glaucoma and/or ocular hypertension. No association was observed between therapeutic adherence and the clinical and demographic variables analysed. Conclusions: Adherence to treatment for glaucoma could be improved. Prostaglandin analogues are the most-prescribed medicines, followed by beta blockers. As well as assessing compliance there is a need to analyse the administration techniques for medication of these types with a view to future health education measures. © 2012 Ediciones Mayo.
Keywords: beta adrenergic receptor blocking agent; prostaglandin derivative; article; clinical article; demography; glaucoma; human; intraocular hypertension; patient compliance; pharmacy (shop); self report

Preservative-containing eye drops and adherence in ophthalmological practice - Lanzl, I.; Kaercher, T. (Ophthalmologe, 2012)
Chronic eye diseases, such as glaucoma or dry eye syndrome, require long-term drug application to the eyes. Good adherence is required to achieve the therapeutic goal and patient needs and requirements have to be taken into account. This distinguishes adherence to drug therapy from the former compliance which implies only following medical instructions. Adherence is influenced by socioeconomic, health system-related, disease-related, treatment-related and patient-related factors. It can be measured by tedious procedures, such as electronic monitoring, self-assessment, drop counting and laboratory findings of systemic drug levels. Non-adherence is a growing medical problem worldwide. An increase in adherence means an increased degree of therapeutic safety for the patient and long-term cost savings for the individual as well as society. Non-adherence in chronic diseases, such as glaucoma and dry eye syndrome is increased by eye drops that cause side effects. Often these side effects are caused by agents such as the preservative benzalkonium chloride. To achieve a good adherence preservative-free eye drops are advised. © 2012 Springer-Verlag Berlin Heidelberg.
Keywords: eye drops; preservative; article; human; ophthalmology; patient compliance; practice guideline; standard

Understanding the side effects of glucocorticoid therapy: Shining a light on a drug everyone thinks they know - Dixon, W.G.; Bansback, N. (Annals of the Rheumatic Diseases, 2012)
Glucocorticoids are one of the most frequently prescribed therapies in rheumatology, a reflection of their effectiveness as a powerful anti-inflammatory drug. Glucocorticoids are also, however, associated with a wide range of adverse events, particularly at higher doses. To make appropriate decisions, doctors and patients need to weigh these bene fits against the potential harms. This article describes the many uncertainties which make informed prescribing difficult. We lack knowledge, for example, on the magnitude of risk, the relationship to dose and duration, and what happens to risk on stopping therapy. Beyond safety, we describe how patients may lack understanding of the nature of the benefits and harms, and how to incorporate value judgements which are crucial to the decision making process. We conclude by exploring how future research might fill these knowledge gaps to enable a better informed decision process.
Keywords: biological product; generic drug; glucocorticoid; methotrexate; adrenal insufficiency; adverse drug reaction; cardiovascular disease; cataract; corticosteroid therapy; diabetes mellitus; disease severity; drug research; drug safety; glaucoma; high risk patient; human; low drug dose; medical decision making; patient compliance; practice guideline; prescription; priority journal; probability; review; rheumatoid arthritis; risk benefit analysis; treatment duration; treatment response; unspecified side effect; body weight gain

Three-month evaluation of dorzolamide hydrochloride/timolol maleate fixed-combination eye drops versus the separate use of both drugs - Inoue, K.; Shiokawa, M.; Sugahara, M.; Wakakura, M.; Soeda, S.; Tomita, G. (Japanese Journal of Ophthalmology, 2012)
Purpose: To investigate the ocular hypotensive effect and safety of dorzolamide hydrochloride 1 %/timolol maleate 0.5 % fixed-combination eye drops. Methods: The study cohort comprised 34 patients with either primary open-angle glaucoma or ocular hypertension who were being concomitantly treated with dorzolamide hydrochloride 1 % eye drops and timolol maleate 0.5 % eye drops. The dorzolamide hydrochloride 1 % and timolol maleate 0.5 % eye drops were replaced with dorzolamide hydrochloride 1 %/timolol maleate 0.5 % fixed-combination eye drops without any washout period. The intraocular pressure (IOP) was evaluated both before and 1 and 3 months after the treatment change. The patients were asked to complete a questionnaire on adherence to the treatment protocol 1 month after the change in treatment. Results: The IOP was 15.5 ± 2.7 mmHg at the time of treatment change, 15.2 ± 2.7 mmHg at 1 month post-change, and 15.5 ± 2.9 mmHg at 3 months post-change, which is consistent with that before the treatment change (p = 0.286). Based on the completed questionnaire, following the treatment change, 50 % of patients felt a stinging sensation following administration of the eye drops and 11.8 % experienced blurred vision. In no case were the eye drops discontinued due to adverse reactions or insufficient IOP decrease. Conclusion: The replacement of concomitant treatment with dorzolamide hydrochloride 1 % and timolol maleate 0.5 % eye drops with dorzolamide hydrochloride 1 %/timolol maleate 0.5 % fixed-combination eye drops improved protocol adherence and preserved the IOP. © Japanese Ophthalmological Society 2012.
Keywords: bunazosin; dipivefrine; dorzolamide; dorzolamide plus timolol; eye drops; latanoprost; tafluprost; timolol; timolol maleate; travoprost; adult; aged; antihypertensive activity; article; bitter taste; blurred vision; burning sensation; clinical article; clinical evaluation; drug safety; drug substitution; drug withdrawal; dry eye; evening dosage; eye discomfort; eye irritation; female; human; intraocular hypertension; intraocular pressure; low tension glaucoma; male; morning dosage; ocular pruritus; open angle glaucoma; patient compliance; priority journal; questionnaire; side effect; treatment outcome; cosopt; timoptol; trusopt

Educating nonmedical prescribers - Stewart, D.; MacLure, K.; George, J. (British Journal of Clinical Pharmacology, 2012)
The last decade has seen developments in nonmedical prescribing, with the introduction of prescribing rights for healthcare professionals. In this article, we focus on the education, training and practice of nonmedical prescribers in the UK. There are around 20000 nurse independent prescribers, 2400 pharmacist supplementary/independent prescribers, several hundred allied health professional supplementary prescribers and almost 100 optometrist supplementary/independent prescribers. Many are active prescribers, managing chronic conditions or acute episodes of infections and minor ailments. Key aims of nonmedical prescribing are as follows: to improve patient care; to increase patient choice in accessing medicines; and to make better use of the skills of health professionals. Education and training are provided by higher education institutions accredited by UK professional bodies/regulators,namely, the Nursing and Midwifery Council, General Pharmaceutical Council, Health Professions Council and General Optical Council. The programme comprises two main components: a university component equivalent to 26 days full-time education and a period of learning in practice of 12 days minimum under the supervision of a designated medical practitioner. Course content focuses on the following factors: consultation, decision making, assessment and review; psychology of prescribing; prescribing in team context; applied therapeutics; evidence-based practice and clinical governance; legal, policy, professional and ethical aspects; and prescribing in the public health context. Nonmedical prescribers must practise within their competence, demonstrating continuing professional development to maintain the quality engendered during training. Despite the substantial progress, there are several issues of strategy, capacity, sustainability and a research evidence base which require attention to fully integrate nonmedical prescribing within healthcare. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.
Keywords: clinical decision making; clinical practice; consultation; education program; evidence based practice; eye care; glaucoma; government regulation; health care access; health care policy; health care quality; human; legal aspect; library; medical society; nurse practitioner; paramedical personnel; patient care; pharmacist; physiotherapist; podiatrist; prescription; priority journal; professional competence; professional development; professional standard; review

