The influence of health literacy level on an educational intervention to improve glaucoma medication adherence - Muir, K.W.; Ventura, A.; Stinnett, S.S.; Enfiedjian, A.; Allingham, R.R.; Lee, P.P. (Patient Education and Counseling, 2012)
Objective: To test an educational intervention targeted to health literacy level with the goal of improving glaucoma medication adherence. Methods: One hundred and twenty-seven veterans with glaucoma were randomized to glaucoma education or standard care. The intervention included a video scripted at a 4th, 7th, or 10th grade level, depending on the subject's literacy level. After six months, the number of days without glaucoma medicine (DWM) according to pharmacy records for the intervention and control groups was compared. Results: The number of DWM in the six months following enrollment was similar for control and intervention groups (intervention, n= 67, DWM = 63 ± 198; standard care, n= 60, DWM = 65 ± 198; p= 0.708). For each subgroup of literacy (adequate, marginal, inadequate), subjects in the intervention group experienced less mean DWM than subjects in the control group and the effect size (ES) increased as literacy decreased: adequate literacy, ES 0.069; marginal, ES 0.183, inadequate, ES 0.363. Decreasing health literacy skills were associated with decreasing self-reported satisfaction with care (slope = 0.017, SE = 0.005, p= 0.002). Conclusions: Patients with decreased health literacy skills may benefit from educational efforts tailored to address their health literacy level and learning style. Practice implications: Providers should consider health literacy skills when engaging in glaucoma education. © 2011.
Keywords: adult; aged; article; comparative effectiveness; controlled study; educational model; educational status; female; glaucoma; health literacy; human; intervention study; learning style; major clinical study; male; outcome assessment; patient care; patient compliance; patient education; patient satisfaction; priority journal; randomized controlled trial; scoring system; self report

Update on twice-daily bromfenac sodium sesquihydrate to treat postoperative ocular inflammation following cataract extraction - Carreño, E.; Portero, A.; Galarreta, D.J.; Herreras, J.M. (Clinical Ophthalmology, 2012)
Ophthalmic bromfenac sodium sesquihydrate is a topically applied selective cyclooxygenase (COX)-2 inhibitor. It is similar to amfenac, except for a bromine atom at the C4 of the benzoyl ring position, which markedly affects its in vitro and in vivo potency, extends the duration of anti-inflammatory activity, and enhances its inhibitory effect on COX-2 absorption across the cornea and penetration into ocular tissues. The United States Food and Drug Administration approved bromfenac in 2005 for the treatment of postoperative inflammation and the reduction of ocular pain in patients who have undergone cataract surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs), and among them bromfenac, could be even more effective than steroids at reestablishing the blood-aqueous barrier, as revealed by flare on slit-lamp examination and as quantitatively measured using ocular fluorophotometry. Similar to other NSAIDs, it has a role in inhibiting intraoperative miosis during cataract surgery. However, bromfenac also seems to be useful in other situations, such as refractive surgery, allergic conjunctivitis (not useful in dry eye), choroidal neovascularization, and even ocular oncology. No reports of systemic toxicity have been published and bromfenac has good topical tolerance with a low incidence of adverse effects. © 2012 Carreño et al, publisher and licensee Dove Medical Press Ltd.
Keywords: acetylsalicylic acid; amfenac; bromfenac; corticosteroid; diclofenac; flurbiprofen; indometacin; ketorolac; ketotifen; nepafenac; nonsteroid antiinflammatory agent; pemirolast; placebo; ranibizumab; steroid; suprofen; abnormal sensation; adjuvant therapy; adverse outcome; allergic conjunctivitis; antiinflammatory activity; asthma; blepharitis; cancer chemotherapy; cataract extraction; chronic disease; clinical effectiveness; colon cancer; conjunctival deposit; conjunctival hyperemia; conjunctivitis; cornea disease; cornea erosion; cornea perforation; cornea ulcer; diabetic macular edema; diabetic retinopathy; disease control; dosage schedule comparison; dose response; drug approval; drug blood level; drug effect; drug efficacy; drug half life; drug indication; drug marketing; drug mechanism; drug penetration; drug potency; drug safety; drug structure; drug tissue level; drug tolerability; dry eye; episcleritis; eye burning; eye disease; eye inflammation; eye irritation; eye pain; eye tumor; fulminant hepatic failure; headache; human; IC50; iritis; liver toxicity; maintenance therapy; mydriasis; nonhuman; ocular pruritus; ocular surface disease; outcome assessment; patient compliance; postoperative inflammation; postoperative pain; pterygium; refractive surgery; age related macular degeneration; retina macula cystoid edema; review; scleritis; single drug dose; subretinal neovascularization; systemic disease; systemic therapy; time to maximum plasma concentration; treatment duration; treatment planning; unspecified side effect; vernal conjunctivitis; bromday; bronuck; xibrom; yellox

Eye Care in Fiji: A population-based study of use and Barriers - Brian, G.; Maher, L.; Ramke, J.; Palagyi, A. (Ophthalmic Epidemiology, 2012)
Purpose: To determine the use of medical services for eye problems in Fiji, and barriers to seeking that care. Methods: An interview-based questionnaire was administered as part of a population-based cross-sectional survey of adults selected by multistage random sampling from those aged ≥40 years living on Fiji's main island. Results: Participation rate was 73.0% (n=1381). A current vision or eye problem was reported by 931 participants, and a further 235 recalled a previous difficulty. Urban dwellers (P=0.002) and those aged ≥50 years (P=0.017) were more likely to report a problem. Gender was not predictive (P=0.215). "Blurred/poor vision" was the most common complaint (78.5%). Over half (53.3%) had not sought care for the problem most important to them. For current problems, being younger (P<0.001) and from a household without paid income (P=0.007) were predictive of being less likely to seek treatment. Gender was not (P=0.416). The most frequently cited principal reason for not seeking care was "able to manage/accept the problem" (66.5%; of whom 84.7% claimed vision problems). Direct and indirect costs were mentioned as deterrents. "Thought nothing could be done" (P=0.032) and "lack of awareness of service availability" (P=0.026) were more common among rural dwellers. Of participants who sought care, 75.6% used government services. Most participants requiring spectacles or medication incurred costs for these. Satisfaction with overall care was independent of provider (P=0.062) and user gender (P=0.851). Conclusion: With expanding service delivery, increased eye health promotion, and attention to the financing of treatments, improved service use ought to be possible in Fiji. © 2012 Informa Healthcare USA, Inc.
Keywords: adult; aged; article; awareness; blurred vision; cataract; controlled study; cross-sectional study; eye care; eye disease; eye injury; female; Fiji; gender; glaucoma; government; health care cost; health care delivery; health care survey; health care utilization; health promotion; human; income; interview; major clinical study; male; medical service; patient satisfaction; population research; priority journal; pterygium; questionnaire; sampling; urban rural difference

Moving forward in ocular pharmacology - Stamer, W.D. (Journal of Ocular Pharmacology and Therapeutics, 2012)
Keywords: adult; cell therapy; clinical pharmacology; drug delivery system; dry eye; editorial; eye disease; eye infection; eye surgery; gene therapy; glaucoma; human; intraocular hypertension; leadership; medical research; outcomes research; patient compliance; physician; publication; responsibility; age related macular degeneration; sustained drug release; vision

Cost-effectiveness of medications compared with laser trabeculoplasty in patients with newly diagnosed open-angle glaucoma - Stein, J.D.; Kim, D.D.; Peck, W.W.; Giannetti, S.M.; Hutton, D.W. (Archives of Ophthalmology, 2012)
Objective: To determine the most cost-effective treatment option for patients with newly diagnosed mild openangle glaucoma: observation only, treatment with generic topical prostaglandin analogs (PGAs), or treatment with laser trabeculoplasty (LTP). Methods: Using a Markov model with a 25-year horizon, we compared the incremental cost-effectiveness of treating newly diagnosed mild open-angle glaucoma with PGAs, LTP, or observation only. Results: The incremental cost-effectiveness of LTP over no treatment is $16 824 per quality-adjusted life year. By comparison, the incremental cost-effectiveness of PGAs over no treatment is $14 179 per quality-adjusted life year, and they provide greater health-related quality of life relative to LTP. If PGAs are 25% less effective owing to poor patient adherence, LTP can confer greater value. Conclusions: Prostaglandin analogs and LTP are both cost-effective options for the management of newly diagnosed mild open-angle glaucoma. Assuming optimal medication adherence, PGAs confer greater value compared with LTP. However, when assuming more realistic levels of medication adherence (making them 25% less effective than the documented effectiveness reported in clinical trials), at current prices for PGAs, LTP may be a more cost-effective alternative. ©2012 American Medical Association. All rights reserved.
Keywords: generic drug; prostaglandin derivative; adult; article; controlled study; cost effectiveness analysis; human; laser surgery; medical documentation; observational study; open angle glaucoma; patient compliance; priority journal; probability; quality adjusted life year; trabeculoplasty

Comparative effectiveness: Insights on treatment options for open-angle glaucoma - Morse, A.R.; Lee, P.P. (Archives of Ophthalmology, 2012)
Keywords: prostaglandin derivative; blindness; cohort analysis; comparative effectiveness; cost effectiveness analysis; disease course; drug cost; editorial; Food and Drug Administration; funding; health care cost; health care personnel; health care policy; health care quality; human; journal impact factor; low level laser therapy; medical documentation; open angle glaucoma; patient compliance; patient transport; physician; prescription; priority journal; reimbursement; trabeculoplasty; United States

Asthma in the elderly - Gillman, A.; Douglass, J.A. (Asia Pacific Allergy, 2012)
As the population increases in age, the diseases of older age will have increasing prevalence and place a greater burden on the health system. Despite asthma being usually considered a disease of younger people, asthma mortality is currently greatest in the over 55 age-group. Symptoms and emergency presentations for health care due to asthma place a great burden on the quality of life of those over age 55 with asthma. Asthma in older people is under-diagnosed due to patient and physiological factors. Medication strategies for asthma have been dominantly derived from younger cohorts so that effective medication strategies have usually not been explored in older people. Older people with asthma are very concerned regarding side effects of medication so that adherence to therapeutic regimes is often poor. In addition physical disability can lead to difficulty in accessing treatment and using inhaler devices. Practical strategies to improve asthma outcomes in older people have been studied infrequently and the goals of selfmanagement suitable for younger age-groups may not be applicable in this group. Consequently, asthma in older people is deserving of further attention both to basic mechanisms of disease, precision in diagnosis and effective therapeutic strategies, including those that involve self-management and device use. © 2012. Asia Pacific Association of Allergy, Asthma and Clinical Immunology.
Keywords: beta adrenergic receptor stimulating agent; corticosteroid; immunoglobulin E; nonsteroid antiinflammatory agent; omalizumab; theophylline; timolol; aged; allergic asthma; asthma; bronchospasm; cohort analysis; daily life activity; delayed diagnosis; diagnostic accuracy; emergency care; gastroesophageal reflux; geriatric patient; glaucoma; groups by age; health care system; health care utilization; heart arrhythmia; human; inhalation spacer; inhaler; insomnia; lung function test; metered dose inhaler; morbidity; mortality; nausea; osteoarthritis; physical disability; potassium blood level; powder inhaler; prevalence; quality of life; reliability; respiratory function; review; seizure; self care; side effect; spirometry; symptomatology; tachycardia; tremor

Prevalence of cognitive impairment, depression, and anxiety symptoms among older adults with glaucoma - Yochim, B.P.; Mueller, A.E.; Kane, K.D.; Kahook, M.Y. (Journal of Glaucoma, 2012)
Purpose: Two factors which may disrupt the ability to adhere to the treatment for glaucoma are cognitive impairment and mental health complications. Poor adherence to treatment may lead to preventable vision loss. Past research in this area has been limited by little focus on older patients with glaucoma, and the use of brief measures of cognition that may not detect subtle deficits related to Alzheimer disease. Patients and Methods: This study examined the prevalence of cognitive impairment, depression, and anxiety in a sample of 41 glaucoma patients at a tertiary care glaucoma clinic. They had a mean age of 70.0 years (SD=9.2 y; range: 51 to 86 y) and 70% (n=30) were female. Two cognitive measures commonly used in detecting dementia were used to measure cognitive functioning. Results: Controlling for age, memory impairment was found in approximately 20% of the sample, and impaired executive functioning was found in approximately 22% of the sample. Forty-four percent of the sample scored in the impaired range on one or more measures. Mild-to-moderate depressive symptoms were found in 12.2% of participants, and 1 person reported clinically significant anxiety. Conclusions: The results from this study indicate that cognitive impairment may be common in older patients with glaucoma. This has implications for treatment adherence, as difficulties in remembering information may significantly impede the ability to follow instructions from a physician. It is imperative that physicians and caregivers are aware of the prevalence of such conditions, as they are among the first to interact with such individuals. Given the high prevalence of cognitive impairment and depressive symptoms, future research should examine the impact of such factors on glaucoma treatment adherence. © 2012 by Lippincott Williams & Wilkins.
Keywords: adult; aged; anxiety disorder; article; clinical article; cognition; cognitive defect; dementia; depression; disease course; executive function; female; glaucoma; human; male; memory disorder; mild cognitive impairment; patient compliance; pilot study; prevalence; priority journal; scoring system

Determinants of medication adherence to topical glaucoma therapy - Dreer, L.E.; Girkin, C.; Mansberger, S.L. (Journal of Glaucoma, 2012)
Introduction/Purpose: To determine the associations between medical, demographic, socioeconomic, and ocular factors and adherence to topical glaucoma ocular hypotensive therapy. Methods: One hundred sixteen patients with ocular hypertension or open-angle glaucoma from 2 tertiary glaucoma services participated in this prospective study. Adherence to ocular hypotensive therapy was measured using an electronic dose monitor (Travatan Dosing Aid, Alcon Laboratories Inc., Fort Worth, TX) and collected data at 3 months after enrollment. We used 3 different definitions of adherence: 1) Definition 1: the proportion of days taking the prescribed number of drops within 3 hours of the prescribed dosing time; 2) Definition 2: the proportion of days taking any drops within 3 hours of the prescribed dosing time; and 3) Definition 3: the proportion of days taking any drops within 6 hours of the prescribed dosing time. Univariate and multivariate models were used to determine the association between the 3 adherence definitions, medical, demographic, socioeconomic, and ocular factors at 3-month follow-up. The main outcome measures for this study were risk factors for poor objective medication adherence. Results: Adherence, using Definition 1, Definition 2, and Definition 3, was 64%, 75%, and 80%, respectively. Age, total number of other eye diseases, and race were significantly associated with full treatment adherence (Definition 1), with race alone significantly predicting 11% of full treatment adherence. For Definition 2, age, income, level of education, and total number of eye diseases were significantly associated with partial adherence (3 h), again race alone significantly predicted 15% of partial adherence (any drops within 3 h). For Definition 3, race, income, level of education, and total number of other eye diseases significantly predicted partial adherence (any drops within 6 h), both race and income predicted 19% of partial treatment adherence. Significant differences for adherence rates between patients of European descent and those of African descent were found for all 3 definitions with those who were less adherent more likely to be of African descent. Conclusions: Electronic dose monitors provide important information regarding adherence to topical ocular hypotensive medications in glaucoma patients. Electronic dose monitors show low adherence in a significant number of participants. Future studies are needed to determine the reasons for these differences in health behaviors related to glaucoma treatment, which should guide treatment of poor adherence with glaucoma therapy. © 2012 by Lippincott Williams & Wilkins.
Keywords: travoprost; adult; article; female; follow up; human; intraocular hypertension; major clinical study; male; open angle glaucoma; outcome assessment; patient compliance; priority journal; prospective study; risk factor; socioeconomics; topical glaucoma therapy; topical treatment

Increased systemic side effects of prostaglandin analogue eye drops in patients with palatal defects - Gruener, A.M.; Griffiths, M.F.P. (British Journal of Oral and Maxillofacial Surgery, 2012)
Keywords: bimatoprost; eye drops; aged; case report; cleft lip palate; coughing; drug withdrawal; evening dosage; geriatric patient; glaucoma; human; letter; morning dosage; patient compliance; treatment outcome; lumigan

Pharmacokinetics, safety and tolerability of bencycloquidium bromide, a novel selective muscarinic M1/M3 receptor antagonist, after single and multiple intranasal doses in healthy Chinese subjects: An open-label, single-center, first-in-human study - Sun, L.; Ding, L.; Wang, Y.; Zhou, W.; Yan, Z.; Sun, W.; Zhang, H.; Ou, N.; Chen, X. (Drugs in R and D, 2012)
Background: Bencycloquidium bromide (BCQB) is a novel, potent and selective muscarinic M1/M3 receptor antagonist under development for the treatment of rhinorrhea in rhinitis. The pharmacokinetics and safety of BCQB in animals have been established in preclinical studies. However, no clinical pharmacokinetic data are available for BCQB in humans. Objective: The aim of this first-in-human study was to evaluate the pharmacokinetics, safety and tolerability of BCQB following single and multiple intranasal doses in healthy Chinese subjects. Methods: The clinical trial was comprised of the following four studies: (i) an open-label, single-dose escalation study to evaluate the safety and tolerability in healthy subjects after intranasal doses of BCQB ranging from 45 to 450 μg (total of six doses); (ii) an open-label, multiple-dose escalation study to assess the safety and tolerability in healthy subjects after intranasal administration with 120 and 150 μg doses of BCQB (360 and 450 μg/day) administered three times daily for 15 days; (iii) a randomized, open-label and parallel-group design to evaluate the single-dose pharmacokinetics of BCQB after intranasal dosing (45, 90, and 180 μg); and (iv) ten subjects received 120 μg of BCQB by intranasal administration, three times daily for 5 days with a final single dose on day 7 to assess its multiple-dose pharmacokinetics. Safety and tolerability of BCQB were evaluated by monitoring adverse events (AEs), ECG recordings, vital signs and clinical laboratory parameters. The pharmacokinetic parameters for BCQB were calculated by software using noncompartmental methods. Results: All AEs were mild, of limited duration and no more frequent at higher doses. There was no serious adverse event, death or withdrawal. No clinically significant change was noted in clinical laboratory parameters, cardiac parameters or vital signs. Following single intranasal dosing, BCQB was rapidly absorbed with a median time to maximum concentration (tmax) of 8 minutes for 45, 90, and 180 μg dose groups; the plasma concentration of BCQB decreased in a biphasic manner with the mean half-life (tmax) of 8.5 hours; the maximum concentration (Cmax) and area under the plasma concentration-time curve (AUC) of BCQB increased linearly across the examined dose range of 45-180 μg. During the multiple dosing, the steady state was achieved within 3 days of 120 μg three times daily dosing of BCQB. A slightly greater AUC was observed after 5 days of multiple dosing, with the mean accumulation ratio of 1.26; however, the half-life was unchanged. Conclusion: BCQB was safe and well tolerated in healthy Chinese subjects when administered intranasally with single and multiple doses across the doses studied. The mean Cmax and AUC increased proportionally to the studied doses, and the steady state was achieved within 3 days after three times daily dosing. A slight accumulation of BCQB following multiple dosing was observed. The pharmacokinetics, safety and tolerability profiles of BCQB pose it as a good candidate for further development in the treatment of rhinorrhea in rhinitis. © 2012 Adis Data Information BV. All rights reserved.
Keywords: bencycloquidium bromide; muscarinic M1 receptor antagonist; muscarinic M3 receptor antagonist; unclassified drug; adult; area under the curve; article; Chinese; controlled study; volume of distribution; dizziness; drowsiness; drug absorption; drug accumulation; drug blood level; drug distribution; drug dose comparison; drug dose escalation; drug half life; drug induced headache; drug monitoring; drug safety; drug tolerability; dry nose; epistaxis; female; human; intraocular hypertension; male; maximum plasma concentration; mydriasis; normal human; nose obstruction; nose disease; nose redness; nose redness; open study; parallel design; patient compliance; patient monitoring; priority journal; randomized controlled trial; single drug dose; time to maximum plasma concentration; xerostomia

A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence - Barbosa, C.D.; Balp, M.-M.; Kulich, K.; Germain, N.; Rofail, D. (Patient Preference and Adherence, 2012)
Purpose: To explore the published evidence on the link between treatment satisfaction and patients' compliance, adherence, and/or persistence. Methods: Articles published from January 2005 to November 2010 assessing compliance, adherence, or persistence and treatment satisfaction were identified through literature searches in Medline, Embase, and PsycInfo. Abstracts were reviewed by two independent researchers who selected articles for inclusion. The main attributes of each study examining the link between satisfaction and adherence, compliance, or persistence were summarized. Results: The database searches yielded 1278 references. Of the 281 abstracts that met the inclusion criteria, 20 articles were retained. In the articles, adherence and compliance were often used interchangeably and various methods were used to measure these concepts. All showed a positive association between treatment satisfaction and adherence, compliance, or persistence. Sixteen studies demonstrated a statistically significant link between satisfaction and compliance or persistence. Of these, ten demonstrated a significant link between satisfaction and compliance, two showed a significant link between satisfaction and persistence, and eight demonstrated a link between either a related aspect or a component of satisfaction (eg, treatment convenience) or adherence (eg, intention to persist). An equal number of studies aimed at explaining compliance or persistence according to treatment satisfaction (n = 8) and treatment satisfaction explained by compliance or persistence (n = 8). Four studies only reported correlation coefficients, with no hypothesis about the direction of the link. The methods used to evaluate the link were varied: two studies reported the link using descriptive statistics, such as percentages, and 18 used statistical tests, such as Spearman's correlation or logistic regressions. Conclusion: This review identified few studies that evaluate the statistical association between satisfaction and adherence, compliance, or persistence. The available data suggested that greater treatment satisfaction was associated with better compliance and improved persistence, and with lower regimen complexity or treatment burden. © 2012 Dias Barbosa et al, publisher and licensee Dove Medical Press Ltd.
Keywords: article; clinical practice; correlational study; data analysis; diabetes mellitus; evidence based medicine; glaucoma; human; medical research; osteoporosis; patient attitude; patient compliance; patient satisfaction; publication; schizophrenia; systematic review; validation study

Comparison of the latanoprost 0.005%/timolol 0.5% + brinzolamide 1% versus dorzolamide 1%/timolol 0.5% + latanoprost 0.005%: A 12-week, randomized open-label trial - Nakakura, S.; Tabuchi, H.; Baba, Y.; Maruiwa, F.; Ando, N.; Kanamoto, T.; Kiuchi, Y. (Clinical Ophthalmology, 2012)
Objective: To compare the safety and effectiveness of fixed-combination regimes (latanoprost- timolol and brinzolamide 1% compared to dorzolamide 1%/timolol and latanoprost) in open-angle glaucoma patients after switching from a combination of three topical antiglaucoma eye drops. Methods: We conducted an open, randomized 12-week multicenter prospective study. We randomly allocated 39 patients who had been treated with three antiglaucoma eye drops (prostaglandin F2α analogues plus beta-blockers and carbonic anhydrase inhibitors) into two groups. Group A (n = 20) were treated with latanoprost-timolol and brinzolamide 1% therapy and Group B (n = 16) were treated with dorzolamide 1%/timolol and latanoprost. Thirty-six patients completed all 12 weeks of this study. The major clinical parameters measured were intraocular pressure (IOP), conjunctive hyperemia, superficial punctate keratopathy and hyperpigmentation of eyelid at baseline, 4, and 12 weeks. Additionally noted were adverse events and patient preferences, measured using a questionnaire at study initiation and at 12 weeks. Results: At baseline, IOPs were (Group A: 14.1 ± 2.9 mmHg, B: 14.5 ± 2.9 mmHg; P = 0.658), (Group A: 13.8 ± 2.6 mmHg, B: 14.3 ± 2.8 mmHg; P = 0.715) at 4 weeks, and (Group A: 14.1 ± 2.7 mmHg, B: 14.2 ± 2.7 mmHg; P = 0.538) at 12 weeks. Among the groups, there was no significant difference at any time point after baseline (P = 0.923, 0.951, respectively). All adverse events were not remarkably different after therapy. In regards to patient preference before and after switching therapy, 10 patients (50%) in Group A and 10 patients (63%) in Group B preferred using fixed-combination eye drop therapy. Conclusions: Effectiveness and safety were maintained in both groups after switching therapy. Overall, patients generally preferred using a fixed-combination therapy. © 2012 Nakakura et al, publisher and licensee Dove Medical Press Ltd.
Keywords: beta adrenergic receptor blocking agent; brinzolamide; carbonate dehydratase inhibitor; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; prostaglandin F2 alpha; adult; aged; article; blurred vision; clinical article; conjunctival hyperemia; controlled study; drug efficacy; drug safety; drug substitution; drug withdrawal; eye burning; eyelid disease; eyelid hyperpigmentation; foreign body; human; intraocular pressure; keratopathy; multicenter study; open angle glaucoma; open study; outcome assessment; patient compliance; patient preference; prospective study; questionnaire; randomized controlled trial; superficial punctate keratopathy; treatment duration; treatment outcome; azopt; cosopt; xalacom; xalatan

There is more to the technology behind ocular delivery than meets the eye - Nazar, H. (Pharmaceutical Journal, 2012)
Keywords: epinephrine; dexamethasone; dipivefrine; eye drops; fluocinolone acetonide; ganciclovir; liposome; ofloxacin; prodrug; timolol; triamcinolone; acquired immune deficiency syndrome; aging; biological therapy; cataract; cornea; cornea epithelium; Cytomegalovirus retinitis; drug approval; drug cost; drug delivery system; drug implant; drug penetration; eye; eye disease; Food and Drug Administration; glaucoma; human; injection; lipid bilayer; medical research; medical technology; patient compliance; patient safety; phase 1 clinical trial (topic); age related macular degeneration; macular edema; short survey; steroid therapy; iluvien; ozurdex; retisert; vitrasert; I-vation

Influence of parental health literacy and dosing responsibility on pediatric glaucoma medication adherence - Freedman, R.B.; Jones, S.K.; Lin, A.; Robin, A.L.; Muir, K.W. (Archives of Ophthalmology, 2012)
Objective: To assess glaucoma medication adherence in children, hypothesizing that poor parental health literacy and eye drop instillation by the child are associated with worse adherence. Methods: This prospective, observational study enrolled pediatric patients with glaucoma who were prescribed eye drops. Parent(s) reported who was responsible for eye drop instillation (parent vs child), took the Rapid Estimate of Adult Literacy in Medicine, and were instructed on the use and purpose of the Medication Event Monitoring System. Calculations included average adherence (proportion of prescribed doses taken), dosing errors (number of overdosing or underdosing events in 24 hours), and proportion of doses taken on schedule (doses taken within2 hours of prescribed dosing interval). Results are reported as mean (SD) or median. Results: The study included 46 of the 50 enrolled children who used the Medication Event Monitoring System for 30 days or more. Adherence ranged from 43% to 107% (93%[12%]) and was not associated with age (slope, 0.09 [0.52]; P=.86) but decreased with the parent's lower health literacy (slope, 0.62 [0.24]; P=.01).The mean number of dosing errors for medications prescribed daily vs twice daily was similar (3.3 vs 2.9; P=.66). The proportion of doses taken on schedule (within2hours of prescribed dosing interval) ranged from 3% to 97% (median, 34%; mean, 41%[24%]) and was better when the parent vs the child instilled eye drops (46% [26%] vs 23% [19%]; P <.001). Conclusions: Time-dependent glaucoma medication adherence was better when the parent was responsible for eye drop instillation. Overall decreased adherence was associated with decreased parental health literacy. Children of parents with poor health literacy are vulnerable to poor medication adherence; efforts to address poor health literacy may improve outcomes. ©2012 American Medical Association. All rights reserved.
Keywords: antiglaucoma agent; adolescent; article; child; clinical article; drug dose regimen; drug instillation; drug monitoring; drug overdose; female; glaucoma; health literacy; human; male; medication error; observational study; parental behavior; patient compliance; preschool child; prescription; priority journal; prospective study; Rapid Estimate of Adult Literacy in Medicine Scale; school child; screening test; treatment outcome

Ocular drug delivery for glaucoma management - Gooch, N.; Molokhia, S.A.; Condie, R.; Burr, R.M.; Archer, B.; Ambati, B.K.; Wirostko, B. (Pharmaceutics, 2012)
Current glaucoma management modalities are hindered by low patient compliance and adherence. This can be due to highly complex treatment strategies or poor patient understanding. Treatments focus on the management or reduction of intraocular pressure. This is most commonly done through the use of daily topical eye drops. Unfortunately, despite effective therapies, glaucoma continues to progress, possibly due to patients not adhering to their treatments. In order to mitigate these patient compliance issues, many sustained release treatments are being researched and are entering the clinic. Conjunctival, subconjunctival, and intravitreal inserts, punctal plugs, and drug depots are currently in clinical development. Each delivery system has hurdles, yet shows promise and could potentially mitigate the current problems associated with poor patient compliance. © 2012 by the authors.
Keywords: 2 hydroxyethyl methacrylate; anecortave; antiglaucoma agent; antisense oligonucleotide; benzalkonium; beta adrenergic receptor blocking agent; brimonidine; carbonate dehydratase inhibitor; dexamethasone; eye drops; hydroxypropylcellulose; latanoprost; liposome; microsphere; nanosphere; pilocarpine; polycaprolactone; polyglactin; prostaglandin derivative; silicone; small interfering RNA; timolol; contact lens; drug absorption; drug delivery system; drug efficacy; drug formulation; drug implant; drug penetration; drug safety; drug tolerability; dry eye; dyspnea; eye burning; fatigue; gel; glaucoma; heart disease; human; hydrogel; hypotension; incision; infusion pump; intraocular foreign body; intraocular hypertension; low level laser therapy; lung disease; mean residence time; nonhuman; open angle glaucoma; ophthalmic insert; patient compliance; pump design; punctal plug; macular edema; review; sustained release preparation; systemic disease; tachycardia; uveitis; alphagan; lacrisert; ocusert; ozurdex; xalatan; Cylindrical Smartplug

Geriatric vision loss due to cataracts, macular degeneration, and glaucoma - Eichenbaum, J.W. (Mount Sinai Journal of Medicine, 2012)
The major causes of impaired vision in the elderly population of the United States are cataracts, macular degeneration, and open-angle glaucoma. Cataracts and macular degeneration usually reduce central vision, especially reading and near activities, whereas chronic glaucoma characteristically attacks peripheral vision in a silent way, impacting balance, walking, and driving. Untreated, these visual problems lead to issues with regard to taking medications, keeping track of finances and personal information, walking, watching television, and attending the theater, and often create social isolation. Thus, visually impaired individuals enter nursing homes 3 years earlier, have twice the risk of falling, and have 4x the risk of hip fracture. Consequently, many elderly with low vision exercise greater demands on community services. With the prospect of little improvement and sustained visual loss, in the face of poor tolerance of low-vision services and not accepting magnification as the only way to read, clinical depression is common. In many instances, however, early and accurate diagnosis can result in timely treatment and can preserve quality of life. This review will look at current diagnostic and therapeutic considerations. Currently, about 20.5 million people in the United States have cataracts. The number will reach 30 million by 2020. About 1.75 million Americans currently have some form of macular degeneration, and the number is estimated to increase to 2.95 million in 2020. Approximately 2.2 million Americans have glaucoma, and by 2020 that number is estimated to be close to 3.4 million people. It is projectedthat by 2030 there will be 72.1 million seniors. With some overlap of the above 3 groups conservatively estimated (if you add the 2030 cataract group to the macular degeneration and glaucoma groups), then about 1 in 2 senior individuals by 2030 may have some significant ocular disease, which could account for about 50% of the healthcare budget for the elderly. © 2012 Mount Sinai School of Medicine.
Keywords: aflibercept; alpha adrenergic receptor stimulating agent; alpha tocopherol; antiglaucoma agent; antiinflammatory agent; antioxidant; ascorbic acid; beta adrenergic receptor blocking agent; beta carotene; bevacizumab; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; cupric oxide; fluorescent dye; prostaglandin derivative; ranibizumab; retinol; steroid; verteporfin; zinc oxide; ADL disability; aged; aqueous humor flow; blindness; bradycardia; budget; capsulotomy; cataract; ciliary body; closed angle glaucoma; cryosurgery; cyclocryopexy; depression; diagnostic accuracy; dietary intake; differential diagnosis; disease course; drain; drug delivery system; environmental factor; eye infection; falling; fluorescence angiography; glaucoma; groups by age; health care cost; hip fracture; human; hypokalemia; intermethod comparison; intraocular pressure; iris disease; laser surgery; lens implant; local anesthesia; neodymium laser; nursing home; onset age; open angle glaucoma; ophthalmoscopy; optical coherence tomography; patient compliance; patient education; peripheral vision; phacoemulsification; pigment disorder; postoperative complication; preoperative care; preoperative evaluation; pseudoexfoliation; quality of life; age related macular degeneration; review; risk factor; shunting; side effect; social isolation; socioeconomics; spectral domain optical coherence tomography; cerebrovascular accident; surgical drainage; surgical technique; trabeculectomy; United States; visual acuity; visual aid; visual field; visual impairment; CyPass; EX-PRESS Glaucoma Filtration Device; iStent