Impact of a health communication intervention to improve glaucoma treatment adherence: Results of the interactive study to increase glaucoma adherence to treatment trial - Glanz, K.; Beck, A.D.; Bundy, L.; Primo, S.; Lynn, M.J.; Cleveland, J.; Wold, J.A.; Echt, K.V. (Archives of Ophthalmology, 2012)
Objective: To determine the efficacy of an automated, interactive, telephone-based health communication intervention for improving glaucoma treatment adherence among patients in 2 hospital-based eye clinics. Method: A total of 312 patients with glaucoma (18-80 years of age) were enrolled in a randomized controlled trial at 2 eye clinics located in hospitals in the southeastern United States. These patients were considered non-adherent because they did not take their medication, refill their medication, and/or keep their appointments. The treatment group received an automated, interactive, tailored, telephone-based health communication intervention and tailored print materials. The control group received usual care. Main Outcome Measures: Adherence with medication taking, prescription refills, and appointment keeping measured by interviews, medical charts, appointment records, and pharmacy data. Results: A statistically significant increase was found for all adherence measures in both the intervention and control groups. Interactive telephone calls and tailored print materials did not significantly improve adherence measures compared with controls. Conclusions: During the study period, patient adherence to glaucoma treatment and appointment keeping improved in both study arms. Participation in the study and interviews may have contributed. Strategies that address individuals' barriers and facilitators may increase the impact of telephone calls, especially for appointment keeping and prescription refills. Application to Clinical Practice: Glaucoma patient care should include reminders about consistent use of medication and the importance of keeping appointments. More frequent, and personalized, telephone contact may be helpful to patients who are known to be non-adherent. Trial Registration: clinicaltrials.gov Identifier: NCT00794170 ©2012 American Medical Association. All rights reserved.
Keywords: NCT00794170; antiglaucoma agent; adult; aged; article; automation; controlled study; female; glaucoma; health communication intervention; human; interview; major clinical study; male; medical information; medical record; multicenter study; outcome assessment; patient compliance; pharmacy (shop); prescription; priority journal; randomized controlled trial; telemedicine; telephone; United States

The Saudi initiative for asthma - 2012 update: Guidelines for the diagnosis and management of asthma in adults and children - Al-Moamary, M.S.; Alhaider, S.A.; Al-Hajjaj, M.S.; Al-Ghobain, M.O.; Idrees, M.M.; Zeitouni, M.O.; Al-Harbi, A.S.; Al Dabbagh, M.M.; Al-Matar, H.; Alorainy, H.S. (Annals of Thoracic Medicine, 2012)
This an updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on "difficult-to-treat asthma." Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient-doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment.
Keywords: acetylsalicylic acid; alkane; allergen; beclomethasone dipropionate; beta 2 adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; bronchodilating agent; budesonide; budesonide plus formoterol; chlorofluorocarbon; cholinergic receptor blocking agent; ciclesonide; corticosteroid; fluticasone propionate; fluticasone propionate plus salmeterol xinafoate; formoterol; hydrocortisone; hydrofluroalkane; ipratropium bromide; leukotriene receptor blocking agent; methylprednisolone; nonsteroid antiinflammatory agent; omalizumab; prednisolone; salbutamol; salmeterol; steroid; theophylline; tiotropium bromide; unclassified drug; unindexed drug; add on therapy; adrenal insufficiency; adult; aerosol; air pollutant; air pollution; allergic asthma; ambient air; anamnesis; anaphylaxis; article; aspirin exacerbated respiratory disease; asthma; Asthma Control Test; bitter taste; breath-actuated inhaler; cataract; child; Childhood Asthma Control Test; corticosteroid induced osteoporosis; cost effectiveness analysis; cough variant asthma; coughing; device safety; diabetes mellitus; diagnostic test; disease exacerbation; disease severity; drug delivery system; drug efficacy; drug fatality; drug formulation; drug intermittent therapy; drug megadose; dysphonia; dyspnea; education program; evidence based practice; exercise induced asthma; gastroesophageal reflux; gastrointestinal symptom; glaucoma; heart arrhythmia; hospital care; human; hypertension; immunotherapy; influenza vaccination; inhalation spacer; inhalation test; inhaler; injection site contusion; injection site pain; intensive care; low drug dose; maintenance therapy; medical nebulizer; metered dose inhaler; muscle weakness; nausea and vomiting; obesity; occupational asthma; occupational exposure; oropharynx candidiasis; outpatient care; oxygen therapy; patient compliance; patient education; phenotype

Observations on Degenerative Changes Within the Optic Nerve in Patients With Primary Open Glaucoma and Arterial Hypertension: 6-Month Follow-Up - Krasińska, B.; Banach, M.; Karolczak-Kulesza, M.; Krasiński, Z.; Gluszek, J.; Tykarski, A. (Journal of Clinical Hypertension, 2012)
The authors aimed to determine the effect of the time of hypotensive drug administration on the progress of degenerative changes within the optic nerve in patients with hypertension and glaucoma. Two groups were included in the study: group A comprised patients-dippers taking drugs in the mornings, and group B comprised patients-nondippers taking drugs both in the mornings and in the evenings. After 6months, group B showed significant drops in nocturnal diastolic blood pressure (BP) (month 1=73.27mmHg vs month 6=67.50mmHg), nocturnal mean BP (89.34 vs 84.65mmHg), and minimum diastolic BP (50.74 vs 44.03mmHg). Group B also showed significant reductions in nocturnal ocular perfusion pressure (43.0 vs 39.73), retinal nerve fiber layer thickness (131.31 vs 113.12μm), and flow in the eye vessels. Taking hypotensive drugs in the evening may significantly decrease blood flow in the eye arteries, cause degenerative changes within the optic nerves, and result in greater loss in the field of vision. © 2012 Wiley Periodicals, Inc.
Keywords: amlodipine; antihypertensive agent; beta adrenergic receptor blocking agent; bisoprolol; calcium channel blocking agent; carbonate dehydratase inhibitor; dipeptidyl carboxypeptidase inhibitor; diuretic agent; indapamide; prostaglandin derivative; ramipril; adult; aging; ambulatory monitoring; antihypertensive therapy; artery blood flow; article; blood pressure monitoring; circadian rhythm; diastolic blood pressure; disease course; evening dosage; eye blood flow; female; glaucoma; hemodynamic parameters; human; hypertension; intraocular pressure; major clinical study; male; morning dosage; ocular blood vessel; open angle glaucoma; optic nerve; priority journal; retina; systolic blood pressure; vision

Oral delivery of small RNA and DNA - Forbes, D.C.; Peppas, N.A. (Journal of Controlled Release, 2012)
The promise of short RNA or DNA segments such as siRNAs, antisense oligonucleotides, and transcription factor decoys to treat disease has prompted nearly 40 clinical trials for RNA interference (RNAi)-based therapeutics and more than 100 clinical trials for antisense oligonucleotide-based technologies; in fact, there are promising in vivo and preclinical studies for many hundreds of technologies. Current treatment strategies are largely injection-based, so effective oral delivery platforms for oligonucleotides may result in improved patient comfort and compliance. We analyze recently developed oral delivery methods for short RNA and DNA segments. © 2012 Elsevier B.V.
Keywords: NCT00144589; NCT00259753; NCT00306904; NCT00363714; NCT00395057; NCT00499590; NCT00557791; NCT00658086; NCT00672542; NCT00689065; NCT00701181; NCT00713518; NCT00716014; NCT00722384; NCT00725686; NCT00802347; NCT00882180; NCT00927459; NCT00938574; NCT00990743; NCT01064505; NCT01065935; NCT01148953; NCT01158079; NCT01188785; NCT01227291; NCT01262235; NCT01437007; NCT01437059; NCT01438281; agn 211745; alginic acid; antisense oligonucleotide; bevasiranib; chitosan; eudragit; microRNA; nanoparticle; nanosphere; nucb 1000; pf 04523655; polyethyleneimine; polylactide; polyvinyl alcohol; pr 04523655; qpi 1007; short hairpin RNA; small interfering RNA; syl 040012; syl 1001; unclassified drug; acquired immune deficiency syndrome; diabetic macular edema; dry eye; eye pain; gene therapy; glaucoma; hepatitis B; human; Human immunodeficiency virus infection; hydrogel; lymphoma; melanoma; nonhuman; ocluar pain; ocluar pain; patient compliance; priority journal; age related macular degeneration; review; RNA interference; transcription regulation; agn 211745; nucb 1000; pf 04523655; qpi 1007; syl 040012; syl 1001

Glucocorticoid-Induced Osteoporosis and Osteonecrosis - Weinstein, R.S. (Endocrinology and Metabolism Clinics of North America, 2012)
Glucocorticoid administration is the most common cause of secondary osteoporosis and the leading cause of nontraumatic osteonecrosis. In patients receiving long-term therapy, glucocorticoids induce fractures in 30% to 50% and osteonecrosis in 9% to 40%. This article reviews glucocorticoid-induced osteoporosis and osteonecrosis, addressing the risk factors, pathogenesis, evaluation, treatment, and uncertainties in the clinical management of these disorders. © 2012.
Keywords: 25 hydroxyvitamin D; alendronic acid; antineoplastic agent; bisphosphonic acid derivative; calcium; corticosteroid; cortisone; creatinine; denosumab; dexamethasone; glucocorticoid; glucose; hydrocortisone; ibuprofen; lipid; methotrexate; methylprednisolone; osteoprotegerin; paracetamol; parathyroid hormone[1-34]; placebo; potassium; prednisolone; prednisone; risedronic acid; zoledronic acid; adrenal insufficiency; adverse outcome; bone density; bone necrosis; breast cancer; calcium blood level; cancer combination chemotherapy; cataract; clinical evaluation; contusion; corticosteroid induced osteoporosis; creatinine blood level; dizziness; drug absorption; drug effect; drug megadose; drug potency; drug safety; drug withdrawal; fever; fluid retention; glaucoma; glucose blood level; headache; healing impairment; hip fracture; human; hypercalcemia; hyperglycemia; hyperlipidemia; hypertension; hypokalemia; infection; jaw osteonecrosis; leg cramp; lipid blood level; low drug dose; molecular pathology; multiple myeloma; musculoskeletal pain; myopathy; nausea; nonhuman; osteoporosis; outcome assessment; patient compliance; percutaneous vertebroplasty; potassium blood level; priority journal; review; rheumatoid arthritis; risk assessment; risk factor; side effect; total hip prosthesis; treatment duration; treatment planning; unspecified side effect; spine fracture; vitamin blood level; body weight gain; withdrawal syndrome; cortef; decadron; deltasone; dexasone; medrol

Long-term medical management of primary open-angle glaucoma and ocular hypertension in the UK: Optimizing cost-effectiveness and clinic resources by minimizing therapy switches - Orme, M.; Collins, S.; Loftus, J. (Journal of Glaucoma, 2012)
PURPOSE: The objective was to assess the long-term economic consequences of the medical management of glaucoma in the UK. METHODS: The economic evaluation was conducted using the results from a 10-year Markov model based around 3 key triggers for a switch in medical therapy for glaucoma, namely: lack of tolerance (using hyperemia as a proxy); intraocular pressure (IOP) not meeting treatment benchmark; and glaucoma progression. Clinical data from a comprehensive systematic literature review and meta-analysis were used. Direct costs associated with glaucoma treatment are considered (at 2008/9 prices) from the perspective of the UK NHS as payer (outpatient/secondary care setting). Using this model, the economic consequences of 3 prostaglandin-based treatment sequences were compared. RESULTS: Drug acquisition costs account for around 8% to 13% of the total cost of glaucoma and, if ophthalmologist visits are included, amount to approximately £0.80 to £0.90 per day of medical therapy. The total long-term costs of all prostaglandin strategies are similar because of a shift in resources: increased drug costs are offset by fewer clinic visits to instigate treatment switches, and by avoiding surgery or costs associated with managing low vision. Under the latanoprost-based strategy, patients would have longer intervals between the need to switch therapies, which is largely due to a reduction in hyperemia, seen as a proxy for tolerance. This leads to a delay in glaucoma progression of 12 to 13 months. For every 1000 clinic appointments, 719 patients can be managed for 1 year with a latanoprost-based strategy compared with 586 or 568 with a bimatoprost or travoprost-based strategy. CONCLUSIONS: Drug acquisition costs are not a key driver of the total cost of glaucoma management and the cost of medical therapy is offset by avoiding the cost of managing low vision. Economic models of glaucoma should include the long-term consequences of treatment as these will affect cost-effectiveness. This analysis supports the hypothesis that the economic and clinical benefits can be optimized by minimizing therapy switches. Copyright © 2012 by Lippincott Williams & Wilkins.
Keywords: antihypertensive agent; beta adrenergic receptor blocking agent; bimatoprost; bimatoprost plus timolol; brimonidine; brimonidine plus timolol; brinzolamide; carbonate dehydratase inhibitor; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; prostaglandin derivative; timolol; timolol plus travoprost; travoprost; conjunctival hyperemia; consultation; cost effectiveness analysis; disease course; drug cost; drug efficacy; drug safety; drug substitution; drug tolerance; lack of drug effect; economic evaluation; follow up; health care cost; health care utilization; human; intraocular hypertension; long term care; meta analysis; open angle glaucoma; patient compliance; priority journal; quality of life; review; statistical model; systematic review; treatment outcome; United Kingdom

Evaluating objective and subjective quantitative parameters at the initial visit to predict future glaucomatous visual field progression - Ungar, A.K.; Wollstein, G.; Ishikawa, H.; Folio, L.S.; Ling, Y.; Bilonick, R.A.; Noecker, R.J.; Xu, J.; Kagemann, L.; Mattox, C.; Schuman, J.S. (Ophthalmic Surgery Lasers and Imaging, 2012)
■ BACKGROUND AND OBJECTIVE: To evaluate the ability of structural assessment to predict glaucomatous visual field progression. ■ PATIENTS AND METHODS: A total of 119 healthy eyes with suspected glaucoma and glaucomatous eyes with 5 or more optic nerve stereophotographs, optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy (CSLO) all acquired within 6 months of each other were enrolled. Odds ratios to predict progression were determined by generalized estimating equation models. ■ RESULTS: Median follow-up was 4.0 years (range: 1.5 to 5.7 years). Fifteen eyes progressed by glaucoma progression analysis, 20 by visual field index, and 10 by both. Baseline parameters from stereophotographs (vertical cup-to-disc ratio and Disc Damage Likelihood Scale), OCT (global, superior quadrant, and inferior quadrant retinal nerve fiber layer thickness), and CSLO (cup shape measure and mean cup depth) were significant predictors of progression. Comparing the single best parameter from all models, only the OCT superior quadrant RNFL predicted progression. ■ CONCLUSION: Baseline stereophotographs, OCT, and CSLO measurements may be clinically useful to predict glaucomatous visual field progression. Copyright © SLACK Incorporated.
Keywords: adult; ambulatory care; article; clinical assessment; disease course; eye photography; female; follow up; glaucoma; glaucomatous visual field progression; human; major clinical study; male; optic disk cup; optic nerve; optical coherence tomography; prediction; priority journal; scanning laser ophthalmoscopy; visual acuity; visual field

Challenges and opportunities in achieving bioequivalence for fixed-dose combination products - Mitra, A.; Wu, Y. (AAPS Journal, 2012)
Fixed-dose combination (FDC) products are becoming a popular treatment option because of increased patient compliance and convenience, improved clinical effectiveness, and reduced cost to the patient, among several other reasons. A commonly applied approach for approval of a FDC product is demonstrating bioequivalence between the FDC and co-administration of individual mono-products, provided that there is adequate safety and efficacy data for co-administration of the individual agents. However, achieving bioequivalence between the FDC and individual mono-products can be very challenging, and sometimes not possible since combining multiple active ingredients, especially insoluble molecules, in a single drug product could complicate its biopharmaceutical and pharmacokinetic behavior. In this review, some of the major challenges often encountered while assessing bioequivalence during FDC development will be presented along with discussion of future opportunities to facilitate FDC development and approval. © 2012 American Association of Pharmaceutical Scientists.
Keywords: amodiaquine; amodiaquine plus artesunate; coarsucam; dorzolamide plus timolol; drug; drug metabolite; drug product; efavirenz plus emtricitabine plus tenofovir disoproxil; emtricitabine plus tenofovir disoproxil; esomeprazole; esomeprazole plus naproxen; ethambutol plus isoniazid plus pyrazinamide plus rifampicin; fixed dose combination product; highly variable drug; isoniazid; isoniazid plus rifampicin; losartan; metformin; metformin plus pioglitazone; metformin plus saxagliptin; metformin plus sitagliptin; metoprolol; mono product; naproxen; nicotinic acid; nicotinic acid plus simvastatin; rifampicin; simvastatin plus sitagliptin; sitagliptin; tetracycline; unclassified drug; unindexed drug; xeed; bioequivalence; drug absorption; drug approval; drug bioavailability; drug combination; drug development; drug dosage form comparison; drug efficacy; drug formulation; drug safety; dyslipidemia; fixed dose combination; food; glaucoma; human; Human immunodeficiency virus infection; hypercholesterolemia; hyperlipidemia; maximum plasma concentration; non insulin dependent diabetes mellitus; nonhuman; patient compliance; review; atripla; coarsucam; cosopt; janumet; juvisync; kombiglyze; nexium; simcor; truvada; vimovo; xeed