Effect analysis of health education on local medication compliance in community glaucoma patients - Hu, C.-L.; Wu, L.-P.; Li, P.-H.; Fang, Z.-J. (International Eye Science, 2012)
AIM: To survey community glaucoma patients about their understanding of glaucoma knowledge and effect of health education on their local medication compliance and normativity. METHODS: Totally 190 cases in the Miaohang community of Shanghai Baoshan district were enrolled with a diagnosis of glaucoma and 1 or more topical ocular hypotensive medications for at least 6 months. Special questionnaire was designed for the purpose of this survey. Effects of health education on nine indicators such as local medication compliance in patients with glaucoma and so on were investigated. RESULTS: Health education had the patient compliance, knowledge of glaucoma, the rate of drug use (handwashing rate before eyedrops, eyes closing time after eyedrops, eyedrops contamination rate, eyedrops missing rate) and patient review (periodical review rate of eye field and intraocular pressure) significantly increased (P < 0.05), no significant effect on the drug type (P > 0.05). CONCLUSION: It is necessary to provide regular medication guide, health education and facilitate possible intervention for the treatment of community glaucoma patients.
Keywords: antihypertensive agent; eye drops; article; community care; contamination; drug use; glaucoma; hand washing; health education; health survey; human; intraocular pressure; major clinical study; patient compliance; practice guideline; questionnaire; treatment duration

Ocular hypotensive effect and safety of travoprost 0.004%/timolol maleate 0.5% fixed combination after change of treatment regimen from β-blockers and prostaglandin analogs - Inoue, K.; Setogawa, A.; Higa, R.; Moriyama, R.; Wakakura, M.; Tomita, G. (Clinical Ophthalmology, 2012)
Introduction: Travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops are available in Japan. We prospectively investigated the intraocular pressure (IOP)-decreasing effect of travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops and the adherence of patients to the administration protocol. Materials and methods: We studied 43 eyes from 43 patients diagnosed with primary open- angle glaucoma, who were using prostaglandin analogs and β-blockers. The prostaglandin analogs and β-blockers were discontinued, and the treatment regimen was changed to travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops without any washout period. IOP before and at 1 month, 3 months, and 6 months after the treatment change was evaluated and compared. A questionnaire about protocol adherence was administered 1 month after the treatment change. Results: IOP was 15.7 ± 2.9 mmHg before the change, 15.5 ± 2.7 mmHg at 1 month after the change, 15.3 ± 3.6 mmHg at 3 months after the change, and 15.8 ± 3.2 mmHg at 6 months after the change, and none of the differences were significant (P = 0.191). The responses to the questionnaire showed that cases where eye drop administration was forgotten decreased after the treatment change. Moreover, because of changes in eye drops, 19.0% of patients had irritation. More than half (54.8%) of the patients preferred travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops. Seven patients (16.3%) discontinued eye drop use because of adverse reactions within 6 months after the change. Conclusion: When the treatment regimen was changed from prostaglandin analogs and β-blockers to travoprost 0.004%/timolol maleate 0.5% fixed combination eye drops, administration protocol adherence increased and IOP was preserved; however, adverse reactions appeared in about 16% of the cases. © 2012 Inoue et al, publisher and licensee Dove Medical Press Ltd.
Keywords: beta adrenergic receptor blocking agent; carteolol; eye drops; latanoprost; levobunolol; nipradilol; prostaglandin derivative; tafluprost; timolol; timolol plus travoprost; travoprost; unoprostone isopropyl ester; abnormal sensation; adult; aged; antihypertensive activity; application site dryness; application site reaction; application site stinging; application site stinging; article; blurred vision; clinical article; contact dermatitis; controlled study; correlation coefficient; drug safety; drug substitution; drug withdrawal; evening dosage; eye irritation; eye pain; female; human; hyperemia; intraocular pressure; iritis; male; ocular pruritus; open angle glaucoma; patient compliance; prospective study; questionnaire

Improving healthcare access for people with visual impairment and blindness - Cupples, M.E.; Hart, P.M.; Johnston, A.; Jackson, A.J. (BMJ (Online), 2012)
Keywords: ADL disability; awareness; congenital glaucoma; family interaction; friendship; health care access; health care delivery; health care facilities and services; health care need; health care personnel; health care planning; help seeking behavior; human; information dissemination; medical device; nurse patient relationship; patient attitude; patient guidance; priority journal; age related macular degeneration; review; verbal communication; visual acuity; visual hallucination; visual impairment

Topical fluticasone propionate: Intervention and maintenance treatment options of atopic dermatitis based on a high therapeutic index - Korting, H.C.; Schöllmann, C. (Journal of the European Academy of Dermatology and Venereology, 2012)
Fluticasone propionate (FP), a medium potent glucocorticoid (class III) of carbothioate nature with a favourable benefit/risk ratio, has emerged as a standard medication for the topical treatment of inflammatory skin disorders, in particular atopic dermatitis (AD). FP is available as a 0.05% cream and a 0.005% ointment formulation. The glucocorticoid is characterized by high lipophilicity, high affinity binding to the glucocorticoid receptor and a rapid hepatic biotransformation. Though skin blanching following topical application of FP surpasses that given with glucocorticoids of medium strength, clinical trials show a low potential of FP for local and systemic adverse effects. Even in paediatric patients with AD as well as in difficult-to-treat areas like face, eyelids and intertriginous areas, FP proved to be both effective and safe. Thus, the therapeutic effects of FP clearly outweigh the unwanted effects. Correspondingly, a therapeutic index of 2.0 can be attributed to this glucocorticoid. In this respect, topical FP does not differ from other topical glucocorticoids with increased benefit-to-risk ratio, e.g. prednicarbate, methylprednisolone aceponate and mometasone furoate. However, randomized controlled trials do not only support conventional intervention but also innovative maintenance treatment. © 2011 European Academy of Dermatology and Venereology.
Keywords: beclometasone; beclomethasone dipropionate; beclomethasone 17 monopropionate; betamethasone valerate; budesonide; clobetasol propionate; dexamethasone; flunisolide; fluocinolone acetonide; fluticasone propionate; glucocorticoid receptor; hydrocortisone butyrate; mometasone furoate; placebo; triamcinolone acetonide; unclassified drug; adult disease; atopic dermatitis; binding affinity; blindness; cataract; childhood disease; comparative effectiveness; corticosteroid therapy; drug efficacy; drug hypersensitivity; drug intermittent therapy; drug receptor binding; drug safety; drug structure; drug tolerability; eczema; eyelid disease; folliculitis; glaucoma; human; maintenance therapy; nonhuman; patient compliance; priority journal; psoriasis; pustule; relapse; review; risk reduction; side effect; skin atrophy; skinfold thickness; topical treatment; vitiligo

Application of drug delivery systems in glaucoma therapy - Chen, X.; Xie, L. (International Eye Science, 2012)
There are much effective medicine currently available for treating glaucoma. However, their clinical efficacy is limited by traditional delivery systems, resulting in poor bioavailability, poor patient adherence, and increased side effects. By topical eye drops, intraocular injection or subconjunctival injection, and surgical implants, drug delivery systems can realize the purpose of sustained-release in target tissue. Poly (DL-lactide-co-glycolide), liposome, chitosan and other sustained-release materials with biodegradation and biocompatibility are becoming research focus gradually. Drug delivery systems have the possibility to become irreplaceable carriers for glaucoma therapy medicine.
Keywords: chitosan; eye drops; liposome; polyglactin; bioavailability; biocompatibility; drug delivery system; drug efficacy; glaucoma; injection; liposomal delivery; patient compliance; review; sustained drug release

Validation of a short version of the glaucoma medication self-efficacy questionnaire - Sleath, B.; Blalock, S.J.; Stone, J.L.; Skinner, A.C.; Covert, D.; Muir, K.; Robin, A.L. (British Journal of Ophthalmology, 2012)
Aims: The aims of this study were: (1) to examine whether the original glaucoma medication adherence and eye drop technique self-efficacy scales could be shortened for easier use in practice settings; and (2) to validate these scales against objective medication adherence measures. Methods: Prospective study conducted at a single private practice site. We measured subjects' adherence to glaucoma medications through Medication Event Monitoring System (MEMS) devices and assessed eye drop instillation technique by video-recording. Principal components factor analysis and logistic and linear regression were used to analyse the data. Results: Our results yielded a 10-item Glaucoma Medication Adherence Self-Efficacy Scale that was strongly associated with subject adherence measured using MEMS (b coefficient 8.52, 95% CI 1.94 to 15.1). In addition, the six-item Eye Drop Technique Self-Efficacy Scale was strongly associated with video-recorded subject eye drop installation technique (OR 10.47, 95% CI 1.78 to 61.63). Conclusions: Eye care providers and researchers could use these shorter scales to identify subjects with either poor glaucoma medication adherence and/or eye drop instillation technique. This could help to identify those who may benefit most from education and training on both adherence and eye drop instillation.
Keywords: eye drops; adult; aged; article; clinical practice; controlled study; disease classification; disease severity; drug instillation; drug monitoring; drug self administration; Eye Drop Technique Self Efficacy Scale; female; glaucoma; Glaucoma Medication Adherence Self Efficacy Scale; human; major clinical study; male; medication adherence monitoring system; patient compliance; patient monitoring; priority journal; prospective study; questionnaire; rating scale; self report; validation study; videorecording; visual field defect

The role of antiviral therapy after the resolution of acute herpes simplex keratitis or acute herpes zoster ophthalmicus - Baratz, K.H. (Archives of Ophthalmology, 2012)
Keywords: aciclovir; corticosteroid; famciclovir; placebo; trifluridine; valaciclovir; virus DNA; add on therapy; antiviral resistance; antiviral therapy; clinical decision making; cornea neovascularization; cost effectiveness analysis; disease duration; disease free interval; disease severity; dose response; drug cost; drug efficacy; drug megadose; drug potency; editorial; health care cost; herpes simplex keratitis; herpes zoster ophthalmicus; human; immunocompetence; keratopathy; patient compliance; priority journal; prophylaxis; recurrent disease; retrospective study; treatment duration; uveitis; virus strain; visual impairment

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment - Leighton, P.; Lonsdale, A.J.; Tildsley, J.; King, A.J. (Eye, 2012)
Aim The aim of this study is to examine the attitudes of patients, who presented with advanced glaucoma in at least one eye, to participation in a randomised prospective trial comparing primary medical treatment with primary surgical treatment for advanced glaucoma. Methods Patients who had presented with advanced glaucoma (>15 dB loss mean deviation on Humphrey visual field testing) in at least one eye were asked to participate. Five focus groups comprising of 4-8 patients and consisting of 29 patients in total were undertaken. The group interviews were conducted by two experienced qualitative researchers, an ophthalmic clinician was present to clarify technical issues. The focus group discussions were taped and transcribed in full, and analysed through a process of familiarisation, open (inductive) coding, theme generation, theme refinement, and thematic mapping. Results Three overarching themes were identified: (1) the extent of patients' knowledge, (2) anxieties about surgery, and (3) concerns about compromised care due to trial involvement; these themes were further classified into eight sub-themes. Conclusion sPatients willingness to participate in randomised clinical studies is significantly connected to their level of comprehension and insight about the medical condition, its treatment, and the research process; misunderstandings about any of these aspects may act as a significant barrier to trial recruitment. Recruitment rates for future randomised trials may be enhanced by ensuring that patients have full and accurate information about the treatment alternatives, and that uncertainty exists for best patient outcomes between treatment options, and reassuring potential participants that the research process, in particular randomisation, will not compromise clinical care. © 2012 Macmillan Publishers Limited All rights reserved.
Keywords: anxiety; clinical article; controlled study; female; glaucoma; glaucoma surgery; human; interview; male; patient attitude; patient compliance; patient education; primary medical care; randomized controlled trial; review; treatment planning

Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: An exploratory randomised controlled trial - Gray, T.A.; Fenerty, C.; Harper, R.; Spencer, A.F.; Campbell, M.; Henson, D.B.; Waterman, H. (Eye, 2012)
Purpose: To evaluate the impact of individualised patient care, as an adjunct to standard care, on adherence to ocular hypotensive therapy. Methods: A two-arm, single-masked exploratory randomised controlled trial recruited patients newly prescribed ocular hypotensive therapy. The intervention involved an individual assessment of health-care needs and beliefs and a 1-year follow-up period according to need. The primary outcome was refill adherence, measured by collating prescription and dispensing data for 12 months. Secondary outcomes included self-reported adherence, glaucoma knowledge, beliefs about illness and medicines, quality of care, intraocular pressure (IOP) fluctuation, and changes in clinical management assessed at 12 months. The strength of the intervention was measured following withdrawal by reviewing clinical outcomes for a further 12 months. Results: In all, 127 patients were recruited (91% response rate). Intervention-arm patients collected significantly more prescriptions than control-arm patients. Self-report adherence was significantly better in the intervention-arm for patients who forgot drops and those who intentionally missed drops. The intervention group demonstrated significantly more glaucoma knowledge, expressed a significantly stronger belief in the necessity of eye drops and believed that they had more personal control over managing their condition. Control-arm patients had more IOP fluctuation and changes in clinical management. However, this finding only reached significance at 24 months. Conclusion: Modelling patient care according to health-care needs and beliefs about illness and medicines can have a significant impact on improving adherence to therapy for this patient group, with the potential benefit of improving clinical outcomes. © 2012 Macmillan Publishers Limited All rights reserved.
Keywords: ISRCTN13706134; eye drops; adult; aged; article; attitude to health; controlled study; exploratory research; female; follow up; glaucoma; health belief; health care need; health care quality; human; intraocular hypertension; intraocular pressure; major clinical study; male; patient care; patient compliance; perception; prescription; randomized controlled trial; self report; treatment outcome

An unusual case of systolic hypertension associated with ticlopidine treatment - Pugi, A.; Borrone, G.; Moschini, M.; Lapi, F.; Mugelli, A.; Vannacci, A. (Journal of Hypertension, 2012)
Keywords: acetylsalicylic acid; aliskiren; amlodipine; atenolol; chlortalidone; furosemide; hydrochlorothiazide; lorazepam; low molecular weight heparin; metformin; metoprolol; paroxetine; piretanide; simvastatin; spironolactone; telmisartan; ticlopidine; timolol; warfarin; aged; anamnesis; angiolipoma; blood pressure fluctuation; blood pressure regulation; carotid artery obstruction; case report; diastolic blood pressure; drug rechallenge; drug substitution; drug withdrawal; female; gastritis; glaucoma; human; hypertension; kidney tumor; letter; non insulin dependent diabetes mellitus; patient compliance; priority journal; recurrent disease; systolic blood pressure; systolic hypertension; thyroid nodule; aspirin

Perspectives on quality of life in glaucoma - Kaur, D.; Gupta, A.; Singh, G. (Journal of Current Glaucoma Practice, 2012)
Chronic diseases are invariably associated with decreased functioning ability of the individual in one form or the other depending upon the system/organ involved. Disability consequent to the disease is the major factor affecting the patient's physical and psychosocial well-being; in other words, the 'Quality of Life (QOL)'. Besides the disease itself, the treatment and its consequences are also major determinants of QOL of the patients. Globally, glaucoma, which is emerging as one of the leading causes of blindness, is one such chronic ophthalmic disease characterized by a progressive loss of visual function and a potential to cause irreversible blindness, if not treated at an early stage. Patients of glaucoma need to take lifelong medications in order to keep their intraocular pressure within limits. It's impact on the daily life of patients cannot be overexpressed and compounded by the fact that it remains asymptomatic for a considerable time after the disease has set in; has led to new imperatives in diagnosis, treatment and epidemiological and outcome studies. Assessment of the debilitating effect of glaucoma and side effects of its treatment on the emotional and physical QOL of the patient is therefore an important criterion for arriving at the treatment regimen. An extensive literature search was done on Pubmed Central, Pubmed and Google Scholar using the keywords 'glaucoma', 'quality of life in glaucoma', 'management in POAG' and 'QOL assessment tools'. Various tools available for the assessment of QOL, and their advantages and limitations have been reviewed in this article.
Keywords: antiglaucoma agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin derivative; blindness; bradycardia; bronchospasm; burning sensation; cost of illness; disease association; drug efficacy; drug tolerability; dry eye; eye redness; functional disease; glaucoma; glaucoma surgery; human; income; intraocular pressure abnormality; iris disease; low level laser therapy; outcome assessment; patient compliance; patient satisfaction; psychological well-being; quality of life; review; risk factor; sex difference; Short Form 36; treatment planning; visual system function

The right to sight - Nepal, B.P. (Kathmandu University Medical Journal, 2012)
Keywords: blindness; cataract; cataract extraction; cornea scar; developing country; editorial; eye care; eye disease; eye examination; financial management; glaucoma; health care access; health care availability; health care delivery; health care facility; health care planning; health care policy; health care quality; health program; health service; health survey; human; integrated health care system; medical education; medical specialist; morbidity; Nepal; posterior eye segment disease; prevalence; refraction error; responsibility; trachoma; visual acuity; World Health Organization

Ocular 'roid rage - Ho, H.; Perera, S.A.; Aung, T. (Proceedings of Singapore Healthcare, 2012)
Corticosteroids use can cause raised intraocular pressure (IOP), leading to glaucoma. We present a case report of steroid induced glaucoma in a young male with keratoconjunctivitis (VKC). Our patient was uncompliant with instructions to stop steroid use, initially started for VKC treatment, and required aggressive medical and surgical intervention for IOP control. He eventually progressed to severe glaucomatous optic neuropathy and eventual tunnel vision. Steroid induced glaucoma is an important and frequently encountered condition in ophthalmology clinics. This report serves to remind all physicians of the dangers of steroid eye drop usage.
Keywords: acetazolamide; brimonidine; chloramphenicol plus dexamethasone sodium phosphate plus tetryzoline; corticosteroid; cyclosporine; ketorolac; loteprednol; mitomycin; olopatadine; spersadexoline; unclassified drug; adult; article; case report; depression; disease association; disease course; drug withdrawal; eczema; glaucoma; human; intraocular pressure abnormality; male; ocular pruritus; optic nerve disease; patient compliance; patient monitoring; patient referral; postoperative period; self report; tonometry; trabeculectomy; treatment response; vernal conjunctivitis; visual acuity; visual field; visual impairment; spersadexoline

Contact lens complications in an urgent-care population: The university of california, los angeles, contact lens study - Lee, S.Y.; Kim, Y.H.; Johnson, D.; Mondino, B.J.; Weissman, B.A. (Eye and Contact Lens, 2012)
Objectives: This is a prospective study in an urgent-care ophthalmic setting to investigate contact lens (CL) complications and their association with extended wear (EW). Methods: Data on CL designs, care system(s), and ocular complications were collected over a 6-month period. Results: One thousand three hundred and sixty-nine patients presented to the Jules Stein Eye Institute urgent care with symptoms of eye problems. Of these, 56 were identified with diagnoses etiologically associated with CL wear, and 49 were studied. The five most common ocular diagnoses found in our study were in the following order: epithelial staining or abrasion/epithelial defect, conjunctival injection, papillae, corneal neovascularization, and presumed microbial keratitis (PMK). Fifteen of 49 patients were diagnosed with PMK. The mean number of complications was 3.43 per eye. Most of the patients (65%) reported some form of EW. Analysis of the patients with PMK showed an association with EW. There seemed to be no statistical difference in the number of complications per symptomatic eye with hydrogel and silicone hydrogel lenses although 13 of the15 patients with PMK were silicone hydrogel wearers. Conclusions: We studied various aspects of care and compliance in an urgent-care population and found that most of our urgent-care patients slept with CLs on their eyes. Symptomatic CL wear-related complications, and specifically MK, strongly correlate with EW with less relation to lens design, material, and wear modality. We therefore conclude that CL EW is a risk factor leading to urgent-care visits. © 2012 Lippincott Williams & Wilkins.
Keywords: adult; aged; article; conjunctivitis; contact lens; cornea epithelium; cornea injury; cornea lesion; cornea neovascularization; corneal epithelial staining; emergency care; extended wear contact lens; human; keratitis; major clinical study; patient compliance; presumed microbial keratitis; priority journal; symptom; United States

Comparison of fixed combinations of dorzolamide/timolol and brimonidine/timolol in patients with primary open-angle glaucoma - Gulkilik, G.; Oba, E.; Odabasi, M. (International Ophthalmology, 2011)
To compare the short-term effectiveness and ocular side-effects of fixed combinations of dorzolamide/timolol (DTFC) and brimonidine/timolol (BTFC) in patients with primary open-angle glaucoma (POAG). Forty-two eyes of 42 patients newly diagnosed with primary open-angle glaucoma were assessed prospectively. One of the two eyes was chosen randomly and treated with DTFC (2 × 1) for 4 weeks. The treatment was then stopped to allow a 4-week wash-out period. Following the wash-out period, the same eye was treated with BTFC (2 × 1) for 4 weeks. Intraocular pressure (IOP) values were measured before and after each treatment at 0800, 1,200 and 1,600 h. Tear function test results and ocular side-effects were also recorded. The mean baseline IOP values for DTFC and BTFC were 24.1 ± 1.8 and 24.6 ± 2.4 mmHg, respectively. The mean IOP values after 4 weeks of treatment with DTFC or BTFC were 17.1 ± 2.9 and 16.9 ± 2.5 mmHg, respectively. Both medications reduced IOP values significantly (P = 0.0000). The effectiveness of both medications was similar (P = 0.7363). Both combinations significantly reduced the amount of tear secretion and tear break-up time (P = 0.0000). Eye burning was more common with DTFC than with BTFC (P = 0.0182). Other adverse effects were observed at similar rates for both combinations. This study demonstrated that the IOP-reducing effects of DTFC and BTFC in patients with POAG are similar. The side-effect profile of BTFC is similar to that of DTFC. Lower occurrence of a burning sensation may improve patient compliance in the BTFC group. © 2011 Springer Science+Business Media B.V.
Keywords: patient; open angle glaucoma; side effect; human; intraocular pressure; eye; lacrimal fluid; drug therapy; burning sensation; patient compliance; commercial phenomena; adverse drug reaction; eye burning; lacrimation; function test

LASIK as an alternative line to treat noncompliant esotropic children - Saeed, A.M.; Abdrabbo, M.A. (Clinical Ophthalmology, 2011)
Purpose: To assess the safety and efficacy of laser-assisted in situ keratomileusis (LASIK) in facilitating strabismus management in noncompliant children with fully accommodative esotropia. Setting: Ebsar Eye Center, Benha University (Benha, Egypt). Methods: The study comprised 20 eyes of ten consecutive patients with accommodative esotropia. All patients were noncompliant with glasses and had refractive stability. They received brief general anesthesia and had bilateral LASIK using Wavelight® Algretto Wave® Eye-Q Excimer Laser (Alcon, Inc, Hunenberg, Switzerland) to fully correct their hyperopic refractive errors aiming to achieve orthophoria. Preoperative and postoperative best corrected visual acuity, cycloplegic refraction, angle of squint, and any LASIK complications were recorded. Follow-up period was 9 months. Results: The age of patients ranged 5.1-9.2 years and the hyperopic error range was +3.5 D to +6.75 D, with anisometropia 2 D or less. No patient had decreased best corrected visual acuity or loss of fusion ability. The postoperative refractive error ranged from -0.75 D to +1.5 D at the end of the study period. All patients achieved orthophoria. No significant intraoperative or postoperative complications were recorded. Conclusion: LASIK appears to be effective and relatively safe to treat accommodative esotropic children by reducing their hyperopic refractive error, however, patient selection is critical. Larger studies with longer follow-up are necessary to determine its long-term effects. © 2011 Saeed and Abdrabbo, publisher and licensee Dove Medical Press Ltd.
Keywords: timolol; timolol maleate; anisometropia; article; child; clinical article; controlled study; convergent strabismus; Egypt; excimer laser; eye refraction; female; human; hypermetropia; intraocular hypertension; keratomileusis; male; patient compliance; patient safety; peroperative complication; postoperative complication; postoperative period; preoperative period; preschool child; refraction error; school child; spectacles; therapy effect; treatment outcome; visual acuity; timolo; Wavelight Algretto Wave Eye-Q Excimer Laser

Diagnosis and management of noninfectious pediatric uveitis - Kim, S.J. (International Ophthalmology Clinics, 2011)
Keywords: adalimumab; alkylating agent; antimetabolite; azathioprine; betamethasone sodium phosphate; calcineurin inhibitor; certolizumab pegol; chlorambucil; corticosteroid; cyclophosphamide; cyclosporine; etanercept; fluocinolone acetonide; folic acid; immunosuppressive agent; infliximab; ketorolac; leflunomide; methotrexate; mycophenolate mofetil; nonsteroid antiinflammatory agent; prednisolone acetate; prednisolone sodium phosphate; recombinant cytokine; anakinra; rimexolone; tacrolimus; tolmetin; triamcinolone acetonide; tumor necrosis factor inhibitor; tumor necrosis factor inhibitor; unindexed drug; acute lymphoblastic leukemia; article; Behcet disease; bone necrosis; cataract; cataract extraction; childhood disease; differential diagnosis; disease severity; drug absorption; drug delivery system; drug efficacy; drug safety; drug tolerability; epidemiological data; eye disease; eye inflammation; gastrointestinal symptom; glaucoma; glaucoma surgery; gonad atrophy; gonad atrophy; histopathology; human; hyperglycemia; hypotony maculopathy; immunosuppressive treatment; incidence; infection; interstitial nephritis; intraocular hypertension; iridocyclitis; juvenile rheumatoid arthritis; keratopathy; leukopenia; linear growth; lung tuberculosis; masquerade syndrome; monotherapy; mucocutaneous lymph node syndrome; neoplasm; nonhuman; osteoporosis; patient compliance; pediatric advanced life support; phakomatosis; priority journal; prognosis; prospective study; randomized controlled trial (topic); macular edema; retinoblastoma; risk factor; sarcoidosis; side effect; slow release formulation; systemic disease; T lymphocyte; tubulointerstitial nephritis and uveitis; uveitis; body weight gain; cimzia; enbrel; fk 506; humira; kineret; remicade; retisert

The challenge of fungal keratitis - Said, D.G.; Otri, M.; Miri, A.; Kailasanathan, A.; Khatib, T.; Dua, H.S. (British Journal of Ophthalmology, 2011)
Keywords: amphotericin B; anidulafungin; antifungal agent; caspofungin; clotrimazole; econazole; fluconazole; flucytosine; itraconazole; ketoconazole; micafungin; miconazole; natamycin; posaconazole; pyrrole derivative; ravuconazole; riboflavin; sterol; voriconazole; antifungal activity; antifungal resistance; Aspergillus; Candida; Candida albicans; Candida parapislosis; cornea transplantation; disease activity; disease association; disease predisposition; drug choice; drug efficacy; drug potentiation; drug safety; editorial; eye infection; human; infection control; infection prevention; keratomycosis; keratoplasty; keratoscleritis; keratoscleritis; molecular pathology; nonhuman; patient compliance; polymerase chain reaction; priority journal; risk assessment; risk factor; scleritis; unspecified side effect

Ocular hypotensive effects and safety over 3 months of switching from an unfixed combination to latanoprost 0.005%/timolol maleate 0.5% fixed combination - Inoue, K.; Okayama, R.; Higa, R.; Sawada, H.; Wakakura, M.; Tomita, G. (Journal of Ocular Pharmacology and Therapeutics, 2011)
Purpose: Latanoprost 0.005%/timolol maleate 0.5% combination eye drops are now available in Japan. The aim of the present study was to investigate the prospective intraocular pressure (IOP) reduction effects and adherence with the combination eye drops in Japanese patients. Methods: The subjects were 162 patients (162 eyes) with glaucoma or ocular hypertension concomitantly using latanoprost 0.005% and timolol maleate 0.5% eye drops. Concomitant use of the 2 eye drops was stopped, and patients were switched to the latanoprost 0.005%/timolol maleate 0.5% combination eye drops without any washout period. IOP was measured before the switch, and at 1 and 3 months after the switch, and then compared. A questionnaire survey on adherence was also conducted 1 month after the switch. Results: IOP was the same before and after the switch: 15.2±3.3 mmHg before the switch, 14.9±3.0 mmHg 1 month after the switch, and 15.1±3.2 mmHg 3 months after the switch. According to the questionnaire survey, the frequency of forgetting to administer eye drops decreased with the switch, but 45.1% of the patients experienced irritation. About 82.1% replied that they preferred the latanoprost 0.005%/timolol maleate 0.5% combination eye drops. By the third month after the switch, 13 patients (8.0%) had discontinued the eye drops due to side effects or insufficient IOP reduction. Conclusion: The switch from the concomitant use of latanoprost 0.005% and timolol maleate 0.5% eye drops to latanoprost 0.005%/timolol maleate 0.5% combination eye drops improved adherence and helped maintain IOP. © Mary Ann Liebert, Inc.
Keywords: brinzolamide; dorzolamide; latanoprost; latanoprost plus timolol; rysmon tg; timolol maleate; timolol maleate; unclassified drug; adult; aged; article; drug effect; drug safety; drug substitution; drug withdrawal; eye irritation; eye pain; female; human; intraocular hypertension; intraocular pressure; major clinical study; male; ocular pruritus; open angle glaucoma; patient compliance; questionnaire; rysmon tg; timoptol xe; timoptol; xalacom

Nonionic surfactant vesicular systems for effective drug delivery-an overview - Kumar, G.P.; Rajeshwarrao, P. (Acta Pharmaceutica Sinica B, 2011)
Vesicular systems are a novel means of drug delivery that can enhance bioavailability of encapsulated drug and provide therapeutic activity in a controlled manner for a prolonged period of time. Liposomes were the first such system but they suffer from a number of drawbacks including high cost and lack of stability at various pHs. Niosomes are a nonionic surfactant vesicular system, which can be easily and reliably made in the laboratory. Many factors affect noisome formation such as the method of manufacture, nature of surfactant and encapsulated drug, temperature at which the lipids are hydrated and the critical packing parameter. This review describes all aspects of niosomes including their different compositions, the various methods of preparation, the effect of changing manufacturing parameters, methods of characterization, factors that affect their stability, their use by various routes of administration, their therapeutic applications and the most important patents. The review also provides detailed information of the various types of niosomes that provide effective drug delivery. © 2011.
Keywords: aceclofenac; aciclovir; alkyl ether; alkyl glyceryl ether; amphophile; beclomethasone dipropionate; brimonidine; cetomacrogol; cholesterol; cyclopentolate; enoxacin; estradiol; ether; fatty acid ester; fluconazole; gatifloxacin; gentamicin; griseofulvin; meloxicam; niosome; nonionic surfactant; ofloxacin; polidocanol; polyoxyethylene ester; polyoxyethylene stearyl ether; recombinant human insulin; rifampicin; sorbitan fatty acid ester; tenoxicam; unclassified drug; unindexed drug; cancer chemotherapy; chemical analysis; chemical structure; chronic obstructive lung disease; drug absorption; drug bioavailability; drug delivery system; drug design; drug dosage form comparison; drug half life; drug penetration; drug stability; edema; encapsulation; evaporation; herpes simplex keratitis; human; hydrophilicity; lipophilicity; microfluidic analysis; molecular weight; nonhuman; particle size; patient compliance; pH measurement; physical chemistry; process development; review; temperature dependence; unspecified side effect; validation process

Compliance with eye care in glaucoma patients with comorbid depression - Weiss, G.A.; Goldich, G.; Bartov, E.; Burgansky-Eliash, Z. (Israel Medical Association Journal, 2011)
Background: Comorbid depression may play an important role in non-compliance with medical treatment among patients with chronic illnesses. Glaucoma is a potentially blinding chronic disease requiring life-long commitment to medical therapy. failure to adhere to anti-glaucoma treatment may lead to disease progression and visual loss. Objectives: To assess the prevalence of depressive symptoms in glaucoma patients and the association between these symptoms and non-compliance with anti-glaucoma therapy. Methods: In this cross-sectional observational study, compliance with pharmacotherapy was assessed with the Morisky Medication Adherence questionnaire (eight items). Screening for depression was performed by means of the CES-D (Center for Epidemiologic Studies Depression scale). The association between depression and compliance rates was analyzed. Results: The study group comprised 76 glaucoma patients; 19.7% of the subjects were classified as non-compliant (Morisky cutoff < 10) and 21.1% suffered from depression (CES-D cutoff ≥ 16). We found a similar level of non-compliance when comparing depressed with non-depressed glaucoma patients. However, a correlation was observed between the level of depression and the level of non-compliance (P = 0.04). Conclusions: Our study revealed a similar rate of depression in glaucoma patients and the general Israeli population. The presence of depression was not associated with the presence of non-compliance, yet the level of depression was associated with the level of non-compliance.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin derivative; adult; aged; article; Center for Epidemiological Studies Depression Scale; comorbidity; cross-sectional study; depression; disease association; eye care; female; follow up; glaucoma; human; Israel; major clinical study; male; observational study; patient compliance; perimetry; prevalence; questionnaire; screening

[Adherence]. - Kiuchi, Y. (Nippon Ganka Gakkai zasshi, 2011)
Keywords: doctor patient relationship; drug administration; editorial; glaucoma; human; interpersonal communication; patient compliance; patient education; psychological aspect

[Causes of patients' non-adherence with glaucoma medication dosing: systemic classification based on dosing schedule]. - Kobayashi, H. (Nippon Ganka Gakkai zasshi, 2011)
To study the causes of patients' nonadherence with the instruction of glaucoma medication dosing and to analyze them based on the dosing schedules by means of systemic classification. Four hundred twenty eight patients who had been prescribed glaucoma medication for at least six months were studied. Adherence was ascertained by means of a predetermined questionnaire. Nonadherent patients were interviewed with stratified questionnaires to elicit the causes for the non-adherence, which were analyzed with cluster analysis. The total number of non-adherents (more than 3 doses missed per month) was 114 (26.6%). The non-adherence rate in the morning was 18.2% (51/280) and in the evening 24.7% (75/304); there was no significant difference. Structured interviews for the 114 non-adherents elicited 194 unique situational problems (1.7 +/- 0.6/individual), which were grouped into four major categories: 25 medication regimen factors (12.9%), 119 patients' related factors (61.3%), 6 provider-related factors (3.1%) and 44 environmental factors (22.7%). Patients' related factors showed the higher incidence compared with other factors in both dosing time (p<0.01): Sleeping and taking a bath caused 39 patients (20.1%) to miss medication in patients with eye-drops' application in the evening. Each dosing time may have its own situational problems, which may be likely to be multidimensional and must considered with each individual patient.
Keywords: eye drops; adolescent; adult; aged; article; child; cluster analysis; drug administration; female; glaucoma; human; male; middle aged; patient compliance; psychological aspect; questionnaire; statistics; time

Adherence to topical glaucoma medication during hospitalization - Yousuf, S.J.; Jones, L.S. (Journal of Glaucoma, 2011)
PURPOSE: To describe the patterns and predictors of adherence to topical glaucoma medication during hospitalization for medical disease. DESIGN: Retrospective, nonrandomized, and comparative case-series. METHODS: Medical records of all the patients hospitalized with a secondary diagnosis of glaucoma between January 2006 and March 2009 were reviewed. Baseline characteristics of all patients were recorded including sex, ethnicity, age, primary medical diagnosis, and the length of stay. The outpatient topical glaucoma medications known on admission and prescribed at the time of admission were recorded, and the numbers of outpatient and inpatient systemic medications were tracked. Adherence was defined as receiving more than 75% of the expected doses. The patient discharge instructions were also reviewed. RESULTS: Of the 184 patients included, 98 (53%) were female, 102 (55%) were African-American, and the mean age was 78.3 (±11.7) years old. The most common reason for hospitalization was cardiovascular disease and the median length of stay was 9.5 days. Adherence was achieved in 51.6% of patients. Knowing (P<0.01) and prescribing (P<0.01) the complete outpatient regimen upon admission was associated with adherence. Neither class of topical glaucoma medication nor the number of medications was associated with adherence. Doses were most commonly omitted owing to the failure to prescribe (72.3%). Discharge instructions correctly listed the outpatient regimen 54.3% of the time. CONCLUSION: Adherence to the topical glaucoma medications was suboptimal during hospitalization; this is likely related to the poor reporting of outpatient regimen upon admission. The effect of hospitalization may be a factor to consider in future studies of adherence and when evaluating glaucoma patients after hospitalization. Copyright © 2011 by Lippincott Williams &Wilkins.
Keywords: African American; aged; article; cardiovascular disease; case study; female; glaucoma; hospital discharge; hospitalization; human; length of stay; major clinical study; male; outpatient; patient compliance; prediction; prescription; priority journal; retrospective study

Thalidomide, dexamethasone, Doxil and Velcade (ThaDD-V) followed by consolidation/maintenance therapy in patients with relapsed-refractory multiple myeloma - Offidani, M.; Corvatta, L.; Polloni, C.; Gentili, S.; Mele, A.; Rizzi, R.; Catarini, M.; Caraffa, P.; Samori, A.; Blasi, N.; Ferranti, M.; Malerba, L.; et al. (Annals of Hematology, 2011)
In newly diagnosed multiple myeloma (MM), three/four-drug combinations as induction therapy seem to be more effective compared with two-drug associations in terms of response rate and duration of remission. Moreover, there is an emergent body of evidences that consolidation/maintenance therapy improves the quality of response and remission duration. However, the impact of these strategies in relapsed/refractory MM (r-rMM) is still unknown. This phase II study explored the four-drug combination of thalidomide, dexamethasone, pegylated liposomal doxorubicin (pLD), and bortezomib (ThaDD-V) as induction followed by consolidation therapy based on bortezomib-dexamethasone and thalidomide-dexamethasone and maintenance therapy with thalidomide in r-rMM patients. The primary end points of this study were best response and toxicity of the planned therapy. Forty-six patients were enrolled. At the end of therapy, the best response was as follows: 37% complete response (CR), 34.5% VGPR, and 4.5% PR with an ORR of 76%. Patients receiving ≤2 prior regimens had a CR rate significantly higher than those heavily treated (41% vs 0%; p = 0.010). With a median follow-up of 31 months, median time to progression (TTP) and OS were 18.5 months and 40 months, respectively. By a 6-month landmark analysis, patients who completed the protocol had a significantly longer TTP compared with those who did not because of toxicity (not reached vs 7 months; p < 0.0001). After the dose intensity of bortezomib was reduced due to an excess of peripheral neuropathy (PN), grade 3 PN occurred in 7.5% of patients. ThaDD-V followed by consolidation-maintenance therapy seems to be very effective in patients with r-rMM provided that this procedure is used early on relapse when very deep responses seem to be the rule. © 2011 Springer-Verlag.
Keywords: acetylsalicylic acid; aciclovir; bortezomib; ciprofloxacin; dexamethasone; doxorubicin; erythropoietin; granulocyte macrophage colony stimulating factor; growth factor; low molecular weight heparin; thalidomide; valaciclovir; adult; aged; anemia; antibiotic prophylaxis; article; bedtime dosage; cancer growth; cancer regression; cancer recurrence; cancer survival; clinical article; continuous infusion; deep vein thrombosis; drug dose reduction; drug response; drug withdrawal; fatigue; female; gastrointestinal disease; glaucoma; hand foot syndrome; heart disease; heart infarction; hematologic disease; herpes zoster; human; infection; maintenance therapy; male; multicenter study; multiple cycle treatment; multiple myeloma; neutropenia; outcome assessment; overall survival; patient compliance; peripheral neuropathy; phase 2 clinical trial; plasmacytoma; pneumonia; priority journal; progression free survival; thrombocytopenia; thromboembolism; thrombosis; treatment response

The relationship between glaucoma medication adherence, eye drop technique, and visual field defect severity - Sleath, B.; Blalock, S.; Covert, D.; Stone, J.L.; Skinner, A.C.; Muir, K.; Robin, A.L. (Ophthalmology, 2011)
Objective: The purpose of the study was to examine (1) how patient adherence and eye drop technique were associated with visual field defect severity and (2) how general glaucoma adherence self-efficacy and eye drop technique self-efficacy were related to visual field defect severity. Design: Cross-sectional study conducted at a single private practice site. Participants: Patients using eye drops for their glaucoma. Methods: Subject adherence to glaucoma medications through Medication Events Monitoring System (MEMS) devices were measured, and eye drop instillation technique was assessed by video recording. General glaucoma medication adherence self-efficacy was measured using a 10-item scale, and eye drop technique self-efficacy was measured using a 6-item scale. Multivariate logistic regression was used to analyze the data. Main Outcome Measures: Visual field defect severity. Results: Patients who were less than 80% adherent according to the MEMS devices were significantly more likely to have worse defect severity. Patients with lower scores on the general glaucoma medication adherence self-efficacy scale also were significantly more likely to have worse defect severity. Eye drop technique and eye drop technique self-efficacy were not related significantly to visual field defect severity. Conclusions: Eye care providers need to assess patient adherence and to work with those patients with poor adherence to find ways to improve their ability and self-efficacy in using their glaucoma medications. © 2011 by the American Academy of Ophthalmology.
Keywords: antiglaucoma agent; eye drops; adult; aged; article; clinical effectiveness; cross-sectional study; disease severity; drug instillation; drug monitoring; drug self administration; ethnicity; female; glaucoma; human; major clinical study; male; outcome assessment; patient compliance; priority journal; rating scale; scoring system; self concept; videorecording; visual field defect

The rate of progression and ocular perfusion pressure in the low-pressure glaucoma treatment study - Quaranta, L.; Floriani, I. (American Journal of Ophthalmology, 2011)
Keywords: brimonidine; timolol maleate; disease course; drug efficacy; glaucoma; intraocular pressure; letter; optic nerve disease; patient compliance; perfusion pressure; priority journal; visual field

[Survey of medical treatment in primary open-angle glaucoma]. - Tchabi, S.; Abouki, C.; Sounouvou, I.; Yèhouessi, L.; Doutetien, C.; Bassabi, S.K. (Journal français d'ophtalmologie, 2011)
To survey patient understanding of primary open-angle glaucoma (POAG) and difficulties associated with medical treatment of POAG patients, to determine patient compliance rates with medical therapy, to study factors influencing compliance rates, and to formulate suggestions to improve patient compliance. Our descriptive prospective study was carried out at the ophthalmology clinic of the Hubert K. Maga national university medical center and in the "La Lumière" ophthalmology clinic in Cotonou, from January 5 through April 25, 2009. The study included all glaucoma patients under medical treatment for at least 1 year with no surgical POAG intervention, seen in consultation during the study period, i.e. 120 patients. The following parameters were studied: whether the patient took or forgot to take his or her medication within the week preceding the survey, the patient's statement of whether or not voluntary interruption of antiglaucoma treatment occurred for more than 1 day, and the regularity of follow-up appointments with the doctor over the preceding 2 years. The median age of the patients was 56.5 ± 11.9years. A percentage of 90.8 of patients understood the chronic nature of POAG. A percentage of 91.7 knew that, in the absence of treatment, POAG can result in irreversible blindness. A percentage of 90 knew that medical treatment is intended to be lifelong. A percentage of 84.2 knew that the dosing schedule must be adhered to. The rate of total compliance was 53.3%. Only regularity of follow-up visits and adherence to dosing schedules were found as significant factors (P<0.05). Compliance is a dynamic variable which ophthalmologists need to evaluate throughout the follow-up of POAG patients, in order to reduce the prevalence of glaucoma blindness in Bénin. Copyright Â© 2011 Elsevier Masson SAS. All rights reserved.
Keywords: antihypertensive agent; adult; aged; article; attitude to health; Benin; clinical trial; evaluation study; female; health survey; human; male; middle aged; multicenter study; open angle glaucoma; patient compliance; socioeconomics; statistics; treatment withdrawal

Heart block following topical latanoprost treatment - De Smit, E.; Theodorou, M.; Hildebrand, G.D.; Bloom, P. (BMJ Case Reports, 2011)
The authors report a case of second degree heart block associated with topical latanoprost treatment. The authors discuss the possibility of a causative effect as the cessation of this treatment resulted in improvement of the arrhythmia. The authors highlight previous reports and research in humans and animals which demonstrate an association of arrhythmias with prostaglandin analogues. This report draws attention to the possibility that an extremely commonly prescribed topical drug may trigger arrhythmias in susceptible individuals. It is important that prescribers are aware of this possible side-effect. Copyright 2011 BMJ Publishing Group. All rights reserved.
Keywords: beta adrenergic receptor blocking agent; latanoprost; adult; article; artificial heart pacemaker; atrioventricular conduction; bradycardia; case report; disease control; dizziness; drug administration route; drug safety; drug withdrawal; dyspnea; electrocardiography; fatigue; female; heart palpitation; human; intraocular pressure; lethargy; mitral valve regurgitation; open angle glaucoma; patient attitude; patient compliance; priority journal; second degree atrioventricular block; topical treatment

Oral acyclovir suppression and neurodevelopment after neonatal herpes - Kimberlin, D.W.; Whitley, R.J.; Wan, W.; Powell, D.A.; Storch, G.; Ahmed, A.; Palmer, A.; Sánchez, P.J.; Jacobs, R.F.; Bradley, J.S.; Robinson, J.L.; Shelton, M.; et al. (New England Journal of Medicine, 2011)
BACKGROUND: Poor neurodevelopmental outcomes and recurrences of cutaneous lesions remain unacceptably frequent among survivors of neonatal herpes simplex virus (HSV) disease. METHODS: We enrolled neonates with HSV disease in two parallel, identical, double-blind, placebo- controlled studies. Neonates with central nervous system (CNS) involvement were enrolled in one study, and neonates with skin, eye, and mouth involvement only were enrolled in the other. After completing a regimen of 14 to 21 days of parenteral acyclovir, the infants were randomly assigned to immediate acyclovir suppression (300 mg per square meter of body-surface area per dose orally, three times daily for 6 months) or placebo. Cutaneous recurrences were treated with open-label episodic therapy. RESULTS: A total of 74 neonates were enrolled - 45 with CNS involvement and 29 with skin, eye, and mouth disease. The Mental Development Index of the Bayley Scales of Infant Development (in which scores range from 50 to 150, with a mean of 100 and with higher scores indicating better neurodevelopmental outcomes) was assessed in 28 of the 45 infants with CNS involvement (62%) at 12 months of age. After adjustment for covariates, infants with CNS involvement who had been randomly assigned to acyclovir suppression had significantly higher mean Bayley mental-development scores at 12 months than did infants randomly assigned to placebo (88.24 vs. 68.12, P = 0.046). Overall, there was a trend toward more neutropenia in the acyclovir group than in the placebo group (P = 0.09). CONCLUSIONS: Infants surviving neonatal HSV disease with CNS involvement had improved neurodevelopmental outcomes when they received suppressive therapy with oral acyclovir for 6 months. (Funded by the National Institute of Allergy and Infectious Diseases; CASG 103 and CASG 104 ClinicalTrials.gov numbers, NCT00031460 and NCT00031447, respectively.) Copyright © 2011 Massachusetts Medical Society.
Keywords: NCT00031447; NCT00031460; aciclovir; placebo; article; body surface; brain development; clinical article; clinical assessment tool; controlled clinical trial; controlled study; double blind procedure; drug activity; drug efficacy; drug safety; drug withdrawal; herpes simplex; herpes simplex encephalitis; herpes simplex keratitis; herpetic stomatitis; human; infant; Mental Development Index of the Bayley Scales of Infant Development; neutropenia; neutrophil count; open study; outcome assessment; patient compliance; priority journal; randomized controlled trial; scoring system; side effect; skin disease; skin infection; treatment duration; treatment response

[Glaucoma County Center]. - Neacşu, A.M. (Oftalmologia (Bucharest, Romania : 1990), 2011)
Sunday 10 April it was opened in Braila Regional Centre of Glaucoma. It was located in the hospital in a new and modern space. The Braila Regional Glaucoma Centre will desire to monitoring and excellent diagnosis in Glaucoma.
Keywords: ambulatory care; article; early diagnosis; glaucoma; human; ophthalmology; public hospital; quality of life; Romania

Balancing efficacy and tolerability of prostaglandin analogues and prostaglandintimolol fixed combinations in primary open-angle glaucoma - Aptel, F.; Denis, P. (Current Medical Research and Opinion, 2011)
Background: Lowering intraocular pressure (IOP) is currently the only therapeutic approach that preserves visual function in primary open-angle glaucoma. In making treatment decisions for first-and second-line therapy, the clinician needs to provide an appropriate balance of efficacy and tolerability. Prostaglandin analogues (PGAs) are frequently used as first-line monotherapy, because of their efficacy and low risk of systemic side effects. Similarly, PGA-based fixed combinations are frequently used in patients who progress or fail to achieve the target IOP. Scope: We have reviewed the literature on the management of primary open-angle glaucoma with PGAs, both as monotherapies and in fixed combinations. Findings: In the clinical trial and meta-analysis data identified, bimatoprost 0.03% seems to be associated with a greater overall ability to lower IOP compared with latanoprost, travoprost or tafluprost, at the cost of a slightly higher incidence of conjunctival hyperaemia. Studies indicate that patients' adherence to treatment is generally better with PGAs than with many other monotherapies. In patients requiring more than one IOP-lowering agent, fixed combination treatments may provide improved adherence and tolerability benefits compared with concomitant use of individual treatments. Bimatoprost/timolol fixed combination appears to be slightly more efficacious than latanoprost/timolol or travoprost/timolol, and tolerability differences between the fixed combinations appear to be slight, probably because the addition of timolol to the PGA component lessens the associated hyperaemia. Surveys on EU physician attitudes appear largely in line with these clinical data. Conclusion: An appropriate balance between efficacy and tolerability ensures optimum IOP lowering and reduces the risk of non-adherence. PGAs largely fulfil this need as monotherapies and as components of combinations. © 2011 Informa UK Ltd.
Keywords: bimatoprost; bimatoprost plus timolol; brimonidine plus timolol; latanoprost; latanoprost plus timolol; saflotan; tafluprost; timolol; timolol plus travoprost; travoprost; unclassified drug; conjunctival hyperemia; disease course; drug cost; drug efficacy; drug safety; drug substitution; drug tolerability; drug withdrawal; dry eye; eye burning; follow up; human; intraocular pressure; meta analysis (topic); monotherapy; ocular pruritus; open angle glaucoma; patient compliance; quality of life; randomized controlled trial (topic); review; single drug dose; duotrav; ganfort; lumigan; saflotan; taflotan; travatan; xalacom; xalatan

Outcomes of pediatric cataract surgery at a tertiary care center in rural southern Ethiopia - Tomkins, O.; Ben-Zion, I.; Moore, D.B.; Helveston, E.E. (Archives of Ophthalmology, 2011)
Objective: To evaluate the etiologies, management, and outcomes of pediatric cataracts in a rural sub-Saharan African setting. Methods: A retrospective, consecutive case series of patients presenting to a tertiary referral center in southern Ethiopia during a 13-month period. All patients underwent clinical examination,were diagnosed as having cataract on the basis of standard clinical assessment, and immediately underwent surgical management. Visual acuity results were grossly divided into ambulatory and nonambulatory vision according to patient age and cooperation. Results: Ninety-one eyes of 73 consecutive patients (57 boys and 16 girls) were included in the study. The mean (SEM) age at diagnosis was 7.1(0.5) years (range, 0.5-15 years). Fifty-five patients had unilateral cataract and 18 had bilateral cataract. Cataracts were categorized according to the etiologic cause: congenital (n=50), traumatic (n=33), congenital glaucoma-related (n=3), partially absorbed cataracts (n=3), and congenital rubella infections (n=2). At presentation, visual acuity ranged from 6/60 to light perception, with 13 eyes (14%) having ambulatory vision (better than hand motion). The mean postoperative visual acuity was significantly improved, ranging from light perception to 6/9. Seventy-five eyes (82%) achieved ambulatory vision. Of the 61 eyes with an implanted intraocular lens, 56 (92%) reached ambulatory visual acuity following surgery. This was significantly greater than preoperative visual acuity results (P<.001). Conclusions: The underlying cause and management of pediatric cataracts in the developing world can differ significantly from that commonly reported in the literature. The effects of appropriate intervention on both visual outcome and associated survival statistics may be profound. ©2011 American Medical Association. All rights reserved.
Keywords: ambulatory monitoring; article; cataract; cataract extraction; child; clinical examination; congenital rubella syndrome; Ethiopia; female; human; lens implant; major clinical study; male; pediatric surgery; priority journal; retrospective study; tertiary health care; vision; visual acuity

New horizons in one of ophthalmology's challenges: Fungal keratitis - Pouyeh, B.; Galor, A.; Miller, D.; Alfonso, E.C. (Expert Review of Ophthalmology, 2011)
Fungal keratitis is a serious ophthalmic condition that requires prolonged medical treatment, often combined with surgical intervention. The prognosis of fungal keratitis is guarded, especially in developing countries where it primarily affects young active males of working class with limited access to medical care. In this article, every effort has been made to appraise and concisely present significant advances in the diagnosis and treatment of fungal keratitis in recent years, and to introduce new perspectives and ideas that may be helpful in decreasing the burden of fungal keratitis. © 2011 Expert Reviews Ltd.
Keywords: amphotericin B; anidulafungin; caspofungin; chlorhexidine; corticosteroid; cyclosporine; econazole; fluconazole; flucytosine; itraconazole; ketoconazole; micafungin; miconazole; natamycin; polyvinyl alcohol; posaconazole; prednisolone acetate; sulfadiazine; voriconazole; antifungal activity; artificial neural network; bedtime dosage; clinical feature; combination chemotherapy; confocal microscopy; cornea ulcer; corneal biopsy; deep lamellar endothelial keratoplasty; delayed diagnosis; disease classification; dose response; drug cost; drug effect; drug hypersensitivity; drug mechanism; drug penetration; drug potentiation; drug safety; drug tissue level; lack of drug effect; fungus culture; fungus identification; fusariosis; graft rejection; graft versus host reaction; gynecomastia; health care access; human; impotence; infection risk; intermethod comparison; keratomycosis; libido disorder; monotherapy; mycosis; nonhuman; ophthalmology; patient compliance; penetrating keratoplasty; polymerase chain reaction; prognosis; rash; recurrent infection; retina disease; review; risk factor; sensitivity and specificity; single drug dose; visual acuity; visual impairment

Multimorbidity, care complexity and prescribing for the elderly - Roughead, E.E.; Vitry, A.I.; Caughey, G.E.; Gilbert, A.L. (Aging Health, 2011)
There is an increasing number of people living with multiple chronic illnesses and consequently taking multiple medicines. More than 50% of these patients will have concomitant diseases that complicate management and will see multiple providers to manage their conditions. This increases their risk of medication-related problems, adverse events and poor treatment outcomes. All of these patients are at high risk of medication misadventure and most will have at least four medication-related problems, of which more than half will be resolvable. The management of medication in these patients will require the increasing involvement of pharmacists to provide a number of cognitive services including medication reconciliation, medication review, adherence services and proactive adverse reaction monitoring. This needs to be integrated into models of practice that coordinate care between multiple providers and accommodate both patient and provider preferences. © 2011 Future Medicine Ltd.
Keywords: antidepressant agent; beta adrenergic receptor blocking agent; corticosteroid; nonsteroid antiinflammatory agent; chronic obstructive lung disease; clinical decision making; clinical pathway; clinical pharmacy; clinical practice; cognitive therapy; comorbidity; depression; disease association; disease exacerbation; doctor patient relationship; drug contraindication; drug surveillance program; drug use; elderly care; glaucoma; gout; health care utilization; human; information dissemination; integrated health care system; interdisciplinary communication; medication error; osteoarthritis; outcome assessment; patient education; patient information; patient preference; pharmacist attitude; physician attitude; polypharmacy; practice guideline; prescription; process model; review; rheumatoid arthritis; risk factor

Glaucoma medication compliance issues in a Jamaican Hospital eye clinic - Mowatt, L.; Nelson-Imoru, J.; Gordon-Strachan, G. (West Indian Medical Journal, 2011)
Objective: To investigate the level of compliance with glaucoma medications in a clinic setting and the factors associated with failed compliance. Method: This was a prospective study done at the Glaucoma Clinic, University Hospital of the West Indies, between April and June 2005. Consecutive patients in the clinic were administered a questionnaire by the doctor. Statistical analysis was done using cross-tabulations, Chi-square (X2) tests and odds ratio using SPSS version 11.0. Results: One hundred glaucoma patients were recruited: 63% were female; 57% of the total group was in the 61-80 year age group. Forty-seven per cent had been attending the glaucoma clinic for over 10 years. Eighty-five per cent knew their diagnosis, although only 22% understood their diagnosis. Patients who did not have a full understanding of glaucoma were more likely to be non compliant (odds ratio 0.771 (95% CI 0.298, 1.995, p = 0.591)). Females were more likely to be compliant than males (odds ratio was 1.64 (95% CI 0.72, 3.75, p = 0.24)). Patients who were clinic attendees for less than five years duration were less compliant than those attending the glaucoma clinic for 6-10 years. The reasons for reduced compliance were financial in 44%, forgetfulness in 20% and eye-drops being unimportant in 12% of cases. The educational level of patients was not related to compliance. Conclusion: The level of full compliance was 50% and partial compliance 43%. There was a 7% level of non-compliance. Higher levels of compliance were seen in females, patients who understood their diagnosis and those who had no co-morbid disease.
Keywords: antiglaucoma agent; eye drops; adult; aged; article; chi square test; controlled study; data analysis software; educational status; female; finance; glaucoma; human; Jamaica; major clinical study; male; patient compliance; prospective study; questionnaire; risk; statistical analysis; university hospital

Measurement of adherence to brimonidine therapy for glaucoma using electronic monitoring - Hermann, M.M.; Bron, A.M.; Creuzot-Garcher, C.P.; Diestelhorst, M. (Journal of Glaucoma, 2011)
Purpose: To assess the patient adherence and behavior with brimonidine twice daily (bid) or 3 times daily (tid) in patients used to topical glaucoma medication. Patients and Methods: Seventy-five patients with glaucoma or ocular hypertension were enrolled in a prospective, observational cohort study. Consenting patients were randomly assigned to brimonidine bid or tid and received conventional brimonidine eye drops with attached electronic monitoring devices for 4 weeks. Patients were not explicitly informed on the compliance monitoring. Results: The study was completed by 67 patients (89%). In 65 patients (97%), at least 1 dosing interval exceeded 24 hours. The mean adherence rates were better in the brimonidine bid group (72±19% vs. 62±16%, P=0.04), although dosing frequency was higher in the tid group (1.9±0.5 vs. 1.4±0.4 per day; P<0.001). On average medication coverage was 70% for the bid group and 67% for the tid group; 19 patients (28%) had a coverage rate above 75%, 42 patients (63%) 50% to 75%, and 6 (9%) below 50%. Patients with normal-tension glaucoma had lower coverage rates than patients with primary open-angle glaucoma and ocular hypertension (P<0.05). Data also showed that on average 20% of the glaucoma medication was wasted owing to inefficient drug delivery by using more than 1 drop per dosing. Conclusions: Individual adherence with brimonidine was highly variable and pharmacologically insufficient for more than two-third of the patients. Special attention should be paid to compliance of patients with normal-tension glaucoma. Our findings underline the need to improve individual adherence and drug delivery in topical glaucoma therapy. Copyright © 2011 by Lippincott Williams & Wilkins.
Keywords: brimonidine; eye drops; prostaglandin; timolol; accuracy; adult; aged; article; clinical article; cohort analysis; devices; dosage schedule comparison; drug efficacy; drug hypersensitivity; dry eye; electronic monitoring; electronics; erythema; female; glaucoma; human; intraocular hypertension; male; medical technology; migraine; monotherapy; observational study; open angle glaucoma; patient compliance; patient monitoring; priority journal; prospective study; alphagan

Depression and medication adherence in the treatment of chronic diseases in the United States: A meta-analysis - Grenard, J.L.; Munjas, B.A.; Adams, J.L.; Suttorp, M.; Maglione, M.; McGlynn, E.A.; Gellad, W.F. (Journal of General Internal Medicine, 2011)
Objective: To conduct a meta-analysis of the association between depression and medication adherence among patients with chronic diseases. Poor medication adherence may result in worse outcomes and higher costs than if patients fully adhere to their medication regimens. Data sources: We searched the PubMed and PsycINFO databases, conducted forward searches for articles that cited major review articles, and examined the reference lists of relevant articles. Study eligibility criteria, participants, and interventions: We included studies on adults in the United States that reported bivariate relationships between depression and medication adherence. We excluded studies on special populations (e.g., substance abusers) that were not representative of the general adult population with chronic diseases, studies on certain diseases (e.g., HIV) that required special adherence protocols, and studies on interventions for medication adherence. Study appraisal and synthesis methods: Data abstracted included the study population, the protocol, measures of depression and adherence, and the quantitative association between depression and medication adherence. Synthesis of the data followed established statistical procedures for meta-analysis. Results: The estimated odds of a depressed patient being non-adherent are 1.76 times the odds of a non-depressed patient, across 31 studies and 18,245 participants. The association was similar across disease types but was not as strong among studies that used pharmacy records compared to self-report and electronic cap measures. Limitations: The meta-analysis results are correlations limiting causal inferences, and there is some heterogeneity among the studies in participant characteristics, diseases studied, and methods used. Conclusions: This analysis provides evidence that depression is associated with poor adherence to medication across a range of chronic diseases, and we find a new potential effect of adherence measurement type on this relationship. Although this study cannot assess causality, it supports the importance that must be placed on depression in studies that assess adherence and attempt to improve it. © 2011 Society of General Internal Medicine.
Keywords: anticoagulant agent; anticoagulant therapy; asthma; Beck Depression Inventory; Center for Epidemiological Studies Depression Scale; chronic disease; clinical evaluation; correlation analysis; data extraction; depression; diabetes mellitus; effect size; glaucoma; heart failure; hemodialysis; human; hyperlipidemia; hypertension; information retrieval; ischemic heart disease; kidney graft; medical record review; meta analysis; assessment of humans; patient compliance; patient health questionnaire; psychologic assessment; review; systemic lupus erythematosus; treatment refusal; United States