Glaucoma medications: How to improve compliance and adherence - Cakiner-Egilmez, T.; Lara-Smalling, A. (Insight - Journal of the American Society of Ophthalmic Registered Nurses, 2012)
Keywords: antihypertensive agent; article; drug effect; glaucoma; human; intraocular pressure; patient compliance

Pharmacotherapy considerations in elderly adults - Wooten, J.M. (Southern Medical Journal, 2012)
Life expectancy for Americans has increased dramatically since 1900, as have the available pharmacotherapeutic options. Unfortunately, pharmacotherapy mishaps occur commonly in the older adult population. This problem greatly affects the morbidity and mortality of elderly patients and greatly increases healthcare costs. To improve patient care among elderly adults, healthcare practitioners must consider several issues when developing a pharmacotherapy plan. A thorough understanding of pharmacokinetics, pharmacodynamics, adverse drug reactions, drug interactions, and several other factors is necessary for practitioners to develop a safe and effective drug therapy plan for older adults. This review provides a general but comprehensive review of the issues pertaining to pharmacotherapy in elderly people and offers several suggestions for improving their pharmaceutical care. © 2012 by The Southern Medical Association.
Keywords: amitriptyline; analgesic agent; antidepressant agent; antihistaminic agent; antitussive agent; benzodiazepine derivative; cytochrome P450; diazepam; digoxin; dipeptidyl carboxypeptidase inhibitor; diphenhydramine; diuretic agent; furosemide; hydrochlorothiazide; ibuprofen; intestine contraction stimulating agent; lisinopril; lorazepam; morphine; muscle relaxant agent; naproxen; neuroleptic agent; non prescription drug; nonsteroid antiinflammatory agent; opiate; prednisone; propranolol; tramadol; unindexed drug; warfarin; amnesia; anticholinergic syndrome; balance impairment; bladder disease; bleeding; blood pressure; blurred vision; closed angle glaucoma; cognitive defect; concentration loss; confusion; constipation; creatinine clearance; dehydration; delirium; dementia; diarrhea; disorientation; dizziness; drowsiness; drug absorption; drug distribution; drug efficacy; drug elimination; drug excretion; drug half life; drug interaction; drug protein binding; elderly care; electrolyte disturbance; falling; first pass effect; fracture; gait disorder; gastrointestinal disease; gastrointestinal hemorrhage; gastrointestinal motility; gastrointestinal symptom; glomerulus filtration rate; health literacy; heart arrhythmia; human; hyperglycemia; hypotension; kidney disease; liver metabolism; medical decision making; mental health; motor dysfunction; nausea; orthostatic hypotension; osteoporosis; outcome assessment; patient compliance; patient monitoring; polypharmacy; practice guideline; QT prolongation; review; sedation; side effect; sweating; urinary dysfunction; urinary hesitancy; urine incontinence; urine retention; vomiting; xerostomia

Development and in-vitro characterization of ocular insert containing erythromycin - Kaul, S.; Kumar, G.; Kothiyal, P. (International Research Journal of Pharmacy, 2012)
Ocular drug delivery is one of the most fascinating and challenging tasks being faced by the Pharmaceutical researchers. The challenges to the formulator are to circumvent the protective barriers of the eye without causing permanent tissue damage, maintain a therapeutic level at the site of action for prolonged period of time. The eye drop dosage form is easy to instill but suffers the drawback of getting the medication immediately diluted in the tear film as soon it is instilled into the cul-de-sac and is rapidly drained away, therefore, only a very small fraction of the instilled dose is absorbed into the target tissues. The frequent periodic instillation of eye drops becomes necessary to maintain a continuous sustained level of medication, which may lead to systemic side effects. Frequent dosing of large doses of drug becomes necessary to achieve the therapeutic objective which often results in corresponding increase in local and systemic side effects. So research on Novel ophthalmic drug delivery systems is in progress to overcome all these disadvantages of conventional ophthalmic dosage forms. In the present study, efforts were made for designing and evaluating Erythromycin ocular inserts. Erythromycin, a macrolide antibiotic is highly useful for the treatment of trachoma, conjunctivitis and keratitis. Erythromycin suffered the disadvantage of instillation as it is available as 0.5% w/w ointment to be placed in eye 6 times a day and hence maximized patient non compliance, leading to ineffective therapy. Various batches of Erythromycin ocular inserts were prepared by solvent casting method using HPMC- K4M, PVP K30 and MC as polymers and PEG-400 as plasticizer. The formulated ocuserts were then evaluated for their average weight variation, thickness, folding endurance, swelling index, drug content, invitro drug release. © 2010 IRJP.
Keywords: erythromycin; hydroxypropylmethylcellulose; macrogol 400; methylcellulose; article; drug delivery system; drug design; drug instillation; drug release; drug screening; drug synthesis; in vitro study; ointment; patient compliance; thickness

A 2-hour information session and patient recall has minimal impact on glaucoma-treatment persistence in a mature practice - Blondeau, P.; Carbonneau, M.; Esper, P.; Turcotte, P.-C. (Journal of Glaucoma, 2012)
PURPOSE: To study the impact of a 2-hour information session and 3 patients' phone calls on patient persistence with glaucoma medication. PATIENTS AND METHODS: All patients with glaucoma treatment, part of a 27-year old solo glaucoma practice, were invited to attend the information session. Patients who attended the session (n=342) were contacted by phone 1, 4, 10 months later and regular use of drops was stressed. Patients were unaware of the study. We compared the persistence of the patients before and after attending the session, and their persistence to that of patients who did not attend (n=1187). Persistence with glaucoma medication was assessed by examination of data (2002 to 2007) from a provincial medical and drug insurance database. RESULTS: Patients attending the session had glaucoma for 10 years. They had a better persistence than those who did not attend (P<0.05). Their persistence remained the same 1 year after attending the session but tended to be improved in the first 180 days (P<0.076). During the study period, there was a 4% increase in overall persistence (P<0.05). This could be due to an increase in prostaglandins prescriptions and changes in β2-blockers formulation. CONCLUSIONS: The information session and patient's recalls had a limited impact on patient persistence. This could be due to the selection of a population already persistent (78.9%). The results could have been different in less persistent patients and new patients. It could be different in another practice setting. Copyright © 2012 by Lippincott Williams & Wilkins.
Keywords: beta adrenergic receptor blocking agent; prostaglandin; article; glaucoma; human; major clinical study; medical practice; patient compliance; patient information; prescription; priority journal; recall

Mirabegron - a selective β3-adrenoreceptor agonist for the treatment of overactive bladder - Bhide, A.A.; Alessandro Digesu, G.; Fernando, R.; Khullar, V. (Open Access Journal of Urology, 2012)
Overactive bladder is a common condition that significantly impacts overall quality of life. Antimuscarinics are the current main pharmacological option for treatment; however, many patients fail to adhere to therapy due to troublesome side effects. Mirabegron is a new beta-3 adrenoreceptor agonist which causes detrusor smooth muscle relaxation and has been proposed to be effective for treating overactive bladder symptoms. Mirabegron has been shown to be superior to placebo for reducing the mean number of incontinence episodes per 24 hours and the mean number of micturitions per 24 hours. Side effects such as dry mouth were observed at similar or lower rates than those seen for placebo and antimuscarinics. Higher doses of mirabegron were associated with minor increases in pulse rate and mean blood pressure. Mirabegron offers a new alternative for treating overactive bladder in patients for which antimuscarinics are either not tolerated or not appropriate. © 2012 Bhide et al, publisher and licensee Dove Medical Press Ltd.
Keywords: NCT01340027; beta 3 adrenergic receptor stimulating agent; cytochrome P450 2D6; cytochrome P450 3A4; darifenacin; desipramine; metformin; mirabegron; muscarinic receptor; muscarinic receptor blocking agent; oxybutynin; placebo; solifenacin; tolterodine; trospium chloride; absence of side effects; bladder training; blurred vision; closed angle glaucoma; constipation; detrusor muscle; disorientation; dizziness; drowsiness; drug dose comparison; drug efficacy; drug fatality; drug half life; drug metabolism; drug safety; drug selectivity; drug tolerability; drug urine level; drug withdrawal; dry eye; fatigue; flatulence; gastrointestinal disease; gastrointestinal symptom; hallucination; headache; heart rate; human; hypertension; infection; infestation; intraocular pressure; maximum plasma concentration; mean arterial pressure; multicenter study (topic); nonhuman; overactive bladder; patient compliance; patient satisfaction; phase 2 clinical trial (topic); phase 3 clinical trial (topic); pulse rate; quality of life; randomized controlled trial (topic); receptor blocking; restlessness; review; rhinopharyngitis; side effect; single drug dose; smooth muscle relaxation; taste disorder; treatment outcome; urinary frequency; urinary tract infection; urine incontinence; xerostomia

Reply - Wu, E.I.; Ritterband, D.C.; Yu, G.; Shields, R.A.; Seedor, J.A. (American Journal of Ophthalmology, 2012)
Keywords: difluprednate; fluorometholone; loteprednol; prednisolone acetate; steroid; clinical feature; hereditary corneal dystrophy; cornea neovascularization; Descemet stripping endothelial keratoplasty; drug substitution; drug withdrawal; eye synechia; glaucoma; graft failure; graft rejection; high risk patient; human; inflammation; intraocular pressure; keratopathy; letter; maintenance therapy; patient compliance; penetrating keratoplasty; postoperative care; priority journal; race; treatment duration; treatment failure; treatment indication; treatment response

Novel drug delivery approaches on antiviral and antiretroviral agents - Arora, S.; Chawla, A.; Pawar, P.; Sharma, P. (Journal of Advanced Pharmaceutical Technology and Research, 2012)
Viruses have the property to replicate very fast in host cell. It can attack any part of host cell. Therefore, the clinical efficacy of antiviral drugs and its bioavailability is more important concern taken into account to treat viral infections. The oral and parenteral routes of drug administration have several shortcomings, however, which could lead to the search for formulating better delivery systems. Now, a day′s novel drug delivery systems (NDDS) proved to be a better approach to enhance the effectiveness of the antivirals and improve the patient compliance and decrease the adverse effect. The NDDS have reduced the dosing frequency and shorten the duration of treatment, thus, which could lead the treatment more cost-effective. The development of NDDS for antiviral and antiretroviral therapy aims to deliver the drug devoid of toxicity, with high compatibility and biodegradability, targeting the drug to specific sites for viral infection and in some instances it also avoid the first pass metabolism effect. This article aims to discuss the usefulness of novel delivery approaches of antiviral agents such as niosomes, microspheres, microemulsions, nanoparticles that are used in the treatment of various Herpes viruses and in human immunodeficiency virus (HIV) infections.
Keywords: aciclovir; antiretrovirus agent; antivirus agent; atazanavir; beta cyclodextrin; chickenpox vaccine; cidofovir; drug carrier; ethosome; famciclovir; foscarnet; ganciclovir; glycyrrhizic acid; idoxuridine; indinavir; liposome; macrogol; nanoparticle; nevirapine; niosome; nonnucleoside reverse transcriptase inhibitor; penciclovir; polymer; RNA directed DNA polymerase inhibitor; solid lipid nanoparticle; unclassified drug; unindexed drug; valaciclovir; valganciclovir; varicella zoster vaccine; Wart virus vaccine; adenovirus infection; adverse drug reaction; anus cancer; biocompatibility; biodegradability; bone marrow toxicity; chickenpox; conference paper; cost effectiveness analysis; cytomegalovirus infection; DNA virus; drug delivery system; drug dosage form comparison; drug efficacy; drug formulation; drug safety; drug synthesis; first pass effect; genital herpes; herpes labialis; herpes simplex; herpes simplex keratitis; herpes zoster; human; Human immunodeficiency virus infection; human T cell leukemia virus; Kaposi varicelliform eruption; keratoconjunctivitis; microemulsion; nanopharmaceutics; nephrotoxicity; nonhuman; novel drug delivery system; papillomavirus infection; patient compliance; physical chemistry; priority journal; RNA virus; treatment duration; uterine cervix cancer; viral skin disease; cervarix; cymevene; cytovene; gardasil; varivax; virgan; virusan; vitrasert; zostavax

COPD and associated Comorbidities: A review of current diagnosis and treatment - Carlin, B.W. (Postgraduate Medicine, 2012)
Health care utilization and costs associated with chronic obstructive pulmonary disease (COPD) continue to increase, notwithstanding evidence-based management strategies described by major respiratory societies. Cardiovascular diseases, asthma, diabetes and its precursors (obesity and metabolic syndrome), depression, cognitive impairment, and osteoporosis are examples of common comorbidities that can affect or be affected by COPD. Appropriate diagnosis and management (from a pharmacologic and nonpharmacologic perspective) of COPD and its associated comorbidities are important to ensure optimal patient care. An evolving understanding of COPD as a multimorbid disease that affects an aging population, rather than just a lung-specific disease, necessitates an integrated, tailored disease-management approach to improve prognoses and reduce costs. © Postgraduate Medicine.
Keywords: beta 2 adrenergic receptor stimulating agent; budesonide; carbocisteine; cholinergic receptor blocking agent; corticosteroid; fluticasone; formoterol; hydroxymethylglutaryl coenzyme A reductase kinase activator; ipratropium bromide; long acting drug; methylxanthine derivative; phosphodiesterase IV inhibitor; prednisone; roflumilast; salbutamol; salmeterol; theophylline; tiotropium bromide; adrenal suppression; aged; aging; article; asthma; blood pressure; cardiovascular disease; chronic obstructive lung disease; cognitive defect; comorbidity; depression; diabetes mellitus; diagnostic test; diarrhea; disease association; disease exacerbation; drug megadose; dysphonia; evidence based medicine; glaucoma; health care access; health care cost; health care utilization; health insurance; heart arrhythmia; heart failure; heart palpitation; human; hypokalemia; insomnia; integrative medicine; medical society; metabolic syndrome X; mucosal dryness; myopathy; nausea; obesity; osteoporosis; palliative therapy; patient care; pneumonia; practice guideline; prognosis; screening test; seizure; self care; side effect; skin atrophy; tachycardia; thrush; tremor; unspecified side effect; urine retention; vomiting; body weight loss

Help ensure that the change to generic latanoprost is free of problems - Titcomb, L. (Pharmaceutical Journal, 2012)
Keywords: bimatoprost plus timolol; dorzolamide plus timolol; eye drops; generic drug; latanoprost; latanoprost plus timolol; timolol plus travoprost; drug delivery system; drug efficacy; drug indication; drug safety; drug storage; glaucoma; human; intraocular hypertension; licence; osmolality; patient compliance; pH; pharmacist; short survey; duotrav; ganfort; xalacom; xalatan; Opticare Arthro; Xal-ease

Ophthalmic drug delivery by contact lenses - Jung Jung, H.; Chauhan, A. (Expert Review of Ophthalmology, 2012)
Keywords: agents acting on the eye; alpha tocopherol; beta adrenergic receptor blocking agent; eye drops; ketotifen fumarate; timolol; cardiotoxicity; contact lens; controlled drug release; drug absorption; drug bioavailability; drug delivery system; drug efficacy; drug formulation; drug instillation; drug safety; eye disease; glaucoma; human; mean residence time; nonhuman; open angle glaucoma; patient compliance; review; soft contact lens; tear film; unspecified side effect