Antiglaucoma drugs: The role of preservative-free formulations - Bagnis, A.; Papadia, M.; Scotto, R.; Traverso, C.E. (Saudi Journal of Ophthalmology, 2011)
Hypersensitive reactions to eyedrops are a common finding in clinical practice and represent a frequent cause of discontinuation of the therapy. Moreover, experimental and clinical studies show that long term use of topical drugs may induce ocular surface changes causing discomfort and potentially negatively affecting the compliance to the treatment as well as the success rate of filtering procedures. The exact mechanism involved and the roles of the active compound and the preservatives in inducing such detrimental effects of ophthalmic solutions are unclear. During the last years several antiglaucoma agents have been marketed as either preservative-free or benzalkonium chloride-free formulations in an attempt to reduce the adverse effects related to preservatives. This paper summarizes the body of evidence from existing studies about preservatives in antiglaucoma eyedrops, focusing on the latest compounds commercially available. A systematic review of the literature was performed. Current research is focusing not only on the efficacy of the drugs but also on their tolerability. Based on the existing data, there is a rationale to support the use of benzalkonium-free solutions whenever possible, especially in patients suffering from concomitant ocular surface diseases, experiencing local side effects and in those expected to need multiple and prolonged topical treatments. © 2011.
Keywords: antiglaucoma agent; benzalkonium chloride; betaxolol; brimonidine; brimonidine plus timolol; carteolol; dorzolamide; dorzolamide plus timolol; levobunolol; pilocarpine; tafluprost; timolol; travoprost; allergic reaction; dermatitis; drug efficacy; drug formulation; drug tolerability; dry eye; epiphora; eye burning; eye pain; glaucoma; human; intraocular pressure; Medline; monotherapy; ocular pruritus; open angle glaucoma; patient compliance; periocular dermatitis; periocular dermatitis; priority journal; quality of life; review; single drug dose; systematic review; treatment response; vision

Compliance and knowledge about glaucoma in patients at tertiary glaucoma units - Mansouri, K.; Iliev, M.E.; Rohrer, K.; Shaarawy, T. (International Ophthalmology, 2011)
To document the rate of self-reported compliance and glaucoma-related knowledge in Swiss patients and to identify risk factors for their poor compliance. This was an observational study, including a total of 200 consecutive patients already under glaucoma medication in two Swiss tertiary glaucoma clinics (Geneva and Bern). Personal characteristics, presence of systemic disease, compliance with glaucoma medication, attitude to the ophthalmologist, and glaucoma-related attitudes were ascertained by means of a predetermined questionnaire with 40 questions. Patients were subsequently assessed for the ability to correctly instil placebo eye drops. Non-compliance with glaucoma medication was defined as omitting more than two doses a week as reported by the patient. Logistic regression was used to evaluate how patient characteristics and knowledge about the disease were related to compliance. Overall, 81% (n = 162) of patients reported to be compliant. Forgetfulness was the most frequently cited reason for non-compliance with dosing regimen (63%). Although 90.5% (n = 181) of patients believed glaucoma medication to be efficient, only 28% (n = 56) could correctly define glaucoma. Factors positively associated with compliance were 'knowledge of glaucoma' [adjusted odds ratio (OR) 4.77 (95% CI 1.36-16.70)] and 'getting help for administration of drops' [OR 2.95 (1.25-6.94)]. These findings indicate that despite the comparatively high compliance rate among glaucoma patients, knowledge of glaucoma remains poor in long-term glaucoma sufferers. Improving knowledge about the disease is important since it is positively associated with compliance in our study. © 2011 Springer Science+Business Media B.V.
Keywords: alpha adrenergic receptor stimulating agent; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; prostaglandin derivative; adult; aged; article; controlled study; female; glaucoma; human; knowledge; major clinical study; male; observational study; open angle glaucoma; patient attitude; patient compliance; questionnaire; risk factor; self report; Switzerland; systemic disease

Treating patients presenting with advanced glaucoma - Should we reconsider current practice? - King, A.J.; Stead, R.E.; Rotchford, A.P. (British Journal of Ophthalmology, 2011)
The management of patients presenting with advanced glaucoma presents a challenge to glaucoma clinicians. Presentation with advanced visual field loss is an important risk factor for progression to blindness in the affected eye(s) during the patients' lifetime. Maximising intraocular pressure (IOP) control in such situations is likely to minimise the risk of further visual field deterioration thus either preventing or slowing progression to blindness. Currently most patients presenting with advanced disease in the UK are managed on an escalating regime of medical treatment. Should this fail glaucoma surgery is usually employed to further lower IOP. Although glaucoma surgery is generally a safe and successful intervention it carries a small risk of severe visual loss and is considered by many clinicians as an intervention only to be used following failure of medical treatment. Recently however the National Institute for Clinical Excellence has suggested in its clinical guidelines for management of ocular hypertension and glaucoma that primary surgery should be offered to patients presenting with advanced glaucomatous visual field loss. This is contrary to the practice of most UK ophthalmologists. In this review the current available evidence underlying the management of presentation with advanced disease is examined.
Keywords: epinephrine; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; fluorouracil; guanethidine; mitomycin; pilocarpine; placebo; timolol; blindness; cataract; cataract extraction; clinical practice; glaucoma; glaucoma surgery; health care cost; human; intraocular hypertension; intraocular pressure; open angle glaucoma; patient compliance; postoperative complication; primary glaucoma; priority journal; quality of life; review; risk factor; surgical risk; trabeculectomy; visual acuity; visual field defect; visual impairment

Prodrugs - An efficient way to breach delivery and targeting barriers - Huttunen, K.M.; Rautio, J. (Current Topics in Medicinal Chemistry, 2011)
The study of prodrugs that are chemically modified bioreversible derivatives of active drug compounds to alter their undesired properties has been expanded widely during the last decades. Despite the commercial success the prodrugs have afforded, the concept is still quite unknown among many scientist. Furthermore, many scientists regard prodrugs as a pure interest of academic research groups and not as a feasible solution to improve the delivery or targeting properties of new chemical entities, drug candidates failed in clinical trials, or drugs withdrawn from the market. Although there are still unmet needs that require addressing, prodrugs should be seen as fine-tuning tools for the successful drug research and development. This review represents the potential of prodrugs to improve the drug delivery by enhanced aqueous solubility or permeability as well as describes several targeted prodrug strategies. © 2011 Bentham Science Publishers.
Keywords: 2,5 bis(4 amidinophenyl)furan; aciclovir; adefovir dipivoxil; amino acid transporter; aminosalicylic acid; antineoplastic agent; banoxantrone; bimatoprost; camptothecin; candesartan hexetil; carbohydrate derivative; cyclophosphamide; daunorubicin; dexamethasone; fosphenytoin sodium; ifosfamide; macrogol derivative; Mannich base; melagatran; mevinolin; organophosphate; paclitaxel; pafuramidine; pradefovir; prednisolone sodium phosphate; prodrug; rolitetracycline; simvastatin; timolol; trofosfamide; unindexed drug; valaciclovir; ximelagatran; allergy; anemia; antibody directed enzyme prodrug therapy; aqueous solution; atherosclerosis; bacterial skin disease; blood brain barrier; brain tumor; cytomegalovirus infection; drug absorption; drug bioavailability; drug delivery system; drug efficacy; drug penetration; drug release; drug safety; drug solubility; drug targeting; drug withdrawal; Epstein Barr virus infection; gene directed enzyme prodrug therapy; glaucoma; glomerulus filtration rate; hair loss; hematologic malignancy; hepadnavirus infection; herpes simplex; herpes virus infection; herpes zoster; human; hydrogen bond; hyperlipidemia; hypoxia; infertility; lipophilicity; liver metabolism; liver toxicity; nausea; neutropenia; nonhuman; patient compliance; permeability barrier; retrovirus infection; review; teratogenicity; thrombocytopenia; thromboembolism; urinary excretion; wound healing impairment; amias; aq4n; atacand; cerebyx; cytoxan; endoxan; exanta; holoxan; ifex; ixoten; lumigan; neosar; pediapred; reverin; taxol; transcycline; valtrex

Rational design and development of colon-specific prodrugs - Dhaneshwar, S.S.; Vadnerkar, G. (Current Topics in Medicinal Chemistry, 2011)
Earlier colon was considered as a black-box, acting as a site for production and temporary storage of excreta and responsible for absorption of electrolytes and water. But, with the discovery of sulfasalazine as colon-specific pro-drug, the promising and challenging issue of treating local pathologies was presented with colon as an organ of significance for target-specific delivery of drugs. The need and desirable attributes of colon-specific drug delivery systems have been well recognized, extensively explored and documented in the literature. The success of a colon-specific prodrug depends on its rational design and understanding the demands of the organ to be targeted and the delivery system to be developed. The present review mainly focuses on anatomy/physiology of colon, colonic microbiota, enzymatic set up of colon, pathophysiology of local diseases of colon, factors, obstacles and rationale for designing colon specific drug delivery system, various targets, potential drug candidates and novel colon-targeting carriers along with varied linkages that could be explored, merits and demerits of this design and recent trends in this field. Brief review of methodologies for characterization and in vitro/in vivo release studies is presented. The available animal models with quantifying parameters for evaluating colon-targeting potential and effectiveness of the colon-specific prodrugs for inflammatory bowel disease is also included in this review. © 2011 Bentham Science Publishers.
Keywords: aminosalicylic acid; azathioprine; balsalazide; bevacizumab; budesonide; cetuximab; corticosteroid; cyclosporine; fluorouracil; interleukin 6; interleukin 8; intestinol; loperamide; mercaptopurine; mesalazine; methotrexate; metronidazole; mycophenolic acid; mycophenolate mofetil; olsalazine; peroxisome proliferator activated receptor gamma; polyamidoamine; prednisolone; prodrug; rifaximin; ademetionine; salazosulfapyridine; taurine; thalidomide; tumor necrosis factor; unclassified drug; unindexed drug; abdominal pain; acne; agranulocytosis; amebiasis; anorexia; antiinflammatory activity; antioxidant activity; arthralgia; congenital malformation; bone marrow disease; bone marrow suppression; cancer adjuvant therapy; cancer combination chemotherapy; cataract; cell differentiation; colon flora; colorectal cancer; congenital disorder; connective tissue disease; convulsion; Crohn disease; cytokine production; depression; diabetes mellitus; diarrhea; digestive system ulcer; disease association; drug bioavailability; drug conjugation; drug design; drug efficacy; drug eruption; drug fever; drug formulation; drug hypersensitivity; drug induced headache; drug megadose; drug safety; drug solubility; drug stability; drug targeting; drug tolerance; enteritis; fatigue; fetus death; first pass effect; gastrointestinal absorption; gastrointestinal tract; glaucoma; glossitis; hemolytic anemia; hepatitis; hirsutism; histopathology; human; hydrophilicity; hypertension; ileitis; in vitro study; in vivo study; infection sensitivity; insomnia; intestine transit time; irritability; irritable colon; kidney failure; kidney injury; leukemia

Association between intraocular pressure and adherence: Is there one - Cate, H.; Broadway, D.C. (Eye, 2011)
Keywords: antiglaucoma agent; disease course; glaucoma; human; intraocular pressure; letter; methodology; outcome assessment; patient compliance; pressure measurement; treatment outcome; visual field defect

Response to Cate and Broadway - Ajit, R.R.; Fenerty, C.H.; Henson, D.B. (Eye, 2011)
Keywords: antiglaucoma agent; prostaglandin; follow up; glaucoma; human; hyperemia; hypotension; intraocular pressure; letter; monitor; patient compliance; treatment outcome

Prevalence and correlates of self-reported nonadherence with eye drop treatment: The belgian compliance study in ophthalmology (BCSO) - Vandenbroeck, S.; De Geest, S.; Dobbels, F.; Fieuws, S.; Stalmans, I.; Zeyen, T. (Journal of Glaucoma, 2011)
PURPOSE: This study aimed to investigate (1) the prevalence of nonadherence with eye drop treatment; (2) selected correlates of nonadherence at the patient and health-care organization level; and (3) the diagnostic value of the ophthalmologists? ratings, using patients? self-reports as standard. METHODS: This cross-sectional multicenter survey used questionnaires for ophthalmologists and their patients to assess self-reported nonadherence and its correlates. One item, using a 4-point scale [never (ie, adherent) to daily], asked the patients whether they had forgotten to administer eye drops during the past 2 weeks. Ophthalmologists rated their patients as adherent or nonadherent. Nonadherence was also determined by combined methods, whereby either could indicate nonadherence. Given the nested structure of the data, multilevel modeling was used to investigate self-reported nonadherence-correlates. Diagnostic values of ophthalmologists? report were calculated. RESULTS: Of 663 patients (48% female, 44% >69 years), nonadherence was indicated in 39.2% (n=260) through self-reporting, 2.1% (n=14) through ophthalmologists? ratings, and 40% (n=266) through combined measures. The multivariable, multilevel model showed following significant nonadherence-correlates: Male sex (P=0.01), younger age (P=0.027), and higher-dose frequency (P=0.001). No significant correlation with treating ophthalmologist (P=0.21) could be seen. Yet, the patients visiting their ophthalmologists at least every 3 months were less nonadherent than patients with fewer consultations (P=0.01). The ophthalmologists? report showed a sensitivity and specificity of 3% and 98.5%, respectively. CONCLUSIONS: The prevalence of self-reported nonadherence was congruent with literature. The patients visiting their ophthalmologists at least every 3 months have a lower risk of nonadherence. Ophthalmologist report is an insensitive method for detecting nonadherence. © 2011 by Lippincott Williams & Wilkins.
Keywords: eye drops; adult; age; aged; article; controlled study; cross-sectional study; diagnostic value; eye care; female; follow up; health survey; human; intraocular hypertension; major clinical study; male; open angle glaucoma; patient compliance; predictive value; priority journal; questionnaire; self report; sex difference; treatment refusal

Update on aqueous shunts - Gedde, S.J.; Parrish, R.K.; Budenz, D.L.; Heuer, D.K. (Experimental Eye Research, 2011)
Medicare claims data and surveys of the American Glaucoma Society membership show that aqueous shunts are being increasingly utilized in the surgical management of glaucoma. New clinical trials data have identified differences in the efficacy and safety of shunts in common use. Recent studies have reported comparable results with trabeculectomy and aqueous shunts in similar patient groups. Intraoperative and postoperative complications may develop with aqueous shunt surgery related to the implantation of a foreign material. Several modifications in surgical technique have been directed toward improving surgical success, reducing complications, and optimizing efficiency and cost. © 2011 Elsevier Ltd.
Keywords: antiglaucoma agent; fibrin glue; fluorouracil; mitomycin; polytetrafluoroethylene; polymacon; polypropylene; adjuvant therapy; article; ciliary sulcus; clinical effectiveness; closed angle glaucoma; comparative effectiveness; corneal endothelial cell loss; device removal; device safety; diplopia; drug utilization; equipment design; eye; eye disease; follow up; glaucoma; glaucoma drainage implant; health care survey; health care utilization; human; intermethod comparison; intraocular pressure abnormality; medical society; medicare; meta analysis (topic); multicenter study (topic); nonhuman; open angle glaucoma; patient preference; peroperative complication; phthisis bulbi; polytetrafluoroethylene implant; postoperative complication; priority journal; prognosis; randomized controlled trial (topic); reoperation; scar; slow drug release; Sri Lanka; strabismus; suture technique; trabeculotomy; treatment failure; treatment outcome; visual impairment; Ahmed; Baerveldt; Molteno

Update on the role of alpha-agonists in glaucoma management - Arthur, S.; Cantor, L.B. (Experimental Eye Research, 2011)
Glaucoma is the second most common cause of world blindness (following cataract) with estimated cases reaching 79.6 million by 2020. Although the etiology of glaucoma is multi-factorial, intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Among various classes of IOP-lowering medications currently available, alpha-adrenergic receptor agonists are used either as monotherapy, as second-line therapy, or in fixed combination with beta-blockers. Non-selective adrenergic agonists such as epinephrine and dipivefrin are infrequently used today for the treatment of glaucoma or ocular hypertension, and have been replaced by the alpha-2-selective agonists. The use of apraclonidine for IOP reduction in glaucoma or OHT is limited due to a high rate of follicular conjunctivitis. The alpha-2-selective agonist in use today is brimonidine. The brimonidine-purite formulations are preferred to brimonidine-benzalkonium chloride (BAC) formulations due better tolerability while maintaining similar efficacy. Brimonidine is also effective when used in combination with a beta-blocker. Using brimonidine-timolol fixed combination (BTFC) as first-line therapy has an added potential for neuroprotection. This would be a valuable strategy for glaucoma treatment, for patients who are intolerant of prostaglandin analogs, or for patients where prostaglandin analogues are contraindicated as first-line therapy, such as in patients with inflammatory glaucoma. © 2011 Elsevier Ltd.
Keywords: epinephrine; alpha adrenergic receptor stimulating agent; apraclonidine; brimonidine; brimonidine plus timolol; dipivefrine; dorzolamide plus timolol; latanoprost; allergic reaction; aphakia; apnea; article; ataxia; bradycardia; conjunctivitis; contact dermatitis; dizziness; drowsiness; drug blood level; drug cost; drug efficacy; drug elimination; drug half life; drug mechanism; drug safety; drug tolerability; drug withdrawal; eye burning; eye discomfort; eye irritation; fatigue; glaucoma; headache; heart arrhythmia; human; hyperemia; hypertension; hypotension; hypothermia; intraocular hypertension; intraocular pressure; irritability; lethargy; miosis; monotherapy; muscle hypotonia; neuroprotection; nonhuman; ocular pruritus; pallor; patient compliance; priority journal; pseudophakia; randomized controlled trial (topic); respiration depression; side effect; somnolence; tachyphylaxis; unspecified side effect; xerostomia; alphagan; combigan

Advances in the treatment of chronic inflammatory demyelinating neuropathies in 2010 - Lozeron, P.; Adams, D. (Journal of Neurology, 2011)
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an uncommon disease of the peripheral nerves. The diagnosis is based mainly on clinical presentation, cerebrospinal fluid (CSF) examination, and electrodiagnostic studies. Treatment of CIDP has at least two components: supportive care and specific therapy including primarily steroids, intravenous immunoglobulins (IVIg), and plasmapheresis (PE). This review summarizes progress in the treatment of CIDP published during the last year. © 2011 Springer-Verlag.
Keywords: alemtuzumab; azathioprine; beta1a interferon; corticosteroid; cyclophosphamide; dexamethasone; immunoglobulin G; immunomodulating agent; immunosuppressive agent; methotrexate; mycophenolate mofetil; natalizumab; placebo; prednisolone; steroid; absence of side effects; add on therapy; arthralgia; article; autoimmune disease; autoimmune hemolytic anemia; chronic inflammatory demyelinating polyneuropathy; cost effectiveness analysis; deep vein thrombosis; diabetes mellitus; disease severity; drug dose regimen; drug fever; drug induced headache; drug megadose; drug pulse therapy; drug substitution; drug tolerability; drug withdrawal; duodenum ulcer; fatigue; glaucoma; Graves disease; heart infarction; human; hypertension; immunosuppressive treatment; loading drug dose; lung embolism; lymphocytopenia; maintenance drug dose; maintenance therapy; Medline; moon face; multicenter study (topic); multiple cycle treatment; myalgia; obesity; osteoporosis; outcome assessment; overall disability sum score; patient compliance; plasmapheresis; priority journal; psychosis; quality adjusted life year; remission; scoring system; side effect; somnolence; steroid therapy; treatment response; vomiting; body weight gain; gammagard; kiovig

The influence of the Travalert® dosing aid on medical treatment compliance and the quality of life of glaucoma patients - Sánchez-Pulgarín, M.; Martínez-De-La-Casa, J.M.; Escalada, A.; Sáenz-Francés, F.; García-Feijoó, J.; García Sánchez, J. (Archivos de la Sociedad Espanola de Oftalmologia, 2011)
Purpose: To study compliance in the medical treatment of glaucoma, its possible association with other factors, and quality of life of patients with glaucoma. Material and methods: Longitudinal prospective study of 60 patients with ocular hypertension or glaucoma who were treated with travoprost, or with a fixed combination of travoprost/timolol nightly. All subjects were given a Travalert® dosing aid and were reviewed after one and four months. Strict and relative compliance data were collected on each visit. The relationship between compliance and other variables was studied using univariate analysis. To analyse quality of life, patients were given self-assessment STAI anxiety questionnaires after the first and last visits. Results: Relative compliance for the four months was significantly greater than the strict compliance (P =.001). In the group of least compliance the number of patients on treatment with combination therapy was significantly higher than those on monotherapy. In the lost cases, the number of men was significantly higher than women. No association was found in the other variables. The anxiety was similar to that in the normal population. Conclusions: Compliance is very important in the treatment of glaucoma, and our study provides objective data through the use of Travalert dosing aid with relative compliances of 70%. Patients with combined therapies have lower compliance than those on monotherapy. © 2010 Sociedad Espanola de Oftalmologia. Published by Elsevier Espana, S.L. All rights.
Keywords: cloprostenol; drug derivative; eye drops; timolol; travoprost; aged; anxiety; article; clinical trial; comparative study; drug administration; drug combination; drug instillation; female; follow up; glaucoma; human; devices; intraocular drug administration; intraocular hypertension; male; middle aged; patient compliance; prospective study; psychological aspect; quality of life; questionnaire; reminder system

Novel ocular antihypertensive compounds in clinical trials - Chen, J.; Runyan, S.A.; Robinson, M.R. (Clinical Ophthalmology, 2011)
Introduction: Glaucoma is a multiflactorial disease characterized by progressive optic nerve injury and visual field defects. Elevated intraocular pressure (IOP) is the most widely recognized risk factor for the onset and progression of open-angle glaucoma, and IOP-lowering medications comprise the primary treatment strategy. IOP elevation in glaucoma is associated with diminished or obstructed aqueous humor outflow. Pharmacotherapy reduces IOP by suppressing aqueous inflow and/or increasing aqueous outflow. Purpose: This review focuses on novel non-FDA approved ocular antihypertensive compounds being investigated for IOP reduction in ocular hypertensive and glaucoma patients in active clinical trials within approximately the past 2 years. Methods: The mode of IOP reduction, pharmacology, efficacy, and safety of these new agents were assessed. Relevant drug efficacy and safety trials were identified from searches of various scientific literature databases and clinical trial registries. Compounds with no specified drug class, insufficient background information, reformulations, and fixed-combinations of marketed drugs were not considered. Results: The investigational agents identified comprise those that act on the same targets of established drug classes approved by the FDA (ie, prostaglandin analogs and β-adrenergic blockers) as well as agents belonging to novel drug classes with unique mechanisms of action. Novel targets and compounds evaluated in clinical trials include an action polymerization inhibitor (ie, latrunculin), Rho-associated protein kinase inhibitors, adenosine receptor analogs, an angiotension II type 1 receptor antagonist, cannabinoid receptor agonists, and a serotonin receptor antagonist. Conclusion: The clinical value of novel compounds for the treatment of glaucoma will depend ultimately on demonstrating favorable efficacy and benefit-to-risk ratios relative to currently approved prostaglandin analogs and β-blockers and/or having complementary modes of action. © 2011 Chen et al, publisher and licensee Dove Medical Press Ltd.
Keywords: NCT00441883; NCT00515424; NCT00523250; NCT00572455; NCT00595101; NCT00650702; NCT00767793; NCT00824720; NCT00846989; NCT00902200; NCT00967811; NCT01016691; NCT01033422; NCT01037036; NCT01060579; NCT01123785; NCT01223378; NCT01227291; NCT01229982; piclidenoson; actin; adenosine derivative; agents acting on the eye; angiotensin 1 receptor antagonist; antiglaucoma agent; ar 102; verosudil; evodenoson; bimatoprost; cannabinoid receptor agonist; ino 8875; ins 115644; ins 117548; k 115; latanoprost; latrunculin B; olmesartan; opa 6566; placebo; Rho kinase; Rho kinase inhibitor; sad 448; serotonin antagonist; syl 040012; taprenepag isopropyl ester; timolol; travoprost; unclassified drug; unindexed drug; y 39983; conjunctival hemorrhage; conjunctival hyperemia; cornea disease; cornea permeability; cornea thickness; drug delivery system; drug dose escalation; drug efficacy; drug mechanism; drug safety; drug tolerability; eye burn; eye disease; eye irritation; glaucoma; human; intraocular hypertension; intraocular pressure; iritis; nonhuman; open angle glaucoma; patient compliance; photophobia; review; risk benefit analysis; side effect; sustained drug release; vascular disease; ar 102; ar 12286; atl 313; cf 101; ino 8875; ins 115644; ins 117548; k 115; opa 6566; opa 6566; pf 04217329; sad 448; y 39983; y 39983

Adherence of Finnish people with glaucoma to treatment plans and connected factors - Lunnela, J.; Kääriäinen, M.; Kyngäs, H. (International Journal of Circumpolar Health, 2011)
Objectives. The aim of the study was to describe the adherence of Finnish people with glaucoma to prescribed treatment plans, the factors connected to adherence and to produce knowledge for developing effective interventions to improve adherence to treatment plans. Study design. This was a cross-sectional study. Methods. The data (n=249) were collected at one point in time from Finnish adults diagnosed with glaucoma with a questionnaire covering adherence to treatment. These patients used glaucoma medication and had follow-up appointments with ophthalmologists. Results. Sixty-seven percent (n=166) of the patients with glaucoma were very adherent to the prescribed treatment plan in terms of self-care, treatment and follow-up visits. Almost all were very adherent to medical care (97%, n=242). More than half of those who had received information from physicians and nurses were very adherent to treatment (66%, n=163). Two factors, support from physicians and nurses (p<0.001) and being informed of the consequences of treatments (p=0.003), had a statistically significant connection to treatment adherence. Conclusions. This study indicates that people with glaucoma in Finland adhere well to care and exceptionally well to medical care. Support and patient education from health care personnel is crucial to maintain patient adherence to treatment. These results indicate that nurses play a very important role in patient education and support. In practice, it is crucial to maintain this level of patient engagement by developing more tailored and time-saving education and support methods. The results of this study could be helpful for developing new patient education and support approaches for people with glaucoma.
Keywords: antihypertensive agent; adult; aged; ambulatory care; article; cross-sectional study; drug utilization; female; Finland; glaucoma; human; male; middle aged; patient compliance; patient education; questionnaire; self care

Do adherence rates and glaucomatous visual field progression correlate? - Rossi, G.C.M.; Pasinetti, G.M.; Scudeller, L.; Radaelli, R.; Bianchi, P.E. (European Journal of Ophthalmology, 2011)
Purpose. To assess the relation between visual field progression and adherence rate in patients with glaucoma using Travatan Dosing Aid® (TDA). Methods. In this 36-month retrospective study, 35 patients with primary open-angle glaucoma on travoprost or travoprost/timolol fixed combination monotherapy were submitted to ophthalmic examination and to visual field (VF) test from 2007 to 2009. Adherence was recorded with TDA. The association between VF progression (from 2007 to the end of the follow-up period) and a number of predictors (adherence rates at 12 months) was tested by means of chi-square test (or Fisher exact test) or Mann-Whitney test as appropriate. Results. The mean (±SD) adherence rates were 71.9%±27.8% after 1 month of follow-up and 76.8%±20.9% at 12 months. A total of 25 (71.4%) patients with stable VF had a median adherence rate (IQR) of 85% (75%-97%); patients who worsened (n=10; 28.6%) recorded a median (IQR) adherence of 21% (9%-45%) (p<0.001). No association was found between VF progression and any of the other variables (age, sex, schooling, visual acuity, intraocular pressure (IOP) at baseline and over time, other ocular diseases, time since diagnosis and actual therapy, number of concomitant systemic therapies). Patients who were at least 90% adherent did not progress, while 43.5% of the patients with lower adherence worsened (p=0.01). Conclusions. Our data suggest that adherence rate may play a role in glaucomatous damage and/or progression; the target IOP therefore should be adjusted by adherence rates. Monitoring tools, educational programs, use of videos, a better doctor-patient relationship, or other means to improve adherence are desirable and necessary to preserve visual function. © 2010 Wichtig Editore.
Keywords: timolol plus travoprost; travoprost; aged; article; clinical article; clinical assessment; controlled study; devices; drug monitoring; human; intraocular pressure; open angle glaucoma; patient attitude; patient compliance; priority journal; retrospective study; visual field; visual system function; Travatan Dosing Aid

Diabetic neovascularisation and secondary glaucoma - Holló, G. (Orvosi Hetilap, 2011)
Neovascular glaucoma develops from intraocular neovascularisation in diabetes mellitus. Neovascularisation is a consequence of hypoxia-induced production of vascular endothelial growth factor-A. Neovascular glaucoma is one of the most serious, sight-threatening late complications of diabetes. Several intraocular pressure lowering drugs, surgical and adjunctive laser treatments have been used to treat this disease, but the efficacy of the interventions is limited. The role of vascular endothelial growth factor-A blocking therapy in the treatment of neovascular glaucoma remains to be determined. Development of neovascularisation, however, can be prevented with adequate long-term glycemic and lipid control, effective treatment of arterial hypertension and optimal timing of adequate panretinal photocoagulation, in the majority of the cases. Unfortunately, in clinical practice diabetic neovascular glaucoma is more frequently experienced in Hungary than would be expected based on the variety of available therapeutic possibilities. In order to increase the success of prevention both cooperation of general practitioners, diabetologists, dietitians and ophthalmologists, and compliance of diabetic patients need to be improved.
Keywords: vasculotropin A; article; diabetes mellitus; human; Hungary; hypertension; laser coagulation; neovascular glaucoma; neovascularization (pathology); patient compliance

Racial and ethnic disparities in adherence to glaucoma follow-up visits in a county hospital population - Murakami, Y.; Lee, B.W.; Duncan, M.; Kao, A.; Huang, J.-Y.; Singh, K.; Lin, S.C. (Archives of Ophthalmology, 2011)
Objectives: To identify predictors of inconsistent attendance at glaucoma follow-up visits in a county hospital population. Methods: Prospective recruitment from August 1, 2008, through January 31, 2009, of 152 individuals with glaucoma, with 1-to-1 matching of patients (those with inconsistent follow-up) and controls (those with consistent follow-up). Data were collected via oral questionnaire. Survey results were correlated with attendance at follow-up examinations, using the t test, χ2 test, and multivariate stepwise logistic regression analysis to calculate the odds ratios (ORs) and 95% confidence intervals. Results: After adjusting for covariates in the logistic regression analysis, factors independently associated with inconsistent follow-up included black race (adjusted OR, 7.16; 95% confidence interval, 1.64-31.24), Latino ethnicity (adjusted OR, 4.77; 1.12-20.29), unfamiliarity with necessary treatment duration (adjusted OR, 3.54; 1.26-9.94), lack of knowledge of the permanency of glaucoma-induced vision loss (adjusted OR, 3.09; 1.18-8.04), and perception that it is not important to attend all follow-up visits (adjusted OR, 3.54; 1.26-9.94). Conclusions: Demographic factors, including race and ethnicity, may directly or indirectly affect adherence to recommended glaucoma follow-up visits. Lack of information regarding irreversible vision loss from glaucoma, need for lifelong treatment, and lack of visual symptoms may be significant barriers to follow-up in this population. Targeted glaucoma education by physicians may improve follow-up, thereby decreasing the morbidity associated with glaucomatous disease. ©2011 American Medical Association. All rights reserved.
Keywords: adult; aged; article; confidence interval; controlled study; correlation analysis; data collection method; demography; disease association; ethnic difference; female; follow up; glaucoma; health service; health survey; Hispanic; hospital; human; major clinical study; male; medical education; multivariate logistic regression analysis; physician; population; predictor variable; priority journal; prospective study; questionnaire; race difference; symptom; treatment duration; visual impairment