Attitudes of physicians, patients, and village health workers toward glaucoma and diabetic retinopathy in rural China: A focus group study - Yan, X.; Liu, T.; Gruber, L.; He, M.; Congdon, N. (Archives of Ophthalmology, 2012)
Objective: To understand the knowledge and attitudes of rural Chinese physicians, patients, and village health workers (VHWs) toward diabetic eye disease and glaucoma. Methods: Focus groups for each of the 3 stakeholders were conducted in 3 counties (9 groups). The focus groups were recorded, transcribed, and coded using specialized software. Responses to questions about barriers to compliance and interventions to remove these barriers were also ranked and scored. Results: Among 22 physicians, 23 patients, and 25 VHWs, knowledge about diabetic eye disease was generally good, but physicians and patients understood glaucoma only as an acutely symptomatic disease of relatively low prevalence. Physicians did not favor routine pupillary dilation to detect asymptomatic disease, expressing concerns about workflow and danger and inconvenience to patients. Providers believed that cost was the main barrier to patient compliance, whereas patients ranked poorly trained physicians as more important. All 3 stakeholder groups ranked financial interventions to improve compliance (eg, direct payment, lotteries, and contracts) low and preferred patient education and telephone contact by nurses. All the groups somewhat doubted the ability of VHWs to screen for eye disease accurately, but patients were generally willing to pay for VHW screening. The VHWs were uncertain about the value of eye care training but might accept it if accompanied by equipment. They did not rank payment for screening services as important. Conclusions: Misconceptions about glaucoma's asymptomatic nature and an unwillingness to routinely examine asymptomatic patients must be addressed in training programs. Home contact by nurses and patient education may be the most appropriate interventions to improve compliance.
Keywords: glucose; adult; aged; article; China; diabetic retinopathy; diet; educational status; eye care; female; financial management; glaucoma; glucose blood level; health care cost; health care personnel; human; major clinical study; male; medical education; mydriasis; optical coherence tomography; patient attitude; patient compliance; patient education; physician attitude; priority journal; rural area; vitrectomy; work experience

Shared care for chronic eye diseases: Perspectives of ophthalmologists, optometrists and patients - O'Connor, P.M.; Alex Harper, C.; Brunton, C.L.; Clews, S.J.; Haymes, S.A.; Keeffe, J.E. (Medical Journal of Australia, 2012)
Objective: To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases. Design, setting and participants: Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable agerelated macular degeneration, diabetic retinopathy and glaucoma, trialled by the Royal Victorian Eye and Ear Hospital in Melbourne during 2007-2009. Semistructured interviews were conducted with optometrists, ophthalmologists and patients at completion of the project to obtain their perspectives on this model. Results: Seventeen optometrists submitted expressions of interest to participate, and 12 completed web-based training modules and clinical observerships and adhered to specified examination and reporting protocols. All five participating ophthalmologists and 11 of the optometrists were interviewed. Ninety-eight patients participated and 37 were interviewed. Optometrists not only met ophthalmologists' expectations but exceeded them, appropriately detecting and referring patients with additional, previously undetected conditions. Patients reported savings in travel time and were satisfied with the quality of care they received. Optometrists, ophthalmologists and patients indicated a general acceptance of shared care arrangements, although there were some issues relating to interprofessional trust. Conclusions: Shared care between local optometrists and hospital-based ophthalmologists can help to reduce patient waiting time for review and offers an opportunity for these two groups of eye care professionals to collaborate in providing localised care for the benefit of patients. However, trust and relationship building need to be further developed.
Keywords: adult; aged; article; Australia; cataract extraction; chronic disease; community care; controlled study; diabetic retinopathy; disease course; doctor patient relationship; eye care; eye disease; female; glaucoma; health care; health care access; health care quality; human; intraocular hypertension; intraocular pressure; major clinical study; male; ophthalmologist; optometrist; patient care; patient satisfaction; personal experience; physician; pigment epithelium; practice guideline; qualitative research; age related macular degeneration; rural area; semi structured interview; trust; urban area; visual acuity

Randomized clinical trial of the efficacy and safety of preservative-free tafluprost and timolol in patients with open-angle glaucoma or ocular hypertension - Chabi, A.; Varma, R.; Tsai, J.C.; Lupinacci, R.; Pigeon, J.; Baranak, C.; Noble, L.; Lines, C.; Ho, T.W. (American Journal of Ophthalmology, 2012)
Purpose: To compare the efficacy and safety of tafluprost, a preservative-free (PF) prostaglandin analogue, with PF timolol in patients with open-angle glaucoma or ocular hypertension. Design: Randomized, double-masked, multicenter clinical trial. Methods: After discontinuation and washout of existing ocular hypotensive treatment, patients who had intraocular pressure (IOP) <23 and ≤36 mm Hg in at least 1 eye at the 08:00 hour time point were randomized 1:1 to 12 weeks of treatment with either PF tafluprost 0.0015% or PF timolol 0.5%. IOP was measured 3 times during the day (08:00, 10:00, 16:00 hours) at baseline and at weeks 2, 6, and 12. It was hypothesized that PF tafluprost would be noninferior to PF timolol over 12 weeks with regard to change from baseline IOP. The trial was powered for a noninferiority margin of 1.5 mm Hg at each of the 9 time points assessed. Results: A total of 643 patients were randomized and 618 completed (PF tafluprost = 306, PF timolol = 312). IOPs at the 3 time points assessed during the baseline visit ranged from 23.8 to 26.1 mm Hg in the PF tafluprost group and 23.5 to 26.0 mm Hg in the PF timolol group. IOPs at the 3 time points assessed during the 12-week visit ranged from 17.4 to 18.6 mm Hg for PF tafluprost and 17.9 to 18.5 mm Hg for PF timolol. At all 9 time points, the upper limits of the 2-sided 95% confidence intervals for the difference between treatments in IOP lowering were less than the prespecified noninferiority margin. Similar percentages of PF tafluprost and PF timolol patients reported ocular pain/stinging/irritation (4.4% vs 4.6%) and pruritus (2.5% vs 1.5%). The percentages of PF tafluprost and PF timolol patients reporting conjunctival hyperemia were 4.4% vs 1.2% (nominal P =.016). Conclusions: The IOP-lowering effect of PF tafluprost was noninferior to that of PF timolol. PF tafluprost is an efficacious and generally well-tolerated ocular hypotensive agent. © 2012 Elsevier Inc. All rights reserved.
Keywords: NCT01026831; bimatoprost; brinzolamide; dorzolamide; latanoprost; tafluprost; timolol; travoprost; adult; article; blurred vision; colitis; conjunctival hyperemia; controlled study; dizziness; double blind procedure; drug effect; drug efficacy; drug fatality; drug safety; evening dosage; eye irritation; eye pain; female; fracture; headache; atrial fibrillation; heart infarction; hernia; human; intraocular hypertension; intraocular pressure; joint dislocation; keratitis; lung embolism; major clinical study; male; morning dosage; multicenter study; ocular pruritus; open angle glaucoma; patient compliance; photophobia; priority journal; retina detachment; tendon rupture; treatment duration; visual acuity

The future of combining inhaled drugs for COPD - Bjerg, A.; Lundbäck, B.; Lötvall, J. (Current Opinion in Pharmacology, 2012)
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality globally, and its prevalence is projected to continue to increase owing to trends in smoking. Treatment of COPD has evolved from the initial adaptations of drugs and treatment strategies successfully used in asthma into more specific pharmacological strategies following global guidelines. Bronchodilating anticholinergic and beta-2-stimulating agents and anti-inflammatory corticosteroid drugs delivered by inhalators are the mainstay of COPD treatment. Despite significant progress, current pharmacotherapies neither fully alleviate the airway obstruction in COPD, nor reverse the progressive nature of the disease. This review discusses inhalation therapies which have recently become clinically available or are being developed, with focus on combination therapies. There is accumulating evidence that the combination of two or all three drug classes, triple therapy, is superior to single drug therapy. Several fixed combinations of both currently available and novel molecules will be launched for clinical use within the next few years. Also, improved understanding of subgroups within the clinical spectrum of COPD, is likely to offer new potentials to improve COPD care. © 2012 Elsevier Ltd. All rights reserved.
Keywords: beclometasone; beclometasone dipropionate plus formoterol fumarate; beta 2 adrenergic receptor stimulating agent; bronchodilating agent; budesonide; budesonide plus formoterol; carmoterol; cholinergic receptor blocking agent; ciclesonide; corticosteroid; flunisolide; fluticasone furoate; fluticasone propionate; fluticasone propionate plus salmeterol; fluticasone propionate plus salmeterol xinafoate; formoterol; formoterol fumarate plus mometasone furoate; glycopyrronium; gsk 961081; indacaterol; ipratropium bromide; mometasone furoate; olodaterol; pf 3429281; placebo; salmeterol; tiotropium bromide; triamcinolone; unclassified drug; unindexed drug; vilanterol trifenatate; article; asthma; bronchus obstruction; cardiovascular risk; chronic obstructive lung disease; combination chemotherapy; constipation; drug efficacy; drug mechanism; drug safety; drug tolerability; hoarseness; human; intraocular hypertension; nonhuman; patient compliance; priority journal; risk assessment; systemic disease; thrush; tremor; urine retention; xerostomia; gsk 961081; pf 3429281; seretide; symbicort