Blindness in Iraq: Leading causes, target patients, and barriers to treatment - Al-Shakarchi, F.I. (Middle East African Journal of Ophthalmology, 2011)
Purpose : To define the main causes of blindness, demographic characteristics and barriers to care of blind patients attending a teaching eye hospital in Iraq. Material and Method : Successive new patients, 6 years of age and older, who attended three outpatients clinics at Ibn Al-Haetham Teaching Eye Hospital (IAHTEH), Baghdad, Iraq, from September 1 to November 30, 2007, were included in this study. Inclusion criterion was fulfillment of the World Health Organization′s definition of blindness. The cause of blindness was identified and subjects were interviewed for collection of data on demographic characteristics and barriers to treatment. Results : Of 18612 consecutive patients who attended the outpatient clinics, 497 (2.7%) patients were blind. Cataract (76.1%), diabetic retinopathy (12.9%), and glaucoma (5%) were the leading causes of blindness. The majority of blind patients had low socioeconomic status and poor educational level. In cases of cataract, the most important barrier to treatment was the waiting list at the hospital (53.7%). A lack of awareness was the most important barrier to treatment for patients with diabetic retinopathy (54.7%) and glaucoma (56%). Conclusions : The preliminary data from our study will aid in the development of blindness prevention programs in Iraq. Priorities include decreasing waiting lists for cataract surgeries at governmental hospitals. Active health promotion programs for early detection and treatment of diabetic retinopathy and glaucoma are also warranted.
Keywords: adolescent; adult; age; aged; article; awareness; blast injury; blindness; cataract; child; cornea dystrophy; demography; diabetic retinopathy; educational status; eye injury; female; glaucoma; health care access; hospital admission; human; interview; Iraq; keratitis; major clinical study; male; optic nerve atrophy; outpatient care; pathogenesis; patient care; preschool child; priority journal; refraction error; retina detachment; retina dystrophy; age related macular degeneration; school child; social status; teaching hospital; urban rural difference; uveitis

Newer therapeutic vistas for Antiglaucoma medicines - Kaur, I.P.; Singh, H.; Kakkar, S. (Critical Reviews in Therapeutic Drug Carrier Systems, 2011)
Glaucoma is second to cataract as a leading cause of global blindness and is the leading cause of irreversible visual loss. By the year 2020, almost 80 million people are estimated to be affected with open-angle glaucoma and angle-closure glaucoma. Sufficiently high concentrations of a free drug should be achieved within the aqueous humor and at the iris/ciliary body for sufficiently illustrating an antiglaucoma effect. Most drug groups including cholinergic agents, prostaglandin analogs, and carbonic anhydrase inhibitors being used in glaucoma were initially developed for other effects or routes and later found their use in the control of glaucoma. Hence, these molecules are not tailor made for delivery into the eye. Discovery of new molecules requires atleast 15-20 years; hence, it may be concluded that instead of abandoning the existing molecules. it may be worthwhile to apply a novel drug-delivery approach to enhance ocular bioavailability and reduce systemic side effects of currently used agents. This review will elaborate on the potential to pharmaceutically tailor existing antiglaucoma agents using approaches including liposomes, collagen shields, dendrimers, in situ forming gels, and micro- and nanoparticles for achieving improved ocular effectiveness. Further to this, a preliminary discussion on miscellaneous agents such as siRNA, peptides, antioxidants and nitric oxide-releasing agents that are recently being proposed for the relief of glaucoma is also covered. © 2011 Begell House, Inc.
Keywords: acetazolamide; epinephrine; antiglaucoma agent; apraclonidine; atropine; betaxolol; bimatoprost; brimonidine; brimonidine plus timolol; brinzolamide; carteolol; collagen; dendrimer; dipivefrine; dorzolamide; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; levobunolol; liposome; methazolamide; metoprolol; nanoparticle; ncx 125; pilocarpine; small interfering RNA; timolet gfs; timolol; timolol maleate; timolol maleate; travoprost; unclassified drug; unindexed drug; unoprostone isopropyl ester; anxiety; article; blepharitis; blood brain barrier; blood pressure; blurred vision; bradycardia; bronchospasm; cardiotoxicity; cataract; ciliary muscle spasm; ciliary muscle spasm; conjunctival hyperemia; conjunctivitis; cornea edema; cornea erosion; diarrhea; dizziness; drowsiness; drug bioavailability; drug cost; drug delivery system; drug efficacy; drug induced headache; drug penetration; drug protein binding; dry eye; epiphora; eye burning; eye disease; eye irritation; eye stinging; eye stinging; eye toxicity; eyelash; eyelid retraction; fatigue; follicular conjunctivitis; follicular conjunctivitis; gastrointestinal symptom; glaucoma; heart block; heart palpitation; human; hydrogen bond; hydrophilicity; hyperemia; hypertrichosis; hypotension; insomnia; intraocular hypertension; iris disease; iris hyperpigmentation; iris hyperpigmentation; iris pigmentation; iris pigmentation; keratitis; lacrimation; lung toxicity; malaise; metabolic acidosis; microemulsion; miosis; monotherapy; muscle spasm; mydriasis

Cancer, Warburg effect and laser photobiomodulation-progress beyond skepticism review - Santana-Blank, L.; Rodríguez-Santana, E.; Santana-Rodríguez, K.E. (Journal of Chinese Clinical Medicine, 2011)
Objective Despite medical ad varices over the last decades, cancer is still a major cause of death worldwide. This paper explores whether laser photobiomodulation, alone and/or combined with other therapies, may be developed into a safe, effective treatment for various forms of cancer (solid tumors). Methods A literature search of English-language articles in five databases (Medline, ISI Web of Knowledge, Cochrane, Google Scholar, Scirus) was conducted using search terms relating to cancer (neoplasm, advanced cancer, palliative) in combination with photobiomodulation and/or low-level laser therapy (LLLT) in the period from January 1990 to December 2010. Controlled clinical trials with at least 1 year of follow up and minimum compliance of 90% were included. Clinical studies evaluating linfaoedema, mucositis or pain were also included to illustrate post-LLLT responses to adverse effects of chemo-radiotherapy. Uro and in studies were further considered as preliminary data for clinical trials. Results Retrieved articles suggest that photobiomodulation can modulate anti-tumor effects and reduce adverse effects of chemo-radiotherapy. Results are discussed giving particular attention to two mechanistic proposals with potential anticancer applications, photo-m-frared pulsed biomodulation (PIPBM) and water oscillator (WO). Other topics include cancer proliferation, Warburg effect, classic photobiomodulation hypothesis and ATP signaling. Conclusion Translational research with laser photobiomodulation appears warranted.
Keywords: antineoplastic agent; cancer palliative therapy; chemoradiotherapy; colon adenocarcinoma; glaucoma; human; laser photobiomodulation; low level laser therapy; lymphedema; malignant meningioma; mucosa inflammation; neoplasm; pain; patient compliance; photo infrared pulsed biomodulation; phototherapy; review; systematic review; therapy effect; treatment response; unspecified side effect

Management of cataracts in patients with glaucoma - Law, S.K.; Riddle, J. (International Ophthalmology Clinics, 2011)
Introduction: Cataracts and glaucoma are 2 of the most common ocular diseases and they frequently coexist as the prevalence of each increases with age.1,2 The treatment of a patient's glaucoma may also increase the severity of his/her cataract. For instance, patients with glaucoma randomized to receive betaxolol and argon laser trabeculoplasty in the Early Manifested Glaucoma Treatment Trial had a significantly higher rapid development of nuclear opacities.3 In the Collaborated Intervention Glaucoma Treatment Study, initial surgical treatment resulted in the development of more cataracts that required removal than initial medical treatment. The crude proportion of cataract extraction in the surgical group (17.3%) was almost 3 times greater than the proportion in the medicine group (6.2%).4 As a result of the interaction of these 2 diseases, different surgical treatment options are available and ophthalmologists often find it difficult to determine the best recommendation for a patient. © 2011, Lippincott Williams & Wilkins.
Keywords: acrylic acid; antimetabolite; betaxolol; fluorouracil; miotic agent; mitomycin; osmotic agent; prostaglandin derivative; silicone; steroid; age; anterior lens capsule; aqueous humor formation; argon laser; article; astigmatism; blood eye barrier; capsular phimosis; capsule opacification; cataract; cataract extraction; ciliary body; clinical assessment; contrast sensitivity; cornea; cornea limbus; corneal wavefront aberration; disease course; disease exacerbation; disease severity; drug tolerability; eye axis length; follow up; glaucoma; glaucoma surgery; glaucomatous optic neuropathy; gold standard; health status; human; hypotony maculopathy; intraocular hypertension; intraocular pressure; iritis; keratometry; lens; lens capsule rupture; lens implant; lens luxation; lens power; lens subluxation; medical decision making; multicenter study (topic); multifocal lens; myopia; open angle glaucoma; optic nerve disease; optical coherence tomography; outcome assessment; patient care planning; patient compliance; patient counseling; phacoemulsification; phacotrab; postoperative inflammation; preoperative care; preoperative evaluation; prevalence; primary angle closure glaucoma; priority journal; professional competence; pseudoexfoliation; pseudophakia; quality of life; randomized controlled trial (topic); retina fovea; retina macula cystoid edema; risk factor; scar formation; Schlemm canal; spike; surgical risk; surgical technique; suture; systematic review (topic); trabecular meshwork; trabeculectomy; trabeculoplasty; vision; visual acuity; visual field defect; visual impairment; vitrectomy; vitreous disease; wound healing; wound healing impairment

Laser trabeculoplasty in the treatment of open-angle glaucoma - Francis, B.A.; Winarko, J. (International Ophthalmology Clinics, 2011)
Keywords: epinephrine; apraclonidine; brimonidine; carbonate dehydratase inhibitor; collagen fiber; interleukin 1; interleukin 1alpha; interleukin 1beta; interleukin 8; matrix metalloproteinase; pilocarpine; timolol; timolol maleate; tumor necrosis factor; tumor necrosis factor; aqueous humor outflow; argon laser trabeculoplasty; article; cell division; cell membrane permeability; cell population; clinical effectiveness; closed angle glaucoma; DNA replication; electromagnetic radiation; endothelium cell; extracellular matrix; follow up; gene expression; human; intraocular pressure; intraocular pressure abnormality; low tension glaucoma; micropulse laser trabeculoplasty; open angle glaucoma; outcome assessment; patient compliance; patient positioning; postoperative complication; priority journal; randomized controlled trial (topic); Schlemm canal; selective laser trabeculoplasty; tissue injury; tissue reaction; titanium sapphire laser trabeculoplasty; trabecular meshwork; trabeculoplasty; treatment indication; United States; upregulation; SOLX 790 laser

Adherence with brimonidine in patients with glaucoma aware and not aware of electronic monitoring - Hermann, M.M.; Papaconstantinou, D.; Muether, P.S.; Georgopoulos, G.; Diestelhorst, M. (Acta Ophthalmologica, 2011)
Purpose: To assess the impact of open versus masked adherence monitoring on adherence with topical brimonidine using two different dosing schedules. Methods: Thirty-seven patients with glaucoma or ocular hypertension were enroled in a prospective, observational cohort study. Patients were randomly assigned to open or masked adherence monitoring and to brimonidine twice daily (BID) or three times daily (TID). Patients received conventional brimonidine eye drops with attached electronic monitoring devices for 4 weeks with weekly intraocular pressure measurements. Adherence calculations comprised dosing intervals, adherence rate and time covered. Subgroup analysis with anova included the factors masking, regimen, diagnosis and age. Results: Among 36 individually analysed patients, 12 (33%) had adherence rates above 75%, therein two (5%)>90%. The mean adherence rate in 19 patients aware of adherence measurements was 70 ± 17% for brimonidine BID and 65 ± 14% for TID, not significantly different to the rates of 17 patients not informed about adherence measurements (77 ± 6% BID, 62 ± 9% TID, p = 0.24). On average, patients with brimonidine TID achieved significantly lower adherence rates (64 ± 12%) than patients on BID (73 ± 13%, p = 0.02). Still, patients on TID applied brimonidine more often (TID 1.9 ± 0.3, BID 1.5 ± 0.1 mean applications per day). The median coverage was 70% and showed no statistically significant difference between patients on BID and TID (p = 0.36). Conclusion: The study findings suggest that adherence measurements are not significantly altered by open adherence monitoring, which may simplify future adherence studies. Adherence with brimonidine eye drops was insufficient for most patients. These results demonstrate the necessity to develop new strategies to improve compliance in glaucoma therapy. © 2010 The Authors. Acta Ophthalmologica © 2010 Acta Ophthalmologica Scandinavica Foundation.
Keywords: brimonidine; promethazine; adult; article; clinical article; clinical trial; cohort analysis; dosage schedule comparison; drug efficacy; drug monitoring; female; human; intraocular hypertension; intraocular pressure; male; monitor; observational study; open angle glaucoma; patient compliance; priority journal; prospective study; visual acuity; allergan; alphagan

Managing treatment side effects: The respective roles of the active ingredient and the preservative - Aptel, F.; Denis, P.; Baudouin, C. (Journal Francais d'Ophtalmologie, 2011)
The side effects of glaucoma hypotensive treatments usually remain moderate and limited to local side effects - conjunctival hyperemia, itching, discomfort after instillation - but are very often a leading source of poor compliance to treatment and thereby may decrease its efficacy. Moreover, these symptoms usually reflect progressive and irreversible major ocular surface changes. These ocular surface changes induced by glaucoma eyedrops may include subconjunctival fibrosis, increasing the risk of failure of a further glaucoma surgery. All the components of the hypotensive eye drops, including the active ingredient, the preservatives, and the excipients, may be involved in the occurrence of these side effects. It is therefore important to identify the agents involved and the mechanisms of these side effects, in order to choose a treatment minimizing their risk and the discomfort felt by patients, and therefore increasing the likelihood of good compliance. When available, preservative-free solutions should be considered. © 2011 Elsevier Masson SAS. Tous droits réservés.
Keywords: benzalkonium; excipient; eye drops; preservative; prostaglandin; article; chemically induced disorder; conjunctiva disease; dry eye; fibrosis; glaucoma; human; hyperemia; patient compliance; pruritus

Socioeconomic status and open-angle glaucoma - Coleman, A.L.; Kodjebacheva, G. (Expert Review of Ophthalmology, 2011)
Evaluation of: Ramdas WD, Wolfs RC, Hofman A, de Jong PT, Vingerling JR, Jansonius NM. Lifestyle and risk of developing open-angle glaucoma: the Rotterdam Study. Arch. Ophthalmol. DOI: 10.1001/archophthalmol.2010.373 (2011) (Epub ahead of print). According to the Rotterdam Study, which was conducted in The Netherlands, socioeconomic status, alcohol consumption and smoking were not related to the onset of open-angle glaucoma. Because participants were from a homogeneous suburb and The Netherlands ranks number one in terms of equity in healthcare for all individuals regardless of income, the lack of an association between socioeconomic status and open-angle glaucoma is not surprising. © 2011 Expert Reviews Ltd.
Keywords: article; disease association; educational status; employment status; health care access; health care disparity; human; income; open angle glaucoma; social status

Therapeutic drug monitoring of newer antiepileptic drugs - Brandt, C.; May, T.W. (LaboratoriumsMedizin, 2011)
Therapeutic drug monitoring (TDM) of antiepileptic drugs (AEDs) has been in clinical use for more than three decades. Its value has, however, been questioned recently for several reasons, e.g., the occurrence of newer AEDs, for which the use of TDM has to be evaluated, but also because of financial strains on health systems. The current review aims at assessing the use of TDM in newer AEDs, i.e., those that entered the market since the beginning of the 1990s. As some have been licensed only recently and others are only in very limited use, either because of orphan drug status or because of limited efficacy or potentially severe adverse events, only limited data exist for some of the newer AEDs. General considerations are made in the review, and each new AED is discussed, and, in some cases preliminary, assessment of the use of TDM is given. © 2011 by Walter de Gruyter Berlin Boston.
Keywords: anticonvulsive agent; carbamazepine; clobazam; eslicarbazepine acetate; etiracetam; felbamate; gabapentin; lacosamide; lamotrigine; mesuximide; oxcarbazepine; phenytoin; pregabalin; rufinamide; stiripentol; tiagabine; topiramate; valproic acid; vigabatrin; zonisamide; abdominal pain; abnormal thinking; add on therapy; aggressiveness; anorexia; aplastic anemia; ataxia; bipolar depression; blurred vision; body weight; brain disease; cerebellar symptom; cerebellar symptom; closed angle glaucoma; cognitive defect; concentration loss; coordination disorder; decreased appetite; depression; diarrhea; differential diagnosis; diplopia; dizziness; drowsiness; drug absorption; drug clearance; drug dose increase; drug dose reduction; drug dose titration; drug elimination; drug excretion; drug formulation; drug half life; drug intoxication; drug marketing; drug metabolism; drug monitoring; drug protein binding; drug tolerability; drug use; drug withdrawal; ecchymosis; epilepsy; epileptic state; fatigue; focal epilepsy; generalized anxiety disorder; generalized epilepsy; headache; hematologic disease; human; hyperthermia; hyponatremia; in vitro study; infantile spasm; lactation; Lennox Gastaut syndrome; leukocyte count; liver failure; liver toxicity; mental disease; mental health; metabolic acidosis; migraine; monotherapy; myoclonus epilepsy; nasuea; nasuea; nausea; nephrolithiasis; neuropathic pain; oligohidrosis; oligohidrosis; paresthesia; patient compliance; peripheral edema; pregnancy; psychosis; psychotic symptom; psychotic symptom

Improve adherence in glaucoma patients: A doctor's duty - Nordmann, J.-P.; Akesbi, J. (Journal Francais d'Ophtalmologie, 2011)
Adherence to treatment through observance and persistence is mandatory to treat any glaucoma patient. Identifying the factors related to nonadherence is therefore crucial. Factors responsible for poor adherence could be related to the patients (doubt, forgetfulness, denial), environmental factors (cost, competing activities, travel, etc.), the treatment regimen (refill, side effects, complexity), and finally the relation with the physician. Physicians should presume that patients have low adherence to their treatment and give clear and precise information about the expected benefits of the treatment, the disease, and its risks of progression. Combined fixed treatments and preservative-free topical treatments should improve adherence and quality of life by simplifying instillation and tolerance of eye drops. © 2011 Elsevier Masson SAS. Tous droits réservés.
Keywords: eye drops; article; attitude to health; cost of illness; disease course; doctor patient relationship; economics; glaucoma; human; lifestyle; patient compliance; patient education; quality of life; risk assessment

Immediate effect on overactive bladder symptoms following administration of imidafenacin - Kitagawa, Y.; Kuribayashi, M.; Narimoto, K.; Namiki, M. (International Urogynecology Journal and Pelvic Floor Dysfunction, 2011)
Hypothesis / aims of study Overactive bladder (OAB) is characterized by urgency, with or without urgency incontinence, and usually with frequency and nocturia. Despite not being life-threatening, OAB symptoms have a marked adverse effect on the patient's quality of life. Patients require long-term therapy with agents that have good efficacy and tolerability. Although one of the factors influencing patient compliance is thought to be the time to reach clinical effectiveness after commencing drug therapy, there have been few reports regarding the time to efficacy for various drugs. Imidafenacin, as a novel antimuscarinic agent to treat OAB, selectively acts on the bladder over salivary gland tissue, and favorable safety, tolerability, and efficacy profiles of administration were clinically shown over 52 weeks. Imidafenacin is rapidly absorbed with maximum plasma concentrations occurring 1-3 h after oral administration. This rapid absolute bioavailability of imidafenacin suggest immediate clinical efficacy after administration. We investigated the immediate effect of imidafenacin on the symptoms of OAB by recording daily changes in the subjective efficacy for 2 weeks after treatment. Study design, materials and methods Patients aged at least 20 years with OAB diagnosed according to the ICS definition were enrolled into this study. Exclusion criteria included clinically significant bladder outlet obstruction and/or postvoid residual volume >100 mL, obvious urinary tract infection, glaucoma or serious complications, and use of anticholinergic drugs within 1 month prior to the study. All patients provided informed consent prior to enrollment in the study. Imidafenacin (0.1 mg) was administered to the patients orally twice daily; this dosage is clinically recommended for treating OAB. The medication period in all cases was 4 weeks. OAB symptom scores (OABSS) of the patients were evaluated before administration, and at 2 and 4 weeks postadministration. Uroflowmetry with postvoid residual volume was performed at the same time. Following enrollment, patients were asked, “To what extent did you feel the effects of this medicine?” daily over a period of 2 weeks. Patients gave their answers on a five-points scale: 0 (not at all), 1 (a little), 2 (moderately), 3 (a great deal), and 4 (my symptoms are gone). Adverse events were examined through history-taking, as conducted by the attending physician. Statistical assessments were performed using the paired t test, and P <0.05 was considered statistically significant. Results Twenty-four patients who consulted our department between September 2008 and May 2009 were enrolled in this study. All cases were evaluated for safety and 20 were evaluated for efficacy with OABSS and uroflowmetry with postvoid residual volume at 2 and 4 weeks postadministration. Nineteen patients completely recorded daily changes of the subjective efficacy over the 2-week study period. The patients ranged in age from 57 to 87 years, with a mean age of 74 years. Five patients were male and the remaining 19 were female. Seventeen patients had urge incontinence, and the remaining 7 were without urge incontinence. The mean total OABSS scores were 9.4 preadministration, 7.4 at 2 weeks postadministration, and 4.4 at 4 weeks postadministration. The mean total OABSS score decreased gradually, and there were significant differences between those at preadministration and at 2 weeks after administration, and between 2 and 4 weeks. The mean scores for nighttime micturition, urgency, and urge incontinence decreased significantly at 2 and at 4 weeks after administration compared to those preadministration. As the changes in patients' subjective efficacy for imidafenacin during the 2 weeks after administration, patients reported the drug's efficacy beginning three days after commencement of administration. The patients' subjective efficacy for imidafenacin seemed to increase favorably during the 2-week study period. The mean rates of maximum and average urinary flow at preadministration were 17.1 mL/s and 9.4 mL/s, respectively. Those at 2 weeks postadministration were 18.4 mL/s and 9.7 mL/s, respectively, and those at 4 weeks were 13.1 mL/s and 6.8 mL/s, respectively. There were no significant differences between each group. The mean preadministration postvoid residual volume was 21.1 mL, while those at 2 and 4 weeks postadministration were 20.3 mL and 8.0 mL, respectively. There were no significant differences between each volume. There were no severe side effects over the 4 weeks of this study. Interpretation of results The subjective efficacy of imidafenacin was observed from 3 days after commencement of administration. Symptom scores decreased gradually at 2 and 4 weeks postadministration. Urinary flow rates and postvoid residual volumes did not change with administration of imidafenacin. Concluding message Imidafenacin may have immediate efficacy in patients with overactive bladder symptoms. This agent can be expected to be well tolerated and show satisfactory effects in patients.
Keywords: imidafenacin; muscarinic receptor blocking agent; cholinergic receptor blocking agent; overactive bladder; society; continence; human; patient; postvoid residual urine volume; urge incontinence; drug therapy; safety; uroflowmetry; physician; Student t test; male; micturition; side effect; urine flow rate; hypothesis; incontinence; nocturia; adverse drug reaction; female; quality of life; patient compliance; clinical effectiveness; bladder; salivary gland; tissues; drug efficacy; oral drug administration; bioavailability; recording; study design; bladder neck stenosis; urinary tract infection; maximum plasma concentration; glaucoma; informed consent; anamnesis; long term care

Persistence with prostaglandin agonist use with and without adjunctive therapy for glaucoma patients: A Canadian population-based analysis - Iskedjian, M.; Covert, D.W.; Walker, J.H. (Patient, 2011)
Background: Glaucoma is one of the leading causes of blindness and visual disability. Few studies have examined persistence and adherence with topical medications in glaucoma patients. Objective: The objective of this study was to compare patient persistence with prostaglandin agonist (PA) monotherapy versus with concomitant adjunctive therapy (AT) in Canada. Methods: Data were obtained from the Québec prescription claims database. Persistence rates were determined for previously treated naive glaucoma patients at 1 year after their index date for use of any of the three available PAs (bimatoprost, latanoprost, and travoprost). Patients who had at least 334 days on their index PA were defined as being persistent during the analysis timeframe. Patient baseline demographics and persistence rates were reported. A logistic regression was used for comparing the PA and PA+AT groups, which incorporated baseline cofounders, such as age and sex, in the analyses. Results: From an initial cohort of 28 534 patients, 14 893 were identified as naive to glaucoma therapy and had a PA as their index therapy. Of these, 11 197 (75.2%) continued to receive monotherapy and 3696 (24.8%) had an AT added to the PA; 59.0% were females, and the average age was 70.5 ± 11.3 years. Overall, at the end of the first year of therapy, 57.4% of patients were persistent on their index PA; however, a statistically significant difference was observed between the two subgroups, with 54.6% for those receiving PA monotherapy and 65.8% for those receiving PA+AT (p < 0.01) persistent with therapy. On average, 10.5 prescriptions per year were dispensed to persistent patients. Conclusions: In this Canadian population, persistence rates fall to approximately 60% at the end of the first year of therapy, with patients taking AT being more persistent. Similar persistence analyses are warranted on other populations, and would yield helpful data for conducting economic evaluations of non-persistence. © 2011 Adis Data Information BV. All rights reserved.
Keywords: antiglaucoma agent; bimatoprost; latanoprost; travoprost; add on therapy; adjuvant therapy; adult; age; aged; article; Canada; cohort analysis; controlled study; drug withdrawal; female; gender; glaucoma; human; major clinical study; male; monotherapy; patient compliance; population research; prescription; priority journal; lumigan; travatan; xalatan

Safety of chronic obstructive pulmonary disease medications: A primary care perspective - Hanania, N.A. (Postgraduate Medicine, 2011)
Chronic obstructive pulmonary disease (COPD), which affects > 210 million individuals worldwide, places primary care practitioners at the forefront of diagnosing and managing COPD, and preventing adverse drug reactions (ADRs) associated with COPD medications. Therefore, it is essential that practitioners understand the safety profiles of these medications. They should also be aware of the host factors and any preexisting comorbidities in their patients that may impact the safety and efficacy of the prescribed therapy. Drug safety information obtained from randomized controlled trials, observational studies, and meta-analyses should be analyzed to assess the risk-benefit to a patient, since the majority of ADRs associated with COPD medications are predictable, and are avoidable with judicious use of these drugs. This article discusses the different medications available for COPD management and the factors affecting their safety based on current evidence. © Postgraduate Medicine.
Keywords: beta 2 adrenergic receptor stimulating agent; bronchodilating agent; budesonide; cholinergic receptor blocking agent; corticosteroid; fluticasone; ipratropium bromide; long acting drug; placebo; salmeterol; short acting drug; theophylline; tiotropium bromide; add on therapy; anxiety; article; asthma; bone mass; cataract; chronic obstructive lung disease; constipation; depression; disease association; disease severity; dose response; drug choice; drug efficacy; drug fatality; drug information; drug safety; drug tolerability; dysphonia; ecchymosis; evidence based medicine; gastroesophageal reflux; glaucoma; glycemic control; headache; heart arrhythmia; heart disease; heart muscle ischemia; high risk patient; human; hyperglycemia; hypertension; hypocalcemia; hypoxemia; immune deficiency; insomnia; intraocular pressure; maintenance therapy; muscle weakness; myopathy; nausea; osteoporosis; patient attitude; patient compliance; patient monitoring; physician attitude; pneumonia; primary medical care; respiratory failure; restlessness; risk factor; risk reduction; seizure; side effect; skin contusion; skin disease; sleep disorder; systemic therapy; tachycardia; taste preference; thrush; tremor; urinary tract obstruction; vomiting; body weight gain; xerostomia

Prostaglandin analogs - Shah, B.; Arora, V.; Wadhwani, M.; Mishra, S.K. (Journal of Current Glaucoma Practice, 2011)
The prostaglandin analogs have emerged as effective, well-tolerated agents for the reduction of intraocular pressure (IOP) in patients with primary open-angle glaucoma and ocular hypertension. Based on the available clinical data, bimatoprost, latanoprost and travoprost appear to be at more effective than the erstwhile gold standard, timolol, while the effectiveness of unoprostone is similar or slightly less. Prostaglandin analogs may be used in conjunction with other antiglaucoma medications, although further studies must establish the optimal combination. Whether clinical experience will yield outcomes in favor of one of the prostaglandin analogs remains to be determined. This review attempts to concisely cover all the clinical aspects of currently available prostaglandin analogs for ocular use.
Keywords: 9 pm; beta adrenergic receptor blocking agent; bimatoprost; bimatoprost plus timolol; carbonate dehydratase inhibitor; careprost; careprost plus; cholinergic receptor stimulating agent; intaprost; latanoprost; latanoprost plus timolol; latim; latocheck; latochek t; latocom; latodrops; latoprost; loprost; loptame; prostaglandin derivative; timolol; travo; travocom; travoprost; unclassified drug; application site pigmentation change; asthma; combination chemotherapy; conjunctival hyperemia; cyst; drug cost; drug efficacy; drug indication; drug mechanism; drug potentiation; drug safety; drug tolerability; dyspnea; eye burning; eyelash; gold standard; herpes simplex keratitis; human; intraocular hypertension; intraocular pressure; iridocyclitis; iris cyst; iris cyst; iris disease; monotherapy; open angle glaucoma; patient attitude; patient compliance; retina macula cystoid edema; review; side effect; smooth muscle relaxation; systemic disease; 9 pm; careprost plus; careprost; ganfort; intaprost; latim; latocheck; latochek t; latocom; latodrops; latoprost; loprost; loptame; lumigan; travatan; travo; travocom; xalacom; xalatan

Pharmacokinetics of antiglaucoma medications - Sachdev, M.; Yadava, U.; Bamrolia, N. (Journal of Current Glaucoma Practice, 2011)
Pharmacokinetics may be simply defined as what the body does to the drug, as opposed to pharmacodynamics which may be defined as what the drug does to the body. This review is dedicated to the fate of antiglaucoma medications administerd externally. A special focus is made on the preservatives used in the antiglaucoma medications. Although from a pharmacokinetic point of view, these preservatives may improve drug penetration but their ocular surface adverse effects cannot be ignored.
Keywords: antiglaucoma agent; benzalkonium chloride; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brinzolamide; buffer; chlorbutol; detergent; dorzolamide; dorzolamide plus timolol; drug preservative; edetic acid; latanoprost; levobunolol; melanin; metipranolol; oxidizing agent; oxychloro complex; pilocarpine; polidronium chloride; polyvinyl alcohol; sofzia; timolol; timolol maleate; timpotic; travoprost; unclassified drug; unoprostone isopropyl ester; cornea; delayed hypersensitivity; drug absorption; drug binding; drug bioavailability; drug delivery system; drug distribution; drug elimination; drug formulation; drug hypersensitivity; drug mechanism; drug metabolism; drug mixture; drug penetration; drug release; drug safety; drug stability; drug tissue level; drug tolerability; eye disease; glaucoma; heredity; human; intraocular pressure; molecular weight; nonhuman; ocular surface disease; ocular surface disease; particle size; patient attitude; patient compliance; pH; pharmacodynamics; pharmacokinetics; quality of life; review; sclera; tear film; tissue distribution; alphagan p; alphagan; azopt; betagan; betoptic s; cosopt; lumigan; optipranolol; rescula; timoptic xe; timpotic; travatan z; travatan; trusopt; xalatan