Avoidable sight loss from glaucoma: Is it unavoidable? - Kotecha, A.; Fernandes, S.; Bunce, C.; Franks, W.A. (British Journal of Ophthalmology, 2012)
Aims: To review the characteristics of patients attending a tertiary ophthalmic referral centre certified as sight impaired (SI) or severely sight impaired (SSI) from glaucoma. Methods: One hundred consecutive patients certified SI/SSI from the Glaucoma Service at Moorfields Eye Hospital, London, from January 2007 were identified from the England and Wales certification of visual impairment database. Clinical and demographic data were collected from hospital case records. Results: The median (IQR) age of patients at presentation was 66.3 (55.6 to 75.3) years; median (IQR) interval to certification was 62.2 (22.5 to 129.3) months. Fifty-seven patients presented with bilateral SSI (median (IQR) age 70.4 (59.0 to 76.9) years); interval to certification was 35.4 (5.6 to 78.1) months. Seventeen patients presented with a bilateral SI (median (IQR) age 62.1 (58.7 to 68.4) years; median (IQR) interval to certification: 137.4 (64.4 to 190.4) months). Twentyeight patients showed disease progression while under National Health Service hospital eye service care, five of whom had no certifiable visual impairment in either eye at presentation. This was attributed to inadequate intraocular pressure control; five of these patients (18%) were deemed poorly compliant to topical hypotensive medication. Conclusions: Over 80% patients on the certification of visual impairment register from Moorfields Eye Hospital with glaucoma as the primary cause had a significant visual disability at presentation, with almost two-thirds of patients presenting bilaterally 'blind'. There appear to be delays to certification. Despite being under the hospital eye service, a number of glaucoma patients still progress to certifiable visual impairment.
Keywords: antihypertensive agent; adult; aged; article; certification; disease course; disease registry; eye care; female; human; intraocular pressure; major clinical study; male; national health service; open angle glaucoma; patient compliance; priority journal; retrospective study; tertiary health care; United Kingdom; visual impairment

Continuous 24-hour intraocular pressure monitoring for glaucoma--time for a paradigm change. - Mansouri, K.; Weinreb, R. (Swiss medical weekly, 2012)
Glaucoma is the main cause of irreversible blindness and intraocular pressure (IOP) is its only modifiable risk factor. The importance of robust lowering of IOP for prevention of glaucoma onset and progression is well established. Although IOP is a dynamic parameter with individual circadian rhythms, current management usually relies on single IOP measurements during regular clinic hours performed a few times a year. Recent technological advances have provided clinicians with tools for continuous IOP monitoring during a 24 hour period in an ambulatory setting. There are two approaches being investigated. The first is permanent IOP monitoring through an implantable sensor and the other is temporary monitoring through a contact lens sensor. In this article, we discuss the shortcomings of the current gold standard for tonometry (Goldmann Applanation Tonometry) and the current experience with the first commercially available continuous 24 hour IOP monitoring technology (SENSIMED Triggerfish®); a telemetric contact lens sensor produced by a Swiss start-up company (Sensimed AG, Lausanne, Switzerland). Recent studies suggest that 24 hour continuous monitoring of IOP can be integrated into clinical practice and have the potential to contribute to the reduction of glaucoma-related vision loss.
Keywords: ambulatory monitoring; blindness; disease course; glaucoma; human; intraocular pressure; methodology; oculoplethysmography; pathophysiology; reproducibility; review

Multicenter, prospective, open-label, observational study of bimatoprost 0.01% in patients with primary open-angle glaucoma or ocular hypertension - Pfennigsdorf, S.; Ramez, O.; von Kistowski, G.; Mäder, B.; Eschstruth, P.; Froböse, M.; Thelen, U.; Spraul, C.; Schnober, D.; Cooper, H.; Laube, T. (Clinical Ophthalmology, 2012)
Background: Bimatoprost 0.01% was developed for improved tolerability over bimatoprost 0.03%, while maintaining efficacy in lowering intraocular pressure (IOP). This multicenter, prospective, open-label, observational study was designed to investigate the efficacy and tolerability of bimatoprost 0.01% in routine clinical practice. Methods: Data were collected from 10,337 patients with primary open-angle glaucoma or ocular hypertension attending 1334 centers in Germany. The primary efficacy outcome was mean change in IOP in each eye from baseline to 10-14 weeks after initiation of bimatoprost 0.01%. Target IOP, prior therapies, additional treatments, and adverse events were also assessed. All treatment decisions were at the physicians' discretion. Results: Bimatoprost 0.01% significantly lowered mean IOP from baseline by -4.1 mmHg (P < 0.0001) in all patients after a mean of 10.45 weeks. In patients without previous treatment, bimatoprost 0.01% reduced mean IOP from baseline by -6.5 mmHg (P<, 0.0001). Bimatoprost 0.01% also significantly reduced IOP in patients previously treated with monotherapy of β-blockers, prostaglandin analogs, carbonic anhydrase inhibitors or bimatoprost 0.03%. No adverse events were reported by 93.9% of patients during treatment with bimatoprost 0.01%; the most commonly reported adverse events were eye irritation (2.0%), ocular hyperemia (1.4%), and conjunctival hyperemia (1.2%). Physicians and patients rated tolerability and adherence as high, and most patients said they would continue with bimatoprost 0.01% treatment. Conclusion: Bimatoprost 0.01% can produce additional IOP-lowering effects when used in routine clinical practice in patients who have received prior therapy, in addition to lowering IOP in previously untreated patients. A high rate of continuation of therapy with bimatoprost 0.01% was observed in patients who switched from a variety of different medications. The results suggest that bimatoprost 0.01% is a suitable first-choice therapy in patients with primary open-angle glaucoma or ocular hypertension. © 2012 Pfennigsdorf et al, publisher and licensee Dove Medical Press Ltd.
Keywords: beta adrenergic receptor blocking agent; bimatoprost; brinzolamide; carbonate dehydratase inhibitor; dorzolamide; prostaglandin derivative; timolol; abnormal sensation; adult; adverse outcome; article; asthma; blurred vision; chronic obstructive lung disease; clinical decision making; clinical practice; conjunctival hyperemia; controlled clinical trial; controlled study; dose response; drug efficacy; drug research; drug safety; drug substitution; drug tolerability; drug use; drug withdrawal; dyspnea; evening dosage; eye irritation; eye pain; eyelid disease; eyelid erythema; female; Germany; headache; human; hyperemia; hyperpigmentation; intraocular hypertension; intraocular pressure; lacrimation disorder; major clinical study; male; monotherapy; multicenter study; observational study; ocular pruritus; open angle glaucoma; outcome assessment; patient compliance; prospective study; treatment duration

Differential pharmacology and clinical utility of preservative-free tafluprost in the treatment of ocular hypertension and glaucoma - Ermiş, S.S. (Clinical Ophthalmology, 2012)
Glaucoma is a chronic disease requiring lifelong treatment. Discomfort due to medications may affect patients' quality of life and may cause poor compliance, which leads to poor intraocular pressure control. To minimize the side effects of long-term treatment, preparations with lower benzalkonium chloride concentrations, preservative-free preparations and alternative preservatives have been developed and reported to have a lower rate of side effects. Tafluprost, launched on the ophthalmic market in 2008, is a new 16-phenoxy analogue of prostaglandin F2α, clinically used as an ocular hypotensive agent for the treatment of glaucoma and ocular hypertension. The safety and intraocular pressure-lowering efficacy of tafluprost has been demonstrated in various preclinical and clinical studies. © 2012 Ermiş, publisher and licensee Dove Medical Press Ltd.
Keywords: aciclovir; antiglaucoma agent; benzalkonium chloride; bimatoprost; dorzolamide; eye drops; latanoprost; prostaglandin derivative; prostaglandin F2 alpha derivative; tafluprost; timolol; travoprost; unoprostone; abnormal sensation; aphakia; blurred vision; clinical effectiveness; conjunctival hyperemia; disease control; disease severity; dose response; drug absorption; drug blood level; drug cost; drug distribution; drug effect; drug efficacy; drug half life; drug hypersensitivity; drug marketing; drug metabolism; drug penetration; drug safety; drug tissue level; drug tolerability; dry eye; epiphora; evening dosage; evidence based medicine; pseudoexfoliation; eye burning; eye pain; eyelash; glaucoma; herpes simplex keratitis; human; intraocular hypertension; intraocular hypotension; intraocular pressure abnormality; iris disease; monotherapy; nonhuman; ocular surface disease; open angle glaucoma; patient compliance; photosensitivity disorder; pigment disorder; pseudophakia; quality of life; retina macula cystoid edema; review; side effect; single drug dose; systemic disease; treatment duration; treatment planning; uveitis; travatan z; travatan

The investigation of severe asthma to define phenotypes - Gibeon, D.; Chung, K.F. (Clinical and Experimental Allergy, 2012)
Severe asthmatics often exhibit poor control despite high doses of inhaled corticosteroids with or without systemic corticosteroids and suffer from persistent symptoms and/or recurrent exacerbations. Five to ten percentage of the asthmatic population falls within this category. Patients with severe asthma are a heterogeneous group and should be investigated to confirm the diagnosis, identify comorbidities, exclude alternative diagnoses, together with an evaluation of treatment adherence and side-effects from medications. Optimization of asthma medications and monitoring the control and pattern of asthma usually takes place over a period of 6 months. In patients with confirmed severe refractory asthma, further evaluation is needed in terms of detailed lung function, of airway and lung structure using high resolution computed tomographic scanning, and of airway inflammatory processes and biomarkers using induced sputum or bronchial biopsies. Patients with severe asthma are best investigated and managed with a multidisciplinary team. Severe asthma consists of different phenotypes that need defining. Investigation of severe asthma should bring into the open the various characteristics of the disease that could point to particular phenotype. Inclusion of investigations based on transcriptomics and proteomics should expand, improve classification and understanding of severe asthma, with the ultimate hope of finding more effective treatments and a step towards personalized medicine. Reviews © 2012 Blackwell Publishing Ltd.
Keywords: beta adrenergic receptor stimulating agent; corticosteroid; itraconazole; leukotriene receptor blocking agent; nitric oxide; omalizumab; prednisolone; proton pump inhibitor; steroid; theophylline; voriconazole; adrenal suppression; airway obstruction; allergic bronchopulmonary aspergillosis; amenorrhea; asthma; atherosclerosis; avascular necrosis; cataract; clinical assessment; comorbidity; computer assisted tomography; Cushingoid syndrome; diabetes mellitus; disease exacerbation; disease severity; drug megadose; dysphoria; electrolyte disturbance; fiberoptic bronchoscopy; fluid shift; gastritis; gastroesophageal reflux; glaucoma; hirsutism; human; hypercholesterolemia; hypertension; hypertrichosis; infection risk; infertility; inflammatory cell; insomnia; larynx spasm; lung function; mental disease; myopathy; nonalcoholic fatty liver; nonhuman; nose polyp; osteopenia; pancreatitis; patient compliance; peptic ulcer; phenotype; priority journal; psychosis; purpura; review; rhinosinusitis; side effect; sleep disordered breathing; sputum analysis; stria; treatment response; vocal cord disorder

Failure to Intensify Hypertension Therapy After Rejected Aliskiren Claims - Zeng, F.; Park, J.; Plauschinat, C.A.; Patel, B.V. (Clinical Therapeutics, 2012)
Background: Failure to intensify therapy when indicated is a serious problem in the management of hypertension. Patients having an antihypertensive prescription rejected because of utilization management tools may be at a high risk of failing to intensify their therapy when it is warranted. Objective: The goal of this study was to investigate the patterns of therapy change after rejected aliskiren claims because of utilization management tools such as prior authorization, step therapy, and restrictive formulary. Methods: A retrospective study was conducted using data from a large national pharmacy benefits manager. Patients with a rejected aliskiren claim because of utilization management and who were naive to aliskiren treatment before having a rejected aliskiren claim were included. Patients were followed up for 6 months after the initial rejected aliskiren claim to see whether there was a therapy change. Therapy change was defined as titration of old regimens, fulfillment of aliskiren, or fulfillment of a new antihypertensive medication not used previously. Results: A total of 1955 patients were identified (mean age, 64.5 years; 54.4% female). Six months after having rejected aliskiren claims, 36.8% overcame the utilization management and filled aliskiren; 45.1% filled a new antihypertensive medication not used previously; and 10.8% patients titrated old antihypertensive medications. More than one quarter of patients (28.4%) had no change in their antihypertensive treatment. Logistic regression analysis revealed that patients rejected because of prior authorization (odds ratio = 4.00 [95% CI, 1.89-8.44]) or step therapy (odds ratio = 2.59 [95% CI, 1.26-5.32]) were more likely to have a therapy change compared with patients rejected because of a restrictive formulary. Conclusions: A significant number of patients had no therapy change 6 months after having rejected aliskiren claims because of utilization management tools, indicating potential clinical inertia or lack of therapy intensification in hypertension management. Patients with restrictive formularies were least likely to have a therapy change. More aggressive follow-up with patients with a rejected claim may be warranted to reduce treatment gaps. © 2012 Elsevier HS Journals, Inc.
Keywords: aliskiren; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; calcium channel blocking agent; diuretic agent; adult; aged; antihypertensive therapy; anxiety disorder; article; comorbidity; coronary artery disease; depression; diabetes mellitus; drug formulary; drug withdrawal; epilepsy; female; follow up; glaucoma; health care utilization; heart disease; human; hyperlipidemia; hypertension; irritable colon; major clinical study; male; peripheral vascular disease; pharmacy (shop); retrospective study; thyroid disease; treatment response

Medical conditions among Iraqi refugees in Jordan: Data from the United Nations refugee assistance information system - Mateen, F.J.; Carone, M.; Al-Saedy, H.; Nyce, S.; Ghosn, J.; Mutuerandu, T.; Black, R.E. (Bulletin of the World Health Organization, 2012)
Objective To determine the range and burden of health services utilization among Iraqi refugees receiving health assistance in Jordan, a country of first asylum. Methods Medical conditions, diagnosed in accordance with the tenth revision of the International classification of diseases, were actively monitored from 1January to 31December 2010 using a pilot centralized database in Jordan called the Refugee Assistance Information System. Findings There were 27 166 medical visits by 7642 Iraqi refugees (mean age: 37.4 years; 49% male; 70% from Baghdad; 6% disabled; 3% with a history of torture). Chronic diseases were common, including essential hypertension (22% of refugees), visual disturbances (12%), joint disorders (11%) and type II diabetes mellitus (11%). The most common reasons for seeking acute care were upper respiratory tract infection (11%), supervision of normal pregnancy (4%) and urinary disorders (3%). The conditions requiring the highest number of visits per refugee were cerebrovascular disease (1.46 visits), senile cataract (1.46) and glaucoma (1.44). Sponsored care included 31 747 referrals or consultations to a specialty service, 18 432 drug dispensations, 2307 laboratory studies and 1090 X-rays. The specialties most commonly required were ophthalmology, dentistry, gynaecology and orthopaedic surgery. Conclusion Iraqi refugees in countries of first asylum and resettlement require targeted health services, health education and sustainable prevention and control strategies for predominantly chronic diseases.
Keywords: adolescent; adult; aged; arthropathy; article; cerebrovascular disease; child; chronic disease; essential hypertension; female; glaucoma; health care utilization; help seeking behavior; human; Jordan; major clinical study; male; medical information system; non insulin dependent diabetes mellitus; patient referral; population risk; pregnancy; preschool child; refugee; respiratory tract infection; school child; senile cataract; urinary tract disease; visual disorder