Treatment of severe fungal keratitis with subconjunctival Amphotericin B - Carrasco, M.A.; Genesoni, G. (Cornea, 2011)
PURPOSE:: To report the beneficial properties of subconjunctival amphotericin B as an adjunctive therapy in patients with severe fungal keratitis. METHODS:: Case reports and review of medical literature. Four patients with advanced fungal keratitis were treated with repeated injections of subconjunctival amphotericin B in addition to topical and systemic antifungal treatment. RESULTS:: Two to 8 injections were given to each patient. All patients showed rapid clinical improvement after the injections. No serious adverse effects were observed. However, all patients experienced pain during the injections. CONCLUSIONS:: Subconjunctival injections of amphotericin B are useful as an adjunctive treatment of advanced fungal keratitis. This treatment assures compliance and may be an alternative to avoid a surgical intervention in an acute stage of advanced fungal keratitis. More cases are needed to validate our findings. Copyright © 2011 by Lippincott Williams & Wilkins.
Keywords: aciclovir; amikacin; amphotericin B; anfotericina b northia; antifungal agent; ceftazidime; ciprofloxacin; corticosteroid; dexamethasone; fluconazole; gatifloxacin; natamycin; unclassified drug; vancomycin; adjuvant therapy; adult; aged; article; case report; disease severity; female; human; injection site pain; keratitis; keratomycosis; male; medical literature; patient compliance; priority journal; repeated drug dose; treatment outcome; visual acuity; anfotericina b northia

Modern industrialisation may increase primary open-angle glaucoma prevalence through easier transmission of Helicobacter pylori infection - Zavos, C.; Kountouras, J.; Katsinelos, P.; Polyzos, S.A.; Deretzi, G.; Zavos, N.; Fragaki, M.; Diamantidis, M.D. (Medical Hypotheses, 2011)
Keywords: bacterial transmission; China; disease severity; ethnicity; geography; health care access; Helicobacter infection; Helicobacter pylori; human; industrialization; letter; nonhuman; open angle glaucoma; prevalence; urban area

A personal health record module improves documentation of family history - Schnipper, J.L.; Volk, L.A.; Wald, J.S.; Gandhi, T.K.; Williams, D.H.; Middleton, B. (Journal of General Internal Medicine, 2011)
BACKGROUND: Collecting and documenting detailed patient family history information is important to identify those at high risk for disease who may benefit from increased surveillance and/or risk factor modification. Currently, effective methods are lacking for systematically collecting and documenting this information for use in clinical decision support and patient care. This study evaluated the use of a family history module within an electronic personal health record (PHR) on the frequency and comprehensiveness of documented family history information. METHODS: We randomized 11 primary care practices within an integrated delivery system in the Northeast that used the Patient Gateway PHR. In the intervention practices, consented patients received access to an electronic Family History module three weeks before a scheduled office visit requesting detailed information on their personal and family history of six target conditions (breast and colon cancer, coronary artery disease, diabetes, glaucoma, and osteoporosis). Patients submitted “eJournals” that could be viewed by physicians during the visit where the information could be verified and easily added to the electronic health record (EHR). Study patients included those who submitted eJournals and had an associated visit. Control patients submitted eJournals about topics unrelated to family history. Study outcomes included mean number of conditions documented in the EHR per patient and mean quality score reflecting the comprehensiveness of the documented history. Scores for each condition were calculated by giving one point each for number of relatives, the degree of relationship, and the age of onset. Differences in documentation before and 30 days after the visit in the two arms of the study were analyzed using Wilcoxon rank sum test. RESULTS: 652 of 975 patients (66.9%) invited to complete a family history module submitted an eJournal. The mean number of conditions per patient documented in the EHR increased significantly more after the visit in the intervention arm compared to the control arm. The increase in quality score was greater in the intervention group, although the difference was not quite statistically significant. A weighted score which integrated quantity and quality of documented family history information also increased more in the intervention arm than in the control arm (Table). CONCLUSION: An electronic PHR module requesting updated family history information from patients prior to an office visit was associated with a significant increase in the number of conditions documented in the EHR. There was also a trend towards more comprehensive information regarding number of relatives, degree of relationship, and age of onset for each condition, information crucial to determine patient risk and guide management. (Table presented).
Keywords: family history; internal medicine; society; health; documentation; human; patient; arm; onset age; ambulatory care; risk; breast; colon cancer; coronary artery disease; diabetes mellitus; glaucoma; osteoporosis; physician; electronic medical record; rank sum test; risk factor; decision support system; patient care; primary medical care

Vision impairment among older adults in an urban, lowincome neighborhood: Implications for diabetes preventionandmanagement - Ramos, M.A.; MacMillan, T.; Kleinman, L.C.; Horowitz, C.R. (Journal of General Internal Medicine, 2011)
BACKGROUND: Racial and ethnic disparities exist in diabetes prevalence and complications, including visual impairment and loss. Recent emphasis on the impact of health literacy on health and health behaviors may overlook the fact that patients may simply not be able to see well enough to read food and medication labels, monitor glucose, take medications and insulin correctly and be safely physically active. The Communities IMPACT Diabetes Center uses a collaborative approach to explore and address diabetesrelated health disparities. As part of this work, community and academic partners assessed the prevalence of visual impairment and the vision-related physical environment in East Harlem, the neighborhood with the highest diabetes morbidity and mortality in New York City. METHODS: We designed an environmental assessment to explore characteristics of the built environment in a 16 square block subsection of East Harlem, including the presence of health and eye care facilities and the condition of sidewalks. Using a structured data collection form, community-academic pairs assessed each block. In addition, we partnered with a vision rehabilitation agency, to survey older adults attending East Harlem senior and community centers. Domains included the Functional Vision Screening Questionnaire, receipt of eye care within the past year, demographics and comorbidities. RESULTS: The environmental assessment revealed less than optimal walkability. Only 53% of sidewalks assessed were characterized as being in good condition and 30% had some type of obstruction. No eye care facilities were identified. With respect to the vision health survey, 555 adults (36% age 75 and older, 44% age 65 to 74, 17% age 55 to 64, and 3% younger than 55) participated, of which 75% were Hispanic and 20% African American. Half had not had their eyes examined within the past year, 26% met criteria for having low vision and 30% self-reported diabetes. Over half (52%) stated that their vision makes it difficult to do things that they would like to do, 58% reported difficulty recognizing faces of family and friends, 44% reported difficulty reading regular size print and 49% reported difficulty reading medicine labels, small print and prices when shopping. Of the total sample, 41% had regular eye care and did not need follow-up, 12% chose to see a local provider and 15% declined care or were lost to follow-up. The remaining 175 adults (32%) received free eye care services, and all but one (99%) needed and received new glasses. Their most common visual comorbidities included cataracts (22%), age-related macular degeneration (17%), glaucoma (13%) and diabetic retinopathy (9%). CONCLUSION: Effective approaches to prevent and control diabetes, including self-management, physical activity and healthy eating, require adequate vision or vision support. The majority of older adults we surveyed had visual difficulties that could be simply addressed through provision and use of glasses. Poor environmental conditions, such as obstructed sidewalks, could make it even more difficult for seniors to adhere to the most commonly prescribed form of exercise - walking. In addition to addressing well-known barriers to diabetes prevention and control, including behavioral and access issues, people with or at risk for diabetes could benefit from providers and policymakers recognizing, understanding and addressing visual challenges. Clinicians should consider routinely asking patients if they experience any difficulties seeing during discussions about medication adherence and self-management, and referring their patients for eye care.
Keywords: insulin; glucose; diabetes mellitus; adult; internal medicine; visual impairment; society; eye care; community; human; patient; follow up; spectacles; health; self care; prevalence; environment; reading; drug therapy; health disparity; morbidity; mortality; United States; information processing; rehabilitation center; vision test; questionnaire; obstruction; health survey; Hispanic; African American; eye; visual disorder; friend; shopping; cataract; age related macular degeneration; glaucoma; diabetic retinopathy; physical activity; eating; exercise; walking; prevention and control; patient compliance; health literacy; health behavior; food; risk

Overcoming gender inequity in prevention of blindness and visual impairment in Africa - Mganga, H.; Lewallen, S.; Courtright, P. (Middle East African Journal of Ophthalmology, 2011)
Background : Globally, and in Africa, after adjusting for age, women are about 1.4 times more likely to be blind than men. While women generally live longer than men, the lack of accessibility to and use of services is likely the most important reason for excess blindness in women in Africa. Aim : We sought to review the literature on vision loss in Africa and summarize the findings related to gender equity. Materials and Methods : Information from across sub-Saharan Africa was collected on the evidence of gender inequity and reasons for this inequity. Finally, the results were used to generate suggestions on how gender equity could be improved. Results : In all published surveys (except one), cataract surgical coverage among women was lower than cataract surgical coverage among men. Although data available are limited, similar findings appeared in the use of services for other disease conditions, notably, childhood cataract and glaucoma. Evidence suggests that a variety of approaches are needed to improve the use of eye care services. Three main strategies are needed to address gender inequity in vision loss in Africa. First, it is important to address transport needs. Second, counseling of patients and family members is required. Finally, programs need to put in place pricing systems that make the services affordable the population. Conclusions : VISION 2020 can be achieved in Africa, but investment is needed in a variety of strategies that will ensure that eye care services are affordable, accessible, and acceptable to women and girls.
Keywords: Africa; article; blindness; cataract; cataract extraction; childhood cataract; congenital cataract; eye care; family counseling; family decision making; gender bias; glaucoma; health care access; health care cost; health care utilization; health service; human; open angle glaucoma; patient counseling; patient transport; priority journal; sex difference; trachoma; visual impairment

Severe visual Impairment and blindness in infants: Causes and opportunities for control - Gogate, P.; Gilbert, C.; Zin, A. (Middle East African Journal of Ophthalmology, 2011)
Childhood blindness has an adverse effect on growth, development, social, and economic opportunities. Severe visual impairment (SVI) and blindness in infants must be detected as early as possible to initiate immediate treatment to prevent deep amblyopia. Although difficult, measurement of visual acuity of an infant is possible. The causes of SVI and blindness may be prenatal, perinatal, and postnatal. Congenital anomalies such as anophthalmos, microphthalmos, coloboma, congenital cataract, infantile glaucoma, and neuro-ophthalmic lesions are causes of impairment present at birth. Ophthalmia neonatorum, retinopathy of prematurity, and cortical visual impairment are acquired during the perinatal period. Leukocoria or white pupillary reflex can be cause by congenital cataract, persistent hyperplastic primary vitreous, or retinoblastoma. While few medical or surgical options are available for congenital anomalies or neuro-ophthalmic disorders, many affected infants can still benefit from low vision aids and rehabilitation. Ideally, surgery for congenital cataracts should occur within the first 4 months of life. Anterior vitrectomy and primary posterior capsulotomy are required, followed by aphakic glasses with secondary intraocular lens implantation at a later date. The treatment of infantile glaucoma is surgery followed by anti-glaucoma medication. Retinopathy of prematurity is a proliferation of the retinal vasculature in response to relative hypoxia in a premature infant. Screening in the first few weeks of life can prevent blindness. Retinoblastoma can be debulked with chemotherapy; however, enucleation may still be required. Neonatologists, pediatricians, traditional birth attendants, nurses, and ophthalmologists should be sensitive to a parent's complaints of poor vision in an infant and ensure adequate follow-up to determine the cause. If required, evaluation under anesthesia should be performed, which includes funduscopy, refraction, corneal diameter measurement, and measurement of intraocular pressure.
Keywords: antibiotic agent; cyclopentolate; phenylephrine; tropicamide; vasculotropin inhibitor; age; amblyopia; aphakia; article; blindness; body mass; breast feeding; capsulotomy; childhood blindness; clinical evaluation; coloboma; color blindness; congenital cataract; congenital disorder; crede prophylaxis; disease severity; early diagnosis; eye care; eye examination; eye movement; genetic counseling; glaucoma; health care access; health care personnel; human; keratomalacia; Leber congenital amaurosis; lens implant; leukokoria; mydriasis; newborn ophthalmia; ocular albinism; optic nerve lesion; parent counseling; patient referral; pediatrics; perinatal period; persistent hyperplastic primary vitreous; prematurity; prenatal period; primary posterior capsulotomy; priority journal; pseudophakia; refraction error; retina dystrophy; retinoblastoma; retinol deficiency; retrolental fibroplasia; surgical risk; training; visual acuity; visual impairment; vitrectomy

Prevalence and causes of blindness and visual impairment in Sokoto State, Nigeria: Baseline data for Vision 2020: The right to sight eye care programme - Muhammad, N.; Mansur, R.; Dantani, A.; Elhassan, E.; Isiyaku, S. (Middle East African Journal of Ophthalmology, 2011)
Purpose : To estimate the prevalence of low vision and blindness, identify the causes, and suggest policies for an effective eye care program based on 2005 data from Sokoto State, Nigeria. Materials and Methods : A stratified two-stage cluster sampling method was used to quantify the prevalence of blindness and the causes from 4 health zones in Sokoto State. Subjects were evaluated using a magnifying loupe, direct ophthalmoscope and torchlight. Data were collected based on the World Health Organization prevention of blindness coding for an eye examination. Prevalences with 95% confidence intervals (CI) were calculated and surgical coverage for causes of blindness was also analyzed. Results : The response rate was 91%. The prevalence of bilateral blindness was 1.9% (95% CI: 1.5-2.3%) ranging from 1.6% to 2.0% across the four health zones. The prevalence was 2.1% (95% CI: 1.6-2.6%) in males and 1.6% (95% CI: 1.1-2.1%) in females. The leading cause of bilateral blindness was cataract (51.6%), followed by uncorrected aphakia (20.9%) and glaucoma (11%). The prevalence of bilateral operable cataract was 1.9% (95% CI: 1.5-2.3%). The cataract surgical coverage (individuals with visual acuity <6/60) for the study was lower than the couching coverage (4.4% vs. 14.9%, respectively). Surgical coverage for trichiasis was 4.4%. The major barrier to cataract and glaucoma management was cost. Conclusions : The prevalence of blindness in Sokoto State is high yet the main causes are largely avoidable. Barriers can be reduced by appropriate health education regarding the eye care program and the provision of integrated, sustainable, affordable and equitable services.
Keywords: adolescent; adult; aged; aphakia; article; blindness; cataract; cataract extraction; child; cornea opacity; diabetic retinopathy; eye examination; eye surgery; eyelid; eyelid surgery; female; glaucoma; groups by age; health care cost; health care utilization; human; injury; keratitis; major clinical study; male; measles; Nigeria; ophthalmoscope; optic nerve atrophy; prevalence; priority journal; refraction error; refusal to participate; macular degeneration; sex difference; spectacles; trachoma; trichiasis; visual impairment; xerophthalmia

Outcomes of cataract surgeries over 16 years in camps held by Al Basar International Foundation in 38 underdeveloped countries - Rushood, A. (Middle East African Journal of Ophthalmology, 2011)
Purpose : To evaluate the outcomes of 16 years of eye campaigns in 38 countries in Africa, Asia and the Middle East Materials and Methods : A descriptive, retrospective study using the Al-Basar International Foundation (BIF) records. BIF is a non-governmental, non-religious philanthropic organization working in the field of the prevention of blindness since 1989. Having its base in Saudi Arabia and working mainly in Asia and Africa. Study variables included the causes of diminished vision, outcomes of eye surgeries, number of camps, patients assessed, surgeries performed, intraocular lenses (IOLs) implanted, spectacles distributed, general outcomes of campaigns, and other variables. Results : Between the periods of November 1989 and June 2006, BIF conducted 620 eye camps. These camps were conducted by ophthalmologists with expertise of working in eye camps with limited resources and harsh environmental conditions. Over two million people were examined and/or treated, and 186, 765 surgeries were performed. Nearly 100,000 IOLs were implanted and more than 140,000 spectacles were prescribed and distributed. The majority of these activities (74%) took place in Asia and the Middle East. The best corrected visual acuity achieved (BCVA) was ranked good (6/6 -6/18) in 59% of patients and borderline (BCVA 6/18 - 6/60) in 35% and poor (BCVA <6/60) in less than 6% of patients based on World Health Organization (WHO) criteria. Conclusion : Quality assured eye campaigns held by BIF helped the most needy countries and people. Intensive volunteer cataract programs and surgeries such as those provided by the BIF add significant support to the efforts of the WHO and International Agency for the Prevention of Blindness in fighting blindness.
Keywords: Africa; Al Basar International Foundation; ametropia; aphakia; article; Asia; blindness; cataract extraction; cornea injury; cornea scar; descriptive research; developing country; entropion; eye camp; glaucoma; health care facility; health care organization; health service; human; infection control; lens implant; major clinical study; Middle East; outcome assessment; patient assessment; patient compliance; patient referral; pediatric ocular muscle misalignment; phacoemulsification; postoperative complication; postoperative period; priority journal; pterygium; retina disease; retrospective study; spectacles; visual acuity; visual impairment

[Health economical aspects of telemedical glaucoma monitoring]. - Swierk, T.; Jürgens, C.; Grossjohann, R.; Flessa, S.; Tost, F. (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 2011)
Telemedical home monitoring of glaucoma patients is not covered by health insurance in Germany. Various clinical studies have indicated that 24 h monitoring of intraocular and blood pressure of glaucoma patients allows a better evaluation of the individual disease condition. If the necessary parameters can be collected with telemedical home monitoring it will be possible to reduce the number of 24 h intraocular pressure profiles which necessitate hospital admission. Therefore inpatient 24 h profiles have been chosen as a health economical allocation base with a presentable economical value for the comparative examination. Assuming an at least identical or even higher clinical outcome of the telemedical glaucoma home monitoring inpatient 24 h profiles were chosen as a health economical allocation base to compare and contrast these methods. All procedures of the inpatient 24 h profiles at the ophthalmic clinic of Greifswald were measured using the stopwatch method. In a 1 day test run all activities of the medical staff were identified and documented in a list and afterwards measurements were carried out over 7 days with several stopwatches to allow the documentation of parallel activities. To determine the consumption of resources in telemedical home monitoring the self-documentation of all employees involved in the research project TT-MV were evaluated. Expert interviews helped to determine the economically relevant data about the applied medical technology, e.g. measuring devices, server and electronic health records. The number and complexity of the subprocesses of the inpatient 24 h intraocular pressure profiles were significantly higher compared to telemedical home monitoring. The total costs of the inpatient 24 h profiles were 571.21 € per patient including 291.21 € for medical care and 280 € for accommodation. In contrast the total costs of telemedical home monitoring were 288.72 € per patient. A direct cost comparison shows that telemedical home monitoring resulted in lower costs compared to hospital admission of glaucoma patients. Telemedical home monitoring of glaucoma patients is not only effective but also cost-efficient. As modern health care systems have to consider cost efficiency, a randomized, controlled longitudinal clinical study of both methods would be required.
Keywords: ambulatory monitoring; article; software; cost; economics; Germany; glaucoma; health care planning; manometry; patient care; public health; telemetry; utilization review

The influence of topical diclofenac sodium on the ocular hypotensive effect of latanoprost in glaucoma patients - Sorkhabi, R.; Alipanahi, R.; Eftakhari-Milani, A.; Ghojazadeh, L. (Journal of Glaucoma, 2011)
Purpose: To evaluate the effect of diclofenac sodium 0.1% on reducing intraocular pressure (IOP) by latanoprost 0.005% in glaucoma patients. Patients And Methods: Twenty-two patients with bilateral primary open angle glaucoma were enrolled in this study. All patients had been given only latanoprost for at least 4 weeks. Topical diclofenac sodium was additionally applied to one eye (dicloptin group), whereas hydroxypropyl methyl cellulose was administered into the other eye (control group); both 4 times a day for 2 weeks. IOP measurement was performed before and 2 weeks after the administrations, and also 2 weeks after discontinuing additional ophthalmic solutions. Results: No significant difference was observed in the IOPs before additional administration of ophthalmic solution between the dicloptin group and the control group (P=0.47). Additional administration of diclofenac sodium increased mean IOP from 15.73±1.75 to 17.32±2.23 mm Hg (P=0.01). This increase was reversed 2 weeks after discontinuing additional solutions (P=0.80); however, no significant difference in mean IOP was observed in the control group after administration and after discontinuing the additional medication (P=0.94 and 0.84, respectively). Conclusions: Topical diclofenac sodium may interfere with the IOP lowering effect of latanoprost in glaucoma patients; therefore this interference should be noted in coadministration of these drugs. © 2011 by Lippincott Williams & Wilkins.
Keywords: artificial tear; diclofenac; dicloptin; hydroxypropylmethylcellulose; latanoprost; unclassified drug; adult; antihypertensive activity; article; clinical article; conjunctival hyperemia; controlled study; drug antagonism; evening dosage; female; human; intraocular pressure; male; ocular pruritus; open angle glaucoma; patient compliance; priority journal; randomized controlled trial; treatment duration; dicloptin

Emerging drugs for ocular hypertension - Lee, A.J.; Goldberg, I. (Expert Opinion on Emerging Drugs, 2011)
Introduction: Glaucoma is a prevalent ocular disease with characteristic optic disc and visual field changes. Globally, it is the second most common cause of visual disability, and the most common cause of irreversible and preventable blindness. Ocular hypertension (OH) occurs where intraocular pressure elevation occurs in the absence of glaucomatous disc and visual field changes. OH is a strong risk factor for glaucoma. Ocular hypotensive medications are the mainstay of glaucoma and OH treatment, and their use modifies the course of the disease by preventing onset and progression of damage. Areas covered: Prostaglandin analogs, β-blockers, α-agonists, carbonic anhydrase inhibitors and parasympathomimetics are available in our glaucoma armamentarium and are reviewed. Novel agents have evolved as our understanding of the complex mechanisms involved in aqueous humor production and obstacles to aqueous outflow increases. Potential future candidates appear to act on enhancing trabecular meshwork outflow: the Rho-kinase inhibitors, ion-channel modulators and chelating agents. Further work is needed on other promising agents: serotonergics, melatonins, cannabinoids, adenosine agonists, components of the actomyosin system, nucleotide analogs and gene silencing. Methods to improve side effect profiles or efficacy of currently available therapies are also being developed. As glaucoma treatment adherence is poor, novel drug delivery methods might address this challenge. Expert opinion: Although there are good intraocular pressure-lowering medications available, novel mechanisms and drug delivery modes may provide more effective glaucoma control in future. © 2011 Informa UK, Ltd.
Keywords: NCT00465621; NCT00523250; NCT00533962; NCT00572455; NCT00705770; NCT00753168; NCT00809848; NCT00820300; NCT00821002; NCT00824720; NCT00848536; NCT00868894; NCT00884039; NCT00892762; NCT00934089; NCT00947661; NCT00967811; NCT01037036; 4 (1 aminoethyl) n (4 pyridyl)cyclohexanecarboxamide; adenosine receptor stimulating agent; agn 210699; al 37807; alpha 2 adrenergic receptor stimulating agent; alpha adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; ar 102; verosudil; benzalkonium chloride; beta adrenergic receptor blocking agent; beta adrenergic receptor stimulating agent; betaxolol; bimatoprost; bimatoprost plus timolol; brimonidine; brimonidine plus timolol; brinzolamide; brinzolamide plus timolol; cannabinoid; carbachol; carbonate dehydratase inhibitor; carteolol; chelating agent; cholinergic receptor stimulating agent; de 104; dnb 001; dorzolamide; dorzolamide plus timolol; doutrav; ecothiopate iodide; h 1152; ino 8875; k 115; latanoprost; latanoprost plus timolol; levobunolol; melatonin; metipranolol; latanoprostene bunod; nucleotide derivative; ot 705; ot 730; taprenepag isopropyl ester; pilocarpine; prostaglandin derivative; prostaglandin F2 alpha derivative; purite; Rho kinase inhibitor; tafluprost; serotonin agonist; st 802; tafluprost; timolol; timolol la; timolol maleate; travoprost; unclassified drug; unindexed drug; unoprostone isopropyl ester; y 39983; aqueous humor; aqueous humor outflow; backache; bitter taste; blepharoconjunctivitis; blepharoconjunctivitis; blurred vision; bradycardia; bronchus hyperreactivity; clinical trial (topic); conjunctival hyperemia; disease control; disease course; drug absorption; drug cost; drug delivery system; drug efficacy; drug eruption; drug hypersensitivity; drug induced headache

Self-reported medication adherence in glaucoma patients - Mirzaian, E.; Johnson, K.; Chopra, V.; Padre, J.; Varma, R. (Journal of the American Pharmacists Association, 2011)
Objective: (1) To survey glaucoma patients on self-reported medication adherence (SRA), knowledge of glaucoma and its treatment, attitudes toward medications, and reasons for nonadherence. (2) To identify patient demographics and characteristics associated with SRA. Methods: Data were extracted from an original academic medical center study designed to measure glaucoma medication adherence in patients under usual care vs. patients with regular physician and pharmacist telephone follow up. Baseline data included demographic information, personal health, a Morisky score for SRA, knowledge of glaucoma and treatment, attitudes toward medications, and reasons for nonadherence. Demographic, clinical, and knowledge data were further categorized to compare between patients with low and high SRA. Data were analyzed using descriptive and inferential statistics. Results: Of 196 enrolled patients, 54% were female and 52% Caucasian. The mean age was 69 years and the mean number of years since glaucoma diagnosis was 12.5. Among those with low SRA, 49% had at least a 4-year college education vs. 53% in those with high SRA. Seventy-four percent of patients with low SRA and 85% with high SRA reported good, very good, or excellent health. No statistically significant differences in knowledge about glaucoma were seen between the patients with low and high SRA, yet those with high SRA provided more correct responses to questions about glaucoma treatment. The majority of patients in both low (85%) and high (92%) SRA groups reported taking their glaucoma medications daily for at least 6 months; however, 89% of patients with low SRA reported forgetfulness as the main reason for nonadherence vs. 40% in the high SRA group. Conclusion: SRA in this population is not predicted by demographic or clinical characteristics. Knowledge of glaucoma or attitudes toward medications did not correlate with SRA. Interventions are needed to address common barriers to medication adherence.
Keywords: patient; human; glaucoma; patient compliance; drug therapy; health; female; university hospital; physician; diagnosis; telephone; follow up; inferential statistics; Caucasian; college; education; population; pharmacist

Therapeutic compliance in primary open angle glaucoma - Taktak, J.; Ajmi Nabli, T.; Ben Othmen, H.; Mtiraoui, A.; Ben Hadj Hamida, F. (Tunisie Medicale, 2011)
Background: Compliance with medical treatment is a public health problem. It denotes the patient's perception of the disease and the treatment prescribed by doctors. It concerns one out of two patients. It may happen to any patient at one or another. It is secondary for reasons that are numerous and modifiable in time. It results from problems related to the patient as much as to the doctor. It represents an obstacle to paying for chronic diseases such as chronic open-angle glaucoma, hence the importance given to it in the recent years. Aim: To evaluate the compliance of adult patients suffering from early open-angle glaucoma and to determine the influential factors. Methods: We conducted a survey at the ophthalmology department of Ibn El Jazzar Hospital among 132 adults being treated for early open-angle glaucoma. The evaluation was done on the basis of patient's medical files and a questionnaire from January 2007 to June of the same year. It ranges between good, average or bad depending on the frequency of the patient's visits to doctors, regularity of treatment and compliance with the doctor's prescription. Results: 40.15% of the patients have positively complied with the prescriptions. This improvement has mainly been due to the following factors: The patient's good knowledge of the disease and its treatment; use of antiseptic eye lotion with the utmost effectiveness for the least instillation and side effects; patient's mastery of drop usage; doctor's intensive care required for some particular cases. Conclusion: Our results need to be confirmed by other studies. It's very important to consider all the determining factors in order to improve patient's compliance.
Keywords: antiinfective agent; adult; ambulatory care; article; human; intensive care; knowledge; major clinical study; medical record review; open angle glaucoma; patient compliance; patient education; prescription; questionnaire

Glaucoma medication adherence: Room for improvement in both performance and measurement - Muir, K.W.; Lee, P.P. (Archives of Ophthalmology, 2011)
Keywords: antiglaucoma agent; eye drops; clinical observation; drug monitoring; editorial; follow up; glaucoma; health care system; human; intraocular pressure abnormality; medical record; patient compliance; pharmacy (shop); prescription; priority journal; self report; visual field defect

Role of fixed combinations in the management of open-angle glaucoma - Hommer, A. (Expert Review of Pharmacoeconomics and Outcomes Research, 2011)
The first-line option for lowering intraocular pressure (IOP) is a single hypotensive agent, but patients frequently require additional IOP-lowering agents to reach their target pressures. Disadvantages of this multi-therapy approach include washout effect, inconvenience and poor adherence. Fixed combinations (FCs) combine two or more hypotensive agents in a single bottle, providing a convenient once-daily therapy, which tends to improve adherence. FCs generally offer equivalent efficacy to concomitant use of the individual components, with equivalent or superior tolerability. Studies also show that FCs can be more cost effective than nonfixed combinations. In terms of optimizing IOP control, minimizing visual field deterioration, preventing visual disability and minimizing associated healthcare costs, FCs are an important component of glaucoma management. © 2011 Expert Reviews Ltd.
Keywords: alpha 2 adrenergic receptor stimulating agent; antiglaucoma agent; antihypertensive agent; beta adrenergic receptor blocking agent; betaxolol plus pilocarpine; bimatoprost; bimatoprost plus timolol; brimonidine; brimonidine plus timolol; brinzolamide plus timolol; carbonate dehydratase inhibitor; carteolol plus pilocarpine; dipifevrine plus guanethidine; dipifevrine plus pilocarpine; dorzolamide plus timolol; eye drops; latanoprost; latanoprost plus timolol; metipranol plus pilocarpine; pilocarpine plus timolol; prostaglandin derivative; thiloadren; thilodigon; timolol; timolol plus travoprost; travoprost; unclassified drug; allergic conjunctivitis; burning sensation; comparative effectiveness; conjunctival hyperemia; cost effectiveness analysis; cost of illness; disease control; disease severity; dosage schedule comparison; dose response; drug cost; drug effect; drug efficacy; drug mechanism; drug mixture; drug tolerability; drug use; evening dosage; pseudoexfoliation; glaucoma; human; hyperemia; intraocular pressure abnormality; medical history; monotherapy; morning dosage; open angle glaucoma; patient assessment; patient compliance; patient satisfaction; review; risk reduction; social aspect; taste disorder; visual field defect; visual impairment; azarga; combigan; cosopt; duotrav; ganfort; thiloadren; thilodigon; xalacom

Contact lens usage characteristics among young individuals and their perception regarding future refractive surgery - Kanonidou, E.; Chatziralli, I.P.; Praidou, A.; Konidaris, V. (Graefe's Archive for Clinical and Experimental Ophthalmology, 2011)
Keywords: abrasion; adult; concept formation; contact lens; cornea disease; cornea edema; cornea neovascularization; cornea ulcer; dry eye; eye examination; giant papillary conjunctivitis; health care access; health care cost; human; keratitis; letter; ophthalmology; optometry; postoperative complication; priority journal; questionnaire; refractive surgery; student; visual field

The efficacy and safety of 0.5% Levofloxacin versus fortified Cefazolin and Amikacin ophthalmic solution for the treatment of suspected and culture-proven cases of infectious bacterial keratitis: A comparative study - Kasetsuwan, N.; Tanthuvanit, P.; Reinprayoon, U. (Asian Biomedicine, 2011)
Background: Bacterial keratitis is a major devastating ocular condition that quickly deteriorates the patient's vision. Vigorous and prompt treatment of bacterial keratitis with broad-spectrum antibiotic eye-drops is preferred. Objective: Evaluate the efficacy and safety of 0.5% Levofloxacin for the treatment of suspected and culture-proven cases of infectious bacterial keratitis in comparison to fortified Cefazolin and Amikacin ophthalmic solution. Materials and methods: Seventy-one eyes from 69 patients suspected of having infectious bacterial keratitis were enrolled in the study. The patients were randomized into two arms, 0.5% Levofloxacin eye drops (34 eyes) or fortified Cefazolin and Amikacin (37 eyes). Sixty-eight eyes were included in the efficacy analysis. During treatment, on days 2, 7, 14, and 21, the patient's symptoms and signs were scored from grade 0-3 (absent to severe). Results: At the end of the treatment, 61 out of 71 eyes completely healed. The resolution of the keratitis was not significantly different between both groups. There were no significant differences in the mean time-duration for the ulcer to heal or for the symptoms and clinical signs to disappear between the two groups. No serious adverse events or side effects from the disease were found. The patients compliance was 80% based on the self-reported diaries. Conclusion: The efficacy and safety of 0.5% topical Levofloxacin was comparable to fortified Cefazolin and Amikacin for the treatment of mild-to-moderate bacterial keratitis. Topical Levofloxacin is far superior because of its availability and patient compliance when used as monotherapy for the treatment of infectious bacterial keratitis.
Keywords: amikacin; cefazolin; levofloxacin; article; bacterial keratitis; comparative study; controlled study; double blind procedure; drug efficacy; drug safety; female; human; major clinical study; male; patient compliance; randomized controlled trial; scoring system; self report; ulcer healing; unspecified side effect

The effect of introducing the Icare tonometer in a pediatric ophthalmology clinic - Grigorian, F.; Grigorian, A.P.; Olitsky, S.E. (Journal of AAPOS, 2011)
Purpose: To demonstrate that the introduction of Icare rebound tonometry in a pediatric ophthalmology clinic resulted in less need for performing examinations under anesthesia to evaluate children with glaucoma. Methods: A retrospective, comparative study of the numbers of EUA's and office visits with IOP check was performed during 3 time periods: before introduction of the Icare rebound tonometer, during the learning period and after the use of the device was well established. The operative reports during each of these periods were reviewed. The number of EUA's done to evaluate the IOP for glaucoma management and the clinic visits when the IOP was checked were collected. Results: 87 patients were enrolled. 49 patients met criteria in the first period and 58 in the third period. The average age for the first period was 4.2 years, and for the third period was 4.9 years (p = 0.3). The numbers of EUA performed before and after the introduction of Icare was 58 and 19 respectively (p = 0.0002). The number of office visits when IOP was measured increased from 37 to 151. The middle period had intermediate data and suggested a trend and also a short learning period. Conclusions: The use of Icare tonometry decreased the need of EUA to evaluate children with glaucoma. This decrease not only limits the need for general anesthesia in young children but increases operating room efficiency for the surgeon and families.
Keywords: ophthalmology; strabismus; hospital; tonometer; child; glaucoma; tonometry; ambulatory care; patient; learning; operating room; anesthesia; examination; comparative study; surgeon; devices; general anesthesia

Antiepileptic Drugs: The Old and the New - Hung, O.L.; Shih, R.D. (Emergency Medicine Clinics of North America, 2011)
During the past decade several new antiepileptic drugs (AEDs) have become available, including new formulations of some of the older medications. Understanding the pharmacokinetics of the new AEDs is important because they are primarily used for adjunctive therapy and interactions with other medications can result in significant toxicities. The new-generation AEDs do not cause serious morbidity in overdose, and treatment is primarily supportive. Specific medications should be chosen based on the patient's history and presentation. © 2011 Elsevier Inc.
Keywords: 4 aminobutyric acid A receptor; anticonvulsive agent; calcium channel; carbamazepine; carbonate dehydratase inhibitor; clonazepam; corticosteroid; cyclosporine; digoxin; ethosuximide; etiracetam; felbamate; fosphenytoin sodium; gabapentin; glutamate receptor; lamotrigine; meprobamate; oral contraceptive agent; oxcarbazepine; phenobarbital; phenothiazine; phenytoin; sodium channel; tiagabine; topiramate; unclassified drug; unindexed drug; valproate semisodium; valproic acid; voltage dependent sodium channel; warfarin; zonisamide; abdominal pain; absence; acne; acute kidney failure; acute pancreatitis; acute psychosis; agitation; aminotransferase blood level; anorexia; aplastic anemia; application site reaction; ataxia; bradycardia; brain death; brain edema; central nervous system depression; central nervous system disease; closed angle glaucoma; coma; complex partial seizure; continuous infusion; crystalluria; diplopia; disruptive behavior; dizziness; drug blood level; drug contraindication; drug elimination; drug eruption; drug excretion; drug fatality; drug half life; drug indication; drug induced headache; drug mechanism; drug megadose; drug metabolism; drug overdose; drug safety; drug withdrawal; dysarthria; epileptic state; erythema; erythema multiforme; face deformity; facial coarsening; facial coarsening; fatigue; focal epilepsy; GABAergic transmission; gastrointestinal toxicity; gingiva hyperplasia; tonic clonic seizure; heart arrest; heart arrhythmia; hematuria; hirsutism; human; hyperactivity; hyperammonemia; hyperthermia; hyponatremia; hypotension; idiosyncratic hepatoxicity; idiosyncratic hepatoxicity; infusion site reaction; infusion site reaction; Lennox Gastaut syndrome

Compliance and adherence in glaucoma management - Robin, A.; Grover, D. (Indian Journal of Ophthalmology, 2011)
Glaucoma is a preventable cause of blindness if timely effective and successful treatment is provided. Patient adherence to the medication is a constant challenge that is now recognized as an essential component to treatment. Several studies have demonstrated that patients are more likely to be adherent to their medication if they understand the disease and the rationale for treatment and if their treatment regimen is simplified. Additionally, using eye drops has its own set of challenges that must be recognized and addressed at the clinical level. Although numerous socioeconomic factors are associated with poor adherence, these factors must be addressed at the societal level. Maximizing patient adherence to medication has the potential to reduce the number of surgical interventions required to treat glaucoma, prevent unnecessary vision loss, and save the overall healthcare system money in the long run.
Keywords: antihypertensive agent; eye drops; blindness; conference paper; glaucoma; human; patient compliance; socioeconomics

Dermatologic manifestations of Sjögren syndrome - Kittridge, A.; Routhouska, S.B.; Korman, N.J. (Journal of Cutaneous Medicine and Surgery, 2011)
Background: Sjögren syndrome (SS) is a chronic autoimmune inflammatory disease that involves primarily the exocrine glands, resulting in their functional impairment. SS typically presents as dry eyes (xerophthalmia) and dry mouth (xerostomia). This process can manifest either as the independent phenomenon of primary SS or as secondary SS when found in the context of another autoimmune process, most commonly rheumatoid arthritis or systemic lupus erythematosus. Nearly half of the patients with SS develop cutaneous manifestations, which may include dry skin (xeroderma), palpable and nonpalpable purpura, and/or urticaria-like lesions. These cutaneous manifestations have been underemphasized because they are often overshadowed by the more prominent sicca symptoms. However, certain skin findings are of paramount clinical and prognostic importance as they confer an increased risk for the development of life-threatening conditions, including multisystem vasculitis and non-Hodgkin lymphoma. Objective and Conclusions: In this review, the cutaneous manifestations of primary SS are discussed, with an emphasis on those findings that portend an increased risk of mortality. © 2011 Canadian Dermatology Association.
Keywords: ammonium lactate; artificial tear; azathioprine; cevimeline; colchicine; cyclophosphamide; cyclosporine; cytokeratin; dapsone; erythromycin; fluoride; hydroxychloroquine; involucrin; leflunomide; loteprednol; lubricating agent; methotrexate; mycophenolate mofetil; nystatin; pilocarpine; rimexolone; rituximab; salazosulfapyridine; steroid; unclassified drug; annular erythema; article; blepharitis; clinical feature; cornea ulcer; cryoglobulinemia; cryoglobulinemic vasculitis; cryoglobulinemic vasculitis; cutaneous vasculitis; cutaneous vasculitis; dermatitis; disease course; drug megadose; dry eye; eye discomfort; eyelid; human; hyperpigmentation; mortality; mouth hygiene; nonhodgkin lymphoma; patient care; patient compliance; patient education; physical examination; priority journal; protein expression; Raynaud phenomenon; risk assessment; Sjoegren syndrome; skin burning sensation; skin defect; skin manifestation; skin pruritus; sweating; symptomatology; thrush; vaginal dryness; vasculitis; xeroderma; xerophthalmia; xerosis; xerostomia

[Specific problems linked to glaucoma in elderly patients]. - Parc, C. (Soins. Gérontologie, 2011)
Chronic glaucoma is one of the main causes of blindness in France. The incidence of the disease increases with age and forms an ever greater public health problem as the population ages. It is therefore important to be aware of the disabilities related to glaucoma in order to optimise the treatment of elderly patients suffering from the disease.
Keywords: age distribution; aged; article; blindness; chronic disease; disease course; France; geriatric nursing; glaucoma; human; incidence; mass screening; methodology; patient; patient compliance

Force requirements in topical medicine usethe squeezability factor - Connor, A.J.; Severn, P.S. (Eye, 2011)
IntroductionPatient compliance is essential to ensure efficacious treatment. The ease of topical drop delivery is of paramount importance. At least 50% of patients report difficulty in self-administration of topical ocular medicine. The two most frequently reported causes of difficulty include aiming the bottle and squeezing the bottle.PurposeThe aims of this study were to identify (I) the force required to deliver a single drop from a bottle (the squeezability factor), (II) are some bottle designs easier to use than others? (III) Do compliance aids reduce the finger strength required to deliver an eye drop?MethodWe measured the force required to deliver a single drop from a variety of commonly used ophthalmic preparations. Force was slowly applied at the midpoint along the bottle until a drop fell from the tip. Compliance aids were also tested with this technique.ResultsWe report a wide variation in the force requirements needed to use topical medicines. Three of the four compliance aids tested increased force requirements but may have had other beneficial effects by altering the grip on the medicine bottle.ConclusionThis study highlights the large variability in force required to deliver a single drop using the ophthalmic preparations and compliance aids tested. We feel our results will be of interest and relevant to prescribing physicians and manufactures alike. © 2011 Macmillan Publishers Limited All rights reserved.
Keywords: apraclonidine; betamethasone sodium phosphate; betamethasone sodium phosphate plus neomycin; betaxolol; bimatoprost; bimatoprost plus timolol; brimonidine; brinzolamide; brinzolamide plus timolol; carboxymethylcellulose; carteolol; ciprofloxacin; cyclopentolate; dexamethasone; diclofenac; dorzolamide; dorzolamide plus timolol; eye drops; gentamicin; hydroxypropylmethylcellulose; ketorolac trometamol; latanoprost; latanoprost plus timolol; levobunolol; ofloxacin; polyvinyl alcohol; prednisolone acetate; prednisolone sodium phosphate; retinol palmitate; tears naturale; timolol maleate; travoprost; unindexed drug; article; drug packaging; experimental design; eye drop delivery aid; finger; force; general medical device; glaucoma; human; sterile bottle; patient compliance; product parameters; squeezability factor; strength; topical treatment; acular; alphagan; azarga; azopt; betagan; betnesol; betnesol n; betoptic; celluvisc; ciloxan; cosopt; exocin; ganfort; genticin; hypromellose; iopidine; liquifilm tears; lumigan; maxidex; mydrilate; oculotect; predforte; predsol; tears naturale; teoptic; timoptol; travatan; trusopt; voltarol; xalacom; xalatan; Eyot; optive Opticare; optive Opticare artho; Xalaease

Novel drug delivery systems for glaucoma - Lavik, E.; Kuehn, M.H.; Kwon, Y.H. (Eye, 2011)
Reduction of intraocular pressure (IOP) by pharmaceutical or surgical means has long been the standard treatment for glaucoma. A number of excellent drugs are available that are effective in reducing IOP. These drugs are typically applied as eye drops. However, patient adherence can be poor, thus reducing the clinical efficacy of the drugs. Several novel delivery systems designed to address the issue of adherence and to ensure consistent reduction of IOP are currently under development. These delivery systems include contact lenses-releasing glaucoma medications, injectables such as biodegradable micro- and nanoparticles, and surgically implanted systems. These new technologies are aimed at increasing clinical efficacy by offering multiple delivery options and are capable of managing IOP for several months. There is also a desire to have complementary neuroprotective approaches for those who continue to show progression, despite IOP reduction. Many potential neuroprotective agents are not suitable for traditional oral or drop formulations. Their potential is dependent on developing suitable delivery systems that can provide the drugs in a sustained, local manner to the retina and optic nerve. Drug delivery systems have the potential to improve patient adherence, reduce side effects, increase efficacy, and ultimately, preserve sight for glaucoma patients. In this review, we discuss benefits and limitations of the current systems of delivery and application, as well as those on the horizon. © 2011 Macmillan Publishers Limited All rights reserved.
Keywords: antiglaucoma agent; bimatoprost; brain derived neurotrophic factor; carbonate dehydratase inhibitor; ciliary neurotrophic factor; drug carrier; glial cell line derived neurotrophic factor; latanoprost; liposome; nanosphere; neuroprotective agent; ocular insert; pilocarpine; polymer; timolol; timolol maleate; travoprost; unclassified drug; application site discoloration; aqueous humor; biomedical microelectromechanical system; blood retina barrier; blurred vision; cell transplantation; conjunctival hyperemia; coughing; diarrhea; disease course; diuresis; drug bioavailability; drug delivery system; drug dosage form comparison; drug efficacy; drug formulation; drug implant; drug induced headache; electrolyte disturbance; fatigue; glaucoma; human; hydrophobicity; intraocular hypertension; intraocular pressure; nausea; neuroprotection; patient attitude; patient compliance; retina detachment; review; side effect; skin discoloration; soft contact lens; vomiting; body weight loss; nyogel; timoptic xe

Eye care utilization in Canada: Disparity in the publicly funded health care system - Jin, Y.-P.; Trope, G.E. (Canadian Journal of Ophthalmology, 2011)
Objectives: To examine patterns in, determinants of, and barriers to eye care utilization in Canada. Design: Cross-sectional survey. Participants: All 132221 respondents to the Canadian Community Health Survey 2005. Methods: Eye care utilization was self-reported and was defined as having seen or talked on the telephone with an eye care provider (ophthalmologist or optometrist) in a 12-month period. Associations of interest were assessed by prevalence ratios (PR). Results: Forty percent (11 million) of Canadians aged 12 years or older reported utilization of eye care providers. The lowest utilization rates occurred in people aged 30-39 years and the highest in those aged 70 years and older. Utilization was not related to levels of education or household income in people with self-reported glaucoma, cataracts, or diabetes. Among Canadians without these conditions, significantly less utilization occurred in men, in those with less than a postsecondary education, and in those with annual household incomes under $30 000. Canadians residing in Newfoundland and Labrador utilized eye care providers significantly less than those residing in other provinces (adjusted PR 0.80, 95% CI 0.74-0.86). Fourteen percent of glaucoma patients, 37% of diabetic patients, and 41% of people aged 65 years or older did not access eye care providers over a 12-month period. Conclusions: Marked disparities occur in eye care utilization among Canadians without known eye diseases. A substantial proportion of people at a high risk of vision loss do not access eye care providers. Attributable factors are likely incomplete government coverage, asymptomatic ocular diseases, and lack of perceived benefits of eye care services.
Keywords: adult; article; cataract; child; diabetes mellitus; educational status; eye care; glaucoma; health care system; health care utilization; human; income; school child; self report

The pharmacotherapy of chronic obstructive pulmonary disease in the elderly: An update - Majid, H.; Sharafkhaneh, A. (Clinical Medicine Insights: Therapeutics, 2011)
Chronic obstructive pulmonary disease (COPD) is a disorder of the airways characterized by inflammation and airflow limitation. It is a major cause of morbidity and mortality globally and its prevalence is on the rise. COPD is predominantly a disease of the older age group. As the average life-span increases world-wide, and the burden of COPD increases, correct recognition and optimal management of this disease has become essential in the elderly. In the proceeding article, changes in the respiratory system associated with normal aging, as well as with COPD are reviewed. Important implications of aging in COPD management are also discussed. © the author(s), publisher and licensee Libertas Academica Ltd.
Keywords: amfebutamone; antibiotic agent; azithromycin; beta adrenergic receptor stimulating agent; bronchodilating agent; cholinergic receptor blocking agent; corticosteroid; cyclic AMP; cyclic GMP; erythromycin; macrolide; methylxanthine derivative; nicotine; phosphodiesterase IV inhibitor; placebo; Pneumococcus vaccine; prednisolone; roflumilast; theophylline; tiotropium bromide; varenicline; acute disease; adrenal suppression; aging; breathing muscle; bronchiolitis obliterans; bullectomy; chronic obstructive lung disease; comorbidity; diabetes mellitus; diarrhea; disease association; disease exacerbation; dose response; drug absorption; drug blood level; drug degradation; drug half life; drug mechanism; drug safety; dyspnea; elderly care; gastritis; gastrointestinal symptom; glaucoma; headache; heart palpitation; human; hypertension; insomnia; lung function test; lung gas exchange; lung parenchyma; lung resection; lung surgery; lung transplantation; mass immunization; mucosal dryness; myopathy; nausea; osteoporosis; oxygen therapy; patient compliance; pharmacodynamics; polypharmacy; pulmonary rehabilitation; rash; repeated drug dose; respiration control; respiratory function; respiratory system; review; side effect; skin contusion; skin irritation; smoking cessation; treatment response; unspecified side effect; urine retention; body weight loss

Management options in advanced prostate cancer: What is the role for sipuleucel-T? - Bitting, R.L.; Armstrong, A.J.; George, D.J. (Clinical Medicine Insights: Oncology, 2011)
Most prostate cancer-related deaths occur in patients with castration-resistant prostate cancer (CRPC). Until recently, only therapy with docetaxel and prednisone has been shown to prolong survival in men with metastatic CRPC. With the United States Food and Drug Administration (US FDA) approvals of sipuleucel-T, cabazitaxel, and abiraterone acetate, all based on improvement in overall survival, the landscape for management of men with metastatic CRPC has dramatically changed. In this review we will discuss the pivotal clinical trial data leading to these approvals, with particular focus on the unique indication for sipuleucel-T and the implications for optimal management and sequencing of treatment in this patient population. © the author(s), publisher and licensee Libertas Academica Ltd.
Keywords: abiraterone acetate; cabazitaxel; corticosteroid; denosumab; docetaxel; estramustine; ipilimumab; mitoxantrone; placebo; prednisone; prostate specific antigen; sipuleucel T; zibotentan; zoledronic acid; advanced cancer; antineoplastic activity; cancer combination chemotherapy; cancer grading; cancer immunization; cancer immunotherapy; cancer screening; cancer survival; castration resistant prostate cancer; chill; dose response; drug approval; drug dependence; drug dose sequence; drug efficacy; drug protein binding; drug safety; drug tolerability; fever; glaucoma; glucose intolerance; headache; health care access; human; hypertension; low drug dose; melanoma; metastasis; myalgia; overall survival; peptic ulcer; progression free survival; prostate cancer; review; side effect; treatment indication; body weight gain; jevtana; provenge; zytiga

Update and optimal use of a brinzolamide-timolol fixed combination in open-angle glaucoma and ocular hypertension - Syed, M.F.; Loucks, E.K.R. (Clinical Ophthalmology, 2011)
Glaucoma encompasses a wide clinical spectrum of disease, with the common pathophysiology of progressive optic neuropathy leading to visual field loss. Elevated intraocular pressure (IOP) is a key risk factor in disease progression. Treatment is aimed at reduction of IOP to minimize continued optic nerve head damage. Pharmacologic treatment with various classes of IOP-lowering medications is generally employed before more aggressive surgical interventions. Monotherapy is generally accepted as initial therapy for glaucoma, but at least half of patients may require more than one IOP-lowering medication. One option is the fixed combination of brinzolamide 1% and timolol maleate 0.5%, which is commercially available in some countries as Azarga® for treatment of glaucoma not adequately responsive to monotherapy. These agents may also be used in an unfixed fashion, but fixed combination therapy is generally more convenient for patients, which may result in improved compliance, a reduction of the "washout effect" from instilling multiple drops, and a potential reduction in the side effects related to multiple doses of preservatives. © 2011 Syed and Loucks.
Keywords: brinzolamide; brinzolamide plus timolol; carbonate dehydratase inhibitor; dorzolamide; dorzolamide plus timolol; polymer; preservative; prostaglandin derivative; timolol; allergic reaction; bitter taste; blood pressure; blurred vision; bradycardia; bronchospasm; chemosis; chronic obstructive lung disease; conjunctival hyperemia; conjunctivitis; cornea disease; depression; dermatitis; dizziness; drug absorption; drug effect; drug efficacy; drug formulation; drug induced headache; drug mechanism; drug safety; drug tolerability; drug use; dry eye; dyspnea; epiphora; exercise tolerance; eye burning; eye discharge; eye discomfort; eye irritation; eye pain; heart arrhythmia; heart block; heart failure; human; hydrogel; hyperemia; impotence; intraocular foreign body; intraocular hypertension; keratitis; lacrimal fluid level; libido disorder; monotherapy; nausea; nephrolithiasis; nonhuman; ocular pruritus; open angle glaucoma; patient compliance; photophobia; pruritus; punctate keratitis; review; side effect; sore throat; faintness; taste disorder; thorax pain; treatment response; urticaria; xerostomia; azarga

Prostaglandin-timolol fixed combinations efficacy: Myth or reality? - Konstas, A.G.P.; Haidich, A.-B.; Rossetti, L.; Webers, C. (European Journal of Ophthalmology, 2011)
Keywords: antiglaucoma agent; bimatoprost plus timolol; latanoprost plus timolol; prostaglandin derivative; prostaglandin plus timolol; timolol; timolol plus travoprost; unclassified drug; bioequivalence; blindness; conjunctival hyperemia; dosage schedule comparison; drug activity; drug efficacy; drug potency; drug potentiation; drug response; drug safety; drug substitution; drug tolerability; lack of drug effect; drug withdrawal; editorial; evening dosage; evidence based medicine; follow up; glaucoma; human; intraocular hypertension; intraocular pressure; long term care; monotherapy; morning dosage; patient compliance; priority journal; treatment outcome; unspecified side effect

Efficacy and tolerability of prostaglandin-timolol fixed combinations: A meta-analysis of randomized clinical trials - Aptel, F.; Cucherat, M.; Denis, P. (European Journal of Ophthalmology, 2011)
Purpose. To evaluate the intraocular pressure (IOP)-lowering effects and tolerability of the 3 prosta-glandin-timolol fixed combinations (PG-timolol FCs). methods. Clinical trials comparing directly the PG-timolol FCs or comparing the PG-timolol FCs to their individual components were thoroughly searched. The main outcome measures were efficacy assessed by IOP (taken at 9 am, noon, 4 pm, and over the mean diurnal curve) change at 3 months (or after 1 to 6 months of treatment if no data were available at month 3) from baseline and tolerability assessed by the incidence of conjunctival hyperemia. results. Twenty trials were identified (n=4684 patients). Intraocular pressure reduction was usually greater with the 3 PG-timolol FCs than the individual PG (mean difference [MD] 0.00 mmHg to 2.59 mmHg; p>0.1 to p<0.001). The incidence of hyperemia was significantly less with latanoprost- and bi-matoprost-timolol FCs than with the individual PG (relative risk = 0.66 and 0.61; p=0.05 and p<0.001). From direct comparisons, IOP reduction was significantly greatest with bimatoprost-timolol FC, at 9 am, 4 pm, and over the mean diurnal curve compared to latanoprost-timolol FC (MD = 0.90 mmHg to 1.48 mmHg; p<0.001) and at all time points compared to travoprost-timolol FC (MD = 0.66 mmHg to 0.90 mmHg; p<0.001). The incidence of hyperemia was not significantly less with latanoprost-timolol FC than with bimatoprost-timolol FC (relative risk = 1.32; p>0.1). ConClusions. The 3 PG-timolol FCs provide a greater IOP reduction and lower incidence of hyperemia than the 3 PGs alone. The direct comparisons suggest a greater efficacy of the bimatoprost-timolol FC compared with latanoprost- and travoprost-timolol FCs. © 2011 Wichtig Editore.
Keywords: antiglaucoma agent; bimatoprost; bimatoprost plus timolol; latanoprost; latanoprost plus timolol; prostaglandin; prostaglandin plus timolol; timolol plus travoprost; travoprost; unclassified drug; adult; article; conjunctival hyperemia; controlled study; dosage schedule comparison; drug activity; drug efficacy; drug tolerability; evening dosage; female; follow up; glaucoma; human; intraocular hypertension; intraocular pressure; intraocular pressure lowering effect; major clinical study; male; meta analysis; monotherapy; morning dosage; patient compliance; priority journal; randomized controlled trial (topic); systematic review

Timogel® vs timolol 0.5% ophthalmic solution: Efficacy, safety, and acceptance - Rolle, T.; Curto, D.; Alovisi, C.; Franzone, M.; Brogliatti, B.; Grignolo, F.M. (European Journal of Ophthalmology, 2011)
Purpose. To evaluate the efficacy, safety, and tolerability of Timogel® preservative-free once daily compared to timolol 0.5% ophthalmic solution bid in patients with ocular hypertension (OHT) and patients with primary open-angle glaucoma (POAG). methods. A total of 75 patients with OHT and patients with POAG treated with timolol 0.5% bid with intraocular pressure (IOP) ≤21 mmHg were enrolled. They underwent complete ophthalmologic examination, IOP measurements (at trough and daytime curve), evaluation of side effects, Schirmer test, break-up time [BUT], blood pressure, heart rate, ocular diastolic perfusion pressure measurements, and acceptance (Comparison of Ophthalmic Medications for Tolerability). Patients switched to Timo-gel® and were re-evaluated 3 months later. The analysis of variance and the Pearson χ2 tests were used to test differences between the treatments results. Intraocular pressure reduction at trough was 23.6% with timolol 0.5% and 22.3% with Ti-mogel®. No statistical differences were observed in IOP values at trough and in the daytime curve between the 2 treatments. Local and systemic side effects were less frequent with Timogel® (hazard ratio: p<0.05). Patients demonstrated a significant improvement of Schirmer test and BUT (p<0.05) and a reduction of dryness and foreign body sensation (42.6% vs 15.4%; p<0.01) after switching to Timogel®. Mild and short-lasting blurred vision after Timogel® instillation occurred in about 18.5% of patients. A total of 82% of patients were satisfied or very satisfied with Timogel® vs 61% with previous treatment (p<0.01). ConClusions. Timogel® preservative-free dosed once every morning has a 24-hour hypotensive effect with a better safety profile than timolol 0.5% bid and it is well-accepted by patients. The once-daily dosing improved acceptance and compliance. © 2011 Wichtig Editore.
Keywords: eye drops; preservative; timolol maleate; timolol; unclassified drug; article; blurred vision; conjunctival hyperemia; controlled clinical trial; controlled study; diastolic blood pressure; disease severity; dosage schedule comparison; drug activity; drug blood level; drug dosage form comparison; drug efficacy; drug formulation; drug hypersensitivity; drug safety; drug tolerability; drug withdrawal; dry eye; evening dosage; eye blood flow; eye burning; eye disease; eye stinging; eye stinging; eyelid edema; eyelid redness; eyelid redness; follow up; foreign body; foreign body sensation; foreign body sensation; gel; heart rate; human; intraocular hypertension; intraocular pressure; major clinical study; morning dosage; ocular diastolic perfusion pressure; ocular pruritus; open angle glaucoma; patient compliance; patient satisfaction; perfusion pressure; pressure measurement; priority journal; prospective study; Schirmer test; side effect; systolic blood pressure; timogel

Taking on glaucoma care as an interprofessional team - Lu, V.H.-J.; Lu, C.Y.; Goldberg, I. (Canadian Journal of Ophthalmology, 2011)
Keywords: editorial; glaucoma; health care access; health care cost; health care delivery; health care quality; health care utilization; human; medical decision making; patient care; treatment outcome

Handiness and acceptability of the new Abak® bottle in chronically treated patients. A cross-sectional, retrospective and multicentre study - Gabisson, P.; Briat, B.; Le Foll, J.; Conan, S.; Bale-Le Bescond, F.; Talmud, M.; Chibret, H. (Annales Pharmaceutiques Francaises, 2011)
Difficulty of use of eyedrops is a factor associated with poor patient compliance that reduces treatment efficacy. The aim of this study was to evaluate the handiness and global acceptability of the new Abak® timolol bottle (multidose preservative-free eyedrops) in comparison with that of other administration systems (classical multidose eyedrops or single-doses) in patients treated for glaucoma or ocular hypertension. Methods: Cross-sectional, retrospective and multicentre study involving 41 ophthalmologists in France. Selected patients were those who had been treated with the new Abak® bottle since at least two months, as a replacement for other beta-blocker eyedrops. Handiness and acceptability of the new Abak® bottle in comparison with other delivery systems were evaluated using a questionnaire filled by the investigator. Results: Almost all the patients were unanimous regarding the handiness of the new Abak® bottle: easy to open for 96.5% of them, easy to handle for 96.0%, and easy to get drops for 91.1%. For all these criteria and in a general manner, patients preferred the new Abak® bottle in comparison with the previous eyedrop container. These results were confirmed in the oldest patients. Conclusion: The new Abak® bottle had a greater acceptability compared to preserved multidose eyedrops or to single-doses. Its handiness and the absence of preservative which may improve local tolerance are in favor of a greater compliance in chronically treated patients. © 2010 Elsevier Masson SAS.
Keywords: eye drops; timolol; Abak; article; chronic patient; cross-sectional study; drug delivery system; France; glaucoma; human; intraocular hypertension; multicenter study (topic); outcome assessment; patient compliance; physician; questionnaire; retrospective study; Abak

Patient communication and the glaucoma surgeon - Bhartiya, S.; Ichhpujani, P. (Journal of Current Glaucoma Practice, 2011)
Glaucoma is a chronic disease which requires a lifelong therapeutic regimen, without any apparent subjective improvement. In fact, the quality of life of patients is known to deteriorate on institution of therapy. It is, therefore, imperative that the risks and benefits of glaucoma therapy be explained to the patient in great detail in order to increase compliance and adherence to the prescribed regimen. Since good communication is a precondition for optimal care and treatment in care of glaucoma patients, this review attempts to offer a solution to the serious communication problems still experienced by patients as well as by health care professionals.
Keywords: article; attitude; blindness; caregiver; communication disorder; doctor patient relationship; glaucoma; health care personnel; human; intelligence; interpersonal communication; intraocular hypertension; intraocular pressure; iridotomy; low level laser therapy; patient care; patient compliance; quality of life; risk assessment; therapeutic misconception; trabeculoplasty; visual impairment

First-year treatment costs among new initiators of topical prostaglandin analog identified from November 2007 through April 2008 - Schmier, J.K.; Covert, D.W.; Robin, A.L. (Current Medical Research and Opinion, 2010)
Objective: Ocular surface disease (OSD) is a common side effect of ophthalmic medications containing the preservative benzalkonium chloride (BAK). Little is known whether and how glaucoma treatment patterns and annual costs vary based on the presence of BAK. The objective of this analysis was to estimate first-year treatment costs among new initiators of topical prostaglandin analogs in a managed care population. Research design and methods: A model was developed to estimate first-year direct medical costs associated with glaucoma prescriptions and outpatient ophthalmic care. Patients were identified from a pharmacy claims database, covering more than 75 million individuals, if they initiated therapy with one of three prostaglandin analog products between November 1, 2007 and April 30, 2008. Patients needed to have at least 6 months of prior claims data in which there were no glaucoma therapy claims and at least 12 months of follow-up data available after the initial claim. Patients were excluded if they were not continuously eligible for pharmacy benefits throughout this 18-month period. Published studies were used to estimate outpatient visit-related health care resource use, and costs for prescription medications and health care resource use were derived from standard, published benchmarks. Results: The database analysis identified 9398 patients meeting study criteria, 45 (n4230) of whom remained on their initial prostaglandin therapy for 12 months after initiation. Adjunctive intraocular pressure lowering therapy was needed in 23.6, 18.5, and 13.3 of bimatoprost, latanoprost, and BAK-free travoprost patients, respectively. Median numbers of days to the first prescription filled for adjunctive therapy (if required) were 72.5, 74.0, and 125.0 for patients initiating on bimatoprost, latanoprost, and BAK-free travoprost. Total estimated first-year costs were $1973, $1807, and $1739 for patients initiating therapy with bimatoprost, latanoprost, and BAK-free travoprost. Findings were consistent through sensitivity analysis. Conclusions: A BAK-free prostaglandin analog may permit longer duration of monotherapy and be associated with lower first-year direct treatment costs. Use of a claims database and the selection of new initiators of prostaglandin analogs limit projecting findings to all glaucoma patients. © 2010 Informa UK Ltd.
Keywords: alpha 2 adrenergic receptor stimulating agent; benzalkonium chloride; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; carbonate dehydratase inhibitor; dorzolamide; dorzolamide plus timolol; latanoprost; timolol; travoprost; adolescent; adult; aged; article; child; drug cost; drug use; female; glaucoma; health care cost; health care utilization; human; infant; major clinical study; male; model; monotherapy

Bimatoprost versus travoprost in an egyptian population: A Hospital-based prospective, randomized study - MacKy, T.A. (Journal of Ocular Pharmacology and Therapeutics, 2010)
Purpose: To compare the efficacy of bimatoprost and travoprost on intraocular pressure (IOP) reduction in an Egyptian population. Methods: Patients with primary open-angle glaucoma or ocular hypertension were randomized to receive either bimatoprost 0.03% or travoprost 0.004% once daily. IOPs were measured at baseline; 2 weeks; and 1, 2, 4, and 6 months using Goldman applanation tonometery. Results: Seventy-two patients were included: 34 and 38 (P=0.142) with a baseline mean IOP=26.52±5.185 and 26.36±1.605mm Hg (P=0.629) for bimatoprost and travoprost, respectively. Both drops provided statistically significant IOP reductions from baseline at all visits (P<0.001). Bimatoprost provided greater (nonsignificant) mean IOP reductions from baseline than travoprost at each visit. Mean IOP reductions was 8.77mm Hg (33.39%) and 8.42mm Hg (31.54%) at 2 weeks (P=0.703), and 8.47mm Hg (31.61%) and 7.84mm Hg (29.50%) at 6 months (P=0.536) for bimatoprost and travoprost, respectively. IOPs at 2 weeks were ≤18mm Hg in 20 (58.8%) versus 19 (50%) eyes (P=0.603), and ≤16mm Hg in 12 (35%) versus 12 (32%) eyes (P=0.456); and at 6 months ≤18mm Hg in 22 (65%) versus 14 (37%) eyes (P=0.045), and ≤16mm Hg in 12 (35%) versus 7 (18%) eyes (P=0.037) for bimatoprost and travoprost, respectively. Ocular adverse and clinical success occurred equally with both drops. Conclusion: Both drops lowered IOP effectively but bimatoprost showed a greater non-significant reductions in mean IOP from baseline. © 2010, Mary Ann Liebert, Inc.
Keywords: bimatoprost; travoprost; adult; article; clinical article; clinical trial; controlled clinical trial; controlled study; drug efficacy; Egypt; eye disease; female; human; intraocular hypertension; intraocular pressure; male; eye redness; eye redness; open angle glaucoma; patient compliance; randomized controlled trial; tonometry; treatment outcome

Meaningful use of electronic health records in ophthalmology - Boland, M.V. (Ophthalmology, 2010)
Keywords: editorial; electronic medical record; glaucoma; health care organization; health care utilization; health service; medicaid; medicare; ophthalmology; priority journal

Identification of noncompliant glaucoma patients using Bayesian networks and the Eye-Drop Satisfaction Questionnaire - Nordmann, J.-P.; Baudouin, C.; Renard, J.-P.; Denis, P.; Regnault, A.; Berdeaux, G. (Clinical Ophthalmology, 2010)
Objective: To identify poorly compliant glaucoma patients, using the Eye-Drop Satisfaction Questionnaire (EDSQ). Methods: This was an observational cross-sectional study with compliance data collected by an electronic monitoring device. Patients with primary open-angle glaucoma or ocular hypertension completed the EDSQ, a six-dimension self-reported questionnaire addressing "treatment concern", "disease concern", "patient-clinician relationship", "positive beliefs", "treatment convenience", and "self-declared compliance". A Bayesian network (BN) was applied to explore compliance associations with EDSQ. Results: Among 169 patients who completed the EDSQ, 113 had valid Travalert® data, of whom 25 (22.1%) demonstrated low compliance. All six EDSQ dimensions were associated directly, or indirectly, with compliance. Two profiles exhibited low compliance, ie, patients aged younger than 77.5 years with a poor patient-physician relationship and self-declared poor compliance and patients aged older than 77.5 years with a poor patient-physician relationship and self-declared good compliance. The third profile showed high compliance, ie, patients aged younger than 77.5 years with a good patient-physician relationship and self-declared good compliance. Conclusion: Our results confirm a central role for the patient-physician relationship in the compliance process. Age, self-declared compliance, and patient satisfaction with the patient- physician relationship are all dimensions worth exploring before glaucoma medication is switched or proceeding to laser treatment or surgery. © 2010 Nordmann et al.
Keywords: eye drops; adult; age; aged; article; Bayes theorem; classification algorithm; computer system; cross-sectional study; disease concern score; doctor patient relationship; drug instillation; Eye Drop Satisfaction Questionniare; female; gender; health belief; human; intraocular hypertension; major clinical study; male; observational study; open angle glaucoma; patient attitude; patient compliance; patient satisfaction; questionnaire; reminder system; scoring system; self report; treatment concern score; Travalert

Safety, tolerability, and efficacy of fixed combination therapy with dorzolamide hydrochloride 2% and timolol maleate 0.5% in glaucoma and ocular hypertension - Bell, N.P.; Ramos, J.L.; Feldman, R.M. (Clinical Ophthalmology, 2010)
Glaucoma is a collection of diseases characterized by multifactorial progressive changes leading to visual field loss and optic neuropathy most frequently due to elevated intraocular pressure (IOP). The goal of treatment is the lowering of the IOP to prevent additional optic nerve damage. Treatment usually begins with topical pharmacological agents as monotherapy, progresses to combination therapy with agents from up to 4 different classes of IOP-lowering medications, and then proceeds to laser or incisional surgical modalities for refractory cases. The fixed combination therapy with the carbonic anhydrase inhibitor dorzolamide hydrochloride 2% and the beta blocker timolol maleate 0.5% is now available in a generic formulation for the treatment of patients who have not responded sufficiently to monotherapy with beta adrenergic blockers. In pre- and postmarketing clinical studies, the fixed combination dorzolamide-timolol has been shown to be safe and efficacious, and well tolerated by patients. The fixed combination dorzolamide-timolol is convenient for patients, reduces their dosing regimen with the goal of increasing their compliance, reduces the effects of "washout" when instilling multiple drops, and reduces the preservative burden by reducing the number of drops administered per day. © 2010 Bell et al.
Keywords: antiglaucoma agent; bimatoprost; brimonidine; brimonidine plus latanoprost; brimonidine plus timolol; brinzolamide plus timolol; carbonate dehydratase inhibitor; dorzolamide; dorzolamide plus timolol; dorzolamide plus timolol maleate; latanoprost; latanoprost plus timolol; timolol maleate; timolol plus travoprost; travoprost; unclassified drug; abdominal pain; add on therapy; adjuvant therapy; article; backache; bitter taste; blepharitis; blurred vision; bradycardia; bronchitis; cataract; cerebrovascular accident; chemosis; choroid detachment; conjunctiva disease; conjunctival discharge; conjunctival discharge; conjunctival hyperemia; conjunctivitis; cornea erosion; coughing; crystalluria; depression; diarrhea; dizziness; drug absorption; drug cost; drug efficacy; drug eruption; drug excretion; drug hypersensitivity; drug induced headache; drug metabolism; drug safety; drug substitution; drug tissue level; drug tolerability; drug withdrawal; dry eye; dysgeusia; dyspepsia; dyspnea; epiphora; eye burning; eye discharge; eye disease; eye pain; eyelid disease; eyelid edema; eyelid erythema; eyelid exudate; eyelid exudate; eyelid pain; fatigue; finger injury; glaucoma; health care cost; heart atrium myxoma; heart block; heart failure; heart infarction; human; hyperglycemia; hyperoxaluria; hypertension; hypertrichosis; hypotension; incidence; influenza; intraocular foreign body; intraocular hypertension; iridocyclitis; leukocytosis; morning dosage; nausea; nose obstruction; ocular pruritus; ocular stinging; ocular stinging; open angle glaucoma; parathyroid hyperplasia; paresthesia; patient compliance; pharmacodynamics

Management of chronic anterior uveitis relapses: Efficacy of oral phospholipidic curcumin treatment. Long-term follow-up - Allegri, P.; Mastromarino, A.; Neri, P. (Clinical Ophthalmology, 2010)
Curcumin has been successfully applied to treat inflammatory conditions in experimental research and in clinical trials. The purpose of our study is to evaluate the efficacy of an adjunctive-to-traditional treatment with Norflo tablets (curcumin-phosphatidylcholine complex; Meriva) administered twice a day in recurrent anterior uveitis of different etiologies. The study group consisted of 106 patients who completed a 12-month follow-up therapeutic period. We divided the patients into three main groups of different uveitis origin: group 1 (autoimmune uveitis), group 2 (herpetic uveitis), and group 3 (different etiologies of uveitis). The primary end point of our work was the evaluation of relapse frequency in all treated patients, before and after Norflo treatment, followed by the number of relapses in the three etiological groups. Wilcoxon signed-rank test showed a P < 0.001 in all groups. The secondary end points were the evaluation of relapse severity and of the overall quality of life. The results showed that Norflo was well tolerated and could reduce eye discomfort symptoms and signs after a few weeks of treatment in more than 80% of patients. In conclusion, our study is the first to report the potential therapeutic role of curcumin and its efficacy in eye relapsing diseases, such as anterior uveitis, and points out other promising curcumin-related benefits in eye inflammatory and degenerative conditions, such as dry eye, maculopathy, glaucoma, and diabetic retinopathy. © 2010 Allegri et al.
Keywords: curcumin; curcumin phosphatidylcholine; cycloplegic agent; immunosuppressive agent; meriva; mydriatic agent; nonsteroid antiinflammatory agent; norflo; steroid; unclassified drug; adjuvant therapy; adult; aged; article; autoimmune disease; chronic disease; controlled study; disease severity; drug efficacy; drug response; drug tolerability; drug withdrawal; eye discomfort; female; follow up; gastrointestinal symptom; herpes simplex; human; iridocyclitis; long term care; major clinical study; male; patient compliance; quality of life; recurrence risk; recurrent disease; risk reduction; meriva; norflo

Efficacy and safety of travoprost alone or in combination with other agents for glaucoma and ocular hypertension: Patient considerations - Suzuki Jr., E.R.; Suzuki, C.L.B. (Clinical Ophthalmology, 2010)
Travoprost is a prostaglandin analog used in the management of glaucoma and ocular hypertension for reducing intraocular pressure (IOP). The IOP-lowering efficacy of travoprost has been shown to be similar to that of other prostaglandins, including latanoprost and bimatoprost. When compared with fixed combinations of timolol and either latanoprost or dorzolamide, travoprost alone can reduce mean IOP in a similar or superior manner. Concomitant therapy of travoprost and timolol can reach even greater IOP reductions than fixed combinations at some time points, but with no difference in the early morning, when IOP is usually higher. In addition, the long duration of action of travoprost can also provide better control of IOP fluctuation, probably due to its stronger prostaglandin F receptor mechanism. The side effects of travoprost do not represent a risk to the vision or health of the patient. The proven efficacy and safety combined with convenient once-daily dosing for travoprost increases patient compliance with treatment for glaucoma. © 2010 Suzuki and Suzuki.
Keywords: adrenergic receptor stimulating agent; benzalkonium chloride; beta adrenergic receptor blocking agent; bimatoprost; bimatoprost plus timolol; brimonidine; brinzolamide; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; dorzolamide; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; placebo; prostaglandin derivative; prostaglandin F; timolol; timolol maleate; timolol plus travoprost; travoprost; unoprostone isopropyl ester; adjuvant therapy; article; cardiovascular system; conjunctival hyperemia; drug dose comparison; drug efficacy; drug mechanism; drug safety; drug withdrawal; evening dosage; eye blood flow; eyelash; glaucoma; hematological parameters; human; hyperemia; hyperpigmentation; intraocular hypertension; intraocular pressure; iritis; morning dosage; open angle glaucoma; patient compliance; respiratory system; macular edema; side effect; unspecified side effect; urine; visual acuity; travatan

Fixed combination of bimatoprost and timolol in patients with primary open-angle glaucoma or ocular hypertension with inadequate IOP adjustment - Brief, G.; Lammich, T.; Nagel, E.; Pfennigsdorf, S.; Spraul, C.W.; Ho, S. (Clinical Ophthalmology, 2010)
Objective: To assess the efficacy and tolerability of a fixed combination of bimatoprost and timolol (BTFC) in a large patient sample in a clinical setting. Methods: In this multicenter, observational, noncontrolled, open-label study, patients (n = 1862) with primary open-angle glaucoma or ocular hypertension were treated with BTFC. Assessments were made at baseline, six weeks, and three months. Results: Prior to starting BTFC, 92.3% of patients were taking other ocular hypotensive medications. In the overall group at three months, mean intraocular pressure was reduced from baseline (21.7 ± 4.5 mmHg and 21.8 ± 4.9 mmHg for the right and left eye, respectively) to 16.1 ± 3.0 mmHg for each eye (P < 0.0001). The majority of patients (92%) reported no adverse events. The most commonly reported adverse events (in >1% of patients) were eye irritation, and ocular and conjunctival hyperemia. Adherence to treatment was generally better than (35.4%) or the same as (57.5%) with prior therapy. BTFC tolerability was rated as excellent or good by 92.3% of physicians and 85.8% of patients. Conclusions: In a large group of patients with primary open-angle glaucoma or ocular hypertension, treatment with BTFC was associated with consistent reductions in IOP, improved adherence to treatment, and good tolerability. © 2010 Brief et al.
Keywords: beta adrenergic receptor blocking agent; bimatoprost; bimatoprost plus timolol; brimonidine; brimonidine plus timolol; brinzolamide; dorzolamide; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; levobunolol; metipranolol; timolol; timolol maleate; timolol plus travoprost; travoprost; aged; article; child; conjunctival hyperemia; drug dose titration; drug efficacy; drug response; drug tolerability; exploratory research; eye irritation; female; follow up; human; intraocular hypertension; intraocular pressure; major clinical study; male; multicenter study; observational study; open angle glaucoma; open study; patient compliance; preschool child; alphagan; arutimol; azopt; betamann; combigan; cosopt; duo trav; ganfort; lumigan; nyogel; tim ophtal; timohexal; travatan; trusopt; vistagan; xalacom; xalatan

[The six keys of the monitoring of the glaucoma patient]. - Detry-Morel, M. (Bulletin de la Société belge d'ophtalmologie, 2010)
Treatment of glaucoma aims at preserving the visual function and the Quality of Life (QoL) of the patients. To slow down the progression of the disease, the IOP should be decreased to a level where the risk of further deterioration is reduced to a minimum. Rates of progression vary between patients. Detection of glaucoma progression should be based on the assessment of structure and function. When making a treatment plan, one should take into consideration the rate of progression and the impact of visual field deterioration on the QoL. Therefore, a careful and reliable baseline examination is crucial. Furthermore, yearly documentation of the optic disc and frequent examinations of the visual field, especially during the first two years of follow-up, are mandatory to evaluate how aggressive the treatment should be. Slowing down progression of the disease is closely related to a good communication with the patient, the quality of the information provided, and the tolerance of the medications, all keys to a good adherence. Other risk factors than IOP should be looked for and treated if possible, especially when worsening of glaucoma damage is observed despite apparently good IOP control and compliance. Modern monitoring of the glaucoma patient can be summarized in six keys. Current limitations of this approach will be briefly discussed.
Keywords: disease course; doctor patient relationship; follow up; glaucoma; human; intraocular pressure; patient compliance; patient education; perimetry; quality of life; review; risk factor; trabeculectomy

Glaucoma expert patient programme and ocular hypotensive treatment - Amro, R.; Cox, C.L.; Waddington, K.; Siriwardena, D. (British Journal of Nursing, 2010)
Expert patient programmes (EPPs) are becoming an increasingly important aspect of chronic disease management, resulting in improved health outcomes for patients. Patients with chronic open angle glaucoma (COAG) require lifelong therapy. However, to date, no EPPs have been designed specifically for patients with chronic eye conditions like COAG. This article describes the development and implementation of the Glaucoma Expert Patient Programme (GEPP), a glaucoma-specific educational self-management programme which aims to improve glaucoma patients' knowledge, self-management skills, expectations and adherence to treatment. A review of theoretical frameworks and models which underpin the design, use and conduct of EPPs was undertaken, and the GEPP was designed based on the model by Kate Lorig (2003). The result is an educational programme which offers COAG patients a different perspective on their condition and supports them with knowledge, skills and strategies to better manage their condition on a daily basis.
Keywords: article; chronic disease; disease management; educational model; health behavior; human; methodology; motivation; nonbiological model; open angle glaucoma; organization and management; patient compliance; patient education; patient participation; peer group; program development; psychological aspect; self care; self help

Brinzolamide 1/timolol 0.5: Safety and efficacy of a new fixed-combination IOP-lowering product for glaucoma - Januleviciene, I. (Current Medical Research and Opinion, 2010)
Objective: To provide a commentary on recent studies with the new IOP-lowering fixed-combination product brinzolamide 1% 0.5. Methods: Medline was searched for brinzolamide% fixed-combination clinical literature (up to May 18, 2010) and the current comprehensive brinzolamide% literature was reviewed. Results: Compared with another carbonic anhydrase inhibitor-containing product, dorzolamide 2% 0.5, brinzolamide% has similar IOP-lowering efficacy. Brinzolamide% also produces superior comfort ratings as assessed by patients who have tried both drugs this may be explained by the more physiologic pH of brinzolamide%. A recent study reported that brinzolamide% was preferred over dorzolamide% at a ratio of nearly 4:1 among those expressing a preference. Conclusion: These results demonstrate that brinzolamide% is equally effective and more comfortable than dorzolamide%, a fact that may positively impact patient adherence, leading to an increased likelihood of reaching target IOP goals. © 2010 Informa UK Ltd All rights reserved.
Keywords: brinzolamide; brinzolamide plus timolol; dorzolamide plus timolol; timolol; unclassified drug; article; blood pressure; blurred vision; chronic obstructive lung disease; clinical trial; drug choice; drug efficacy; drug safety; dysgeusia; eye discomfort; eye irritation; eye pain; glaucoma; human; intraocular pressure; patient compliance; side effect; sore throat

Intravitreal therapy for neovascular age-related macular degeneration and inter-individual variations in vitreous pharmacokinetics - Laude, A.; Tan, L.E.; Wilson, C.G.; Lascaratos, G.; Elashry, M.; Aslam, T.; Patton, N.; Dhillon, B. (Progress in Retinal and Eye Research, 2010)
This article aims to provide an interpretation and perspective on current concepts and recent literature regarding the evidence for individualizing intravitreal therapy (IVT), particularly considering iatrogenic and patient factors in the management of neovascular age-related macular degeneration (AMD). As ocular parameters that govern IVT pharmacokinetics do vary between individuals with AMD, developing a personalized strategy could improve safety and efficacy. This has to be derived from clinical measurements and data from laboratory animals; however, it is recognized that the animal models used in the development of intraocular formulations differ in their vitreous geometry from humans. These factors may be of relevance to the design of ophthalmic formulations and optimizing treatment outcomes in AMD. Further studies are needed to drive improvements in clinical practice which are aimed at maximizing the efficacy profile in IVT for AMD by a more rigorous evaluation of patient and surgeon-related variables. © 2010 Elsevier Ltd.
Keywords: amikacin; antiglaucoma agent; bevacizumab; carbenicillin; carbonate dehydratase inhibitor; dexamethasone; ganciclovir; gentamicin; pegaptanib; ranibizumab; triamcinolone; vancomycin; vasculotropin inhibitor; aqueous humor flow; blood eye barrier; clinical practice; clinical protocol; clinical trial; diffusion; disease model; dosage schedule comparison; drug absorption; drug binding; drug clearance; drug delivery system; drug distribution; drug dose increase; drug effect; drug efficacy; drug elimination; drug formulation; drug half life; drug penetration; drug safety; drug solubility; experimental animal; geometry; glaucoma; human; injection site; intraocular hypertension; intraocular pressure; iris disease; lens; liquefaction; loading drug dose; methodology; Haplorhini; needle; neovascularization (pathology); neurotoxicity; nonhuman; nuclear magnetic resonance imaging; outcome assessment; patient compliance; prediction; priority journal; Leporidae; age related macular degeneration; retinitis pigmentosa; review; scintigraphy; procedures; toxicity; treatment outcome; treatment planning; viscosity; visual system parameters; vitrectomy; vitreous body; volumetry; avastin

Patient compliance during contact lens wear: Perceptions, awareness, and behavior - Bui, T.H.; Cavanagh, H.D.; Robertson, D.M. (Eye and Contact Lens, 2010)
Objectives: Patient noncompliance with recommended hygienic practices in contact lens wear is often considered a significant risk factor for microbial keratitis and adverse contact lens-related events. Despite advancements in lens materials and care solutions, noncompliant behavior continues to hinder efforts to maximize contact lens safety. The objective of this pilot study was to assess the relationship between perceived and actual compliance with awareness of risk and behavior. Methods: One hundred sixty-two established contact lens wearers were sequentially evaluated after their routine contact lens examination at the Optometry Clinic at the University of Texas Southwestern Medical Center at Dallas, TX. Each patient was questioned by a single trained interviewer regarding his or her lens care practices and knowledge of risk factors associated with lens wear. Results: Eighty-six percent of patients believed they were compliant with lens wear and care practices; 14% identified themselves as noncompliant. Using a scoring model, 32% demonstrated good compliance, 44% exhibited average compliance, and 24% were noncompliant; age was a significant factor (P = 0.020). Only 34% of patients who perceived themselves as compliant exhibited a good level of compliance (P<0.001). Eighty percent of patients reported an awareness of risk factors, but awareness did not influence negative behavior. Replacing the lens case was the only behavior associated with a positive history for having experienced a prior contact lens-related complication (P = 0.002). Conclusions: Perceived compliance is not an indicator for appropriate patient behavior. A large proportion of patients remain noncompliant despite awareness of risk. Education alone is not a sufficient strategy to improve behavior; newer approaches aimed at improving compliance with lens care practices are urgently needed. Copyright © Contact Lens Association of Opthalmologists, Inc.
Keywords: adolescent; adult; aged; article; awareness; contact lens; female; human; hygiene; keratitis; major clinical study; male; patient compliance; priority journal; risk factor

ISPOR 4th Asia-Pacific Conference Research Abstracts (Value in Health, 2010)
The proceedings contain 333 papers. The topics discussed include: a case study evaluating Malaysian community pharmacists' professional practices and services; comparison of costing methods: cost to charge ratio and diagnosis related group using Stevens-Johnson syndrome and toxic epidermal necrolysis as a case study; epidemiology and comorbidities of patients with psoriasis in Taiwan; the economic burdens for patients with psoriasis in Taiwan; burden of disease in patients with glaucoma in china: results from 2009 national health and wellness survey; health resource utilization and costs in patients with age-related macular degeneration in Thailand: preliminary findings; economic evaluation on vision screening for preschool children; and cost-effectiveness of brinzolamide/timolol fixed combination (BTFC) versus dorzolamide/timolol fixed combination (DTFC) for patients with open angle glaucoma in Korea and Taiwan.
Keywords: Asia; human; patient; Taiwan; case study; psoriasis; wellbeing; health care utilization; age related macular degeneration; Thailand; economic evaluation; vision test; preschool child; cost effectiveness analysis; Korea; community; pharmacist; professional practice; open angle glaucoma; Stevens Johnson syndrome; toxic epidermal necrolysis; epidemiology; glaucoma; China; public health; diagnosis related group

Predictive factors of glaucoma treatment cost in Germany - Lorenz, K.; Wolfram, C.; Claus, V.; Plesnila-Frank, C.; Verboven, Y.; Pfeiffer, N. (Value in Health, 2010)
OBJECTIVES: To describe total costs and factors predicting cost in Germany for glaucoma disease states: ocular hypertension (OHT), and early (EARLY), moderate (MOD) and advanced (ADV) glaucoma. METHODS: A 5-year retrospective analysis collected health care utilization, clinical parameters, treatment(s) used and reasons for treatment change. Disease states defined by the European Glaucoma Society were applied. Costs for health care resources were based upon the German EBM/OPS code for ambulatory visits/procedures, diagnosis-related groups for hospital procedures and the Rote Liste for medication. Factors predicting cost were identified using stepwise backward multiple linear regression, entry criterion a = 0.2. RESULTS: A total of 154 patients (27 OHT, 43 EARLY, 35 MOD, 49 ADV) were enrolled from 15 centers across 5 German regions. Average age was 67 ± 11 and 57% were female. Number of years since diagnosis was 9.0 ± 5.7, 8.7 ± 4.6, 8.7 ± 4.1 and 13.2 ± 8.3 years for OHT, EARLY, MOD and ADV, respectively. Total costs, for patients with OHT, EARLY, MOD or ADV, were €226 ± 117, €423 ± 647, €493 ± 385, and €808 ± 877, respectively. Most costs were due to medication (€121 ± 99, €217 ± 150, €245 ± 161, €340 ± 193) and hospital interventions (€32 ± 101, €115 ± 538, €154 ± 285, €367 ± 811). Other costs included consultations (€54, €63, €64, €58) and examinations (€19, €26, €26, €26). Factors predicting high cost (R2 = 0.6426) were the number of hospital interventions, treatment switches, disease state changes, current disease state and issues with ocular burning, stinging or aching affecting daily activities. For glaucoma patients having 0, 1, 2 or ≥3 treatment switches this gave total costs of €273 ± 108, €320 ± 231, €511 ± 462 and €932 ± 950, respectively. Medication costs were €177, €187, €268 and €368, and interventional procedure costs were €0, €50, €166 and €478, respectively. CONCLUSIONS: Glaucoma treatments (medication and interventional procedures) are the key cost drivers in management of glaucoma in Germany. Avoiding treatment switches, disease progression and interventional procedures should have an impact on the cost of glaucoma care.
Keywords: glaucoma; Germany; drug therapy; patient; hospital; human; society; health care; diagnosis; examination; multiple linear regression analysis; female; consultation; disease course; intraocular hypertension; health care utilization; diagnosis related group

Management of COPD in community pharmacy - Mehuys, E.; Boussery, K.; Adriaens, E.; Van Bortel, L.; De Bolle, L.; Van Tongelen, I.; Remon, J.-P.; Brusselle, G. (Farmaceutisch Tijdschrift voor Belgie, 2010)
Background: This observational study aimed to provide a detailed description of (i) drug therapy, (ii) drug adherence, (iii) inhalation technique, and (iv) health status of COPD patients recruited via community pharmacies. Based on these results, problem areas can be detected and targeted pharmacist interventions for improvement of COPD management could be developed. Method: We conducted a cross-sectional, observational study in 93 pharmacies (Belgium). Participants (n=555) completed a questionnaire collecting personal characteristics, smoking history, influenza vaccination, COPD medication and side effects. Adherence to COPD maintenance medication was analysed 1 year-retrospectively through prescription refill rates. Inhalation technique was scored using a checklist. Results: The COPD patients had a mean age of 68.6 yr, 73.7% were men and 37.2% were current smokers. The influenza vaccination status was significantly lower in patients aged <65 yr (65.7%) than in patients aged ≥65 years (86.2%) (p<0.001). Fixed combinations of inhaled corticosteroids and long-acting β2-agonists were the most frequently used COPD medications (75.4%). About 48% of patients was underadherent (<80% adherence), 47% was adherent (80-120% adherence) and 5% was overadherent (>120% adher- ence). Twenty-one % of patients made major inhalation technique errors with rescue medication; these were all errors in handling pressurized metered dose inhalers (pMDI's). Conclusion: This study on COPD management in primary care highlights 4 main aspects which could be improved: (i) drug adherence, (ii) inhalation technique with pMDI's, (iii) influenza vaccination in COPD patients <65 yr and (iv) smoking cessation.
Keywords: beta 2 adrenergic receptor stimulating agent; corticosteroid; aged; angina pectoris; article; cataract; cerebrovascular accident; chronic obstructive lung disease; comorbidity; cross-sectional study; depression; diabetes mellitus; gastroesophageal reflux; glaucoma; health status; heart failure; heart infarction; human; hypertension; influenza vaccination; major clinical study; medication error; metered dose inhaler; myopathy; observational study; osteoporosis; patient compliance; pharmacy (shop); prescription; primary medical care; questionnaire; retrospective study; smoking; smoking cessation

Utilization of services by legally blind patients in Western Australia - Crewe, J.M.; Morgan, W.H.; Morlet, N.; Crowley, M.; Semmens, J.B. (Clinical and Experimental Ophthalmology, 2010)
Keywords: adolescent; adult; aged; analgesia; Australia; blindness; braille; child; diabetic retinopathy; female; glaucoma; health care cost; health care utilization; health service; health survey; human; letter; major clinical study; male; occupational therapy; optic nerve disease; patient transport; pension; preschool child; retina dystrophy; age related macular degeneration; school child; sporting event; trichiasis; vision; visual acuity; visual aid

Continuous 24 h monitoring of changes in intraocular pressure with the wireless contact lens sensor Triggerfish™.First results in patients - Faschinger, C.; Mossböck, G. (Ophthalmologe, 2010)
Background: For many years researchers have been striving for a non-invasive 24 h continuous method of ambulatory intraocular pressure monitoring. A wireless device with a contact lens sensor is now on the market for clinical use, which is not a quantitative measurement of the intraocular pressure but is at least a recording of qualitative changes. These changes of corneal curvature due to changes of the intraocular pressure result in a distinct profile which gives information about fluctuations of the intraocular pressure, the behaviour during supine sleeping time and the 24 h efficacy of glaucoma therapy. We investigated the practicability and tolerability of this device. Method: The sensor is embedded in a soft silicone contact lens and consists of 4 strain gauges. Additionally there is an antenna made out of gold and a microchip. A second antenna is fixed around the eye which sends impulses to the microchip and receives data from the microchip. The data are sent to a recorder via a wire. Measurements are made for 90 s every 8. 5 min resulting in 144 measurements within 24 h. Of the 4 strain gauges 2 sense changes in the corneal curvature due to changes of the intraocular pressure. This device was used in 11 patients with ocular hypertension or glaucoma. Results: The result of the 24 h continuous measurement is a pressure profile which may be flat, fluctuating and with no, some or many spikes. We describe 2 examples of profiles from patients with glaucoma. The changes in the profiles were mostly during the sleeping hours in a supine position. Due to the lack of validation of the results it is not known if intermittent spikes are true spikes or artefacts. Practicability was simple and tolerability was reported to be good by all patients. Conclusions: For the first time a practicable, well tolerated, non-invasive device for continuous 24 h monitoring of changes of the corneal curvature due to changes of the intraocular pressure is available. It is not a direct measurement of the intraocular pressure. The resulting profile gives additional information about the behaviour of the intraocular pressure, especially during out-of-office times and night times. Disadvantages are the high cost of the contact lens sensor and the lack of validation of the results and reproducibility in patients. © 2010 Springer-Verlag.
Keywords: adult; ambulatory monitoring; article; contact lens; devices; equipment design; female; glaucoma; human; devices; intraocular pressure; male; manometry; middle aged; oculoplethysmography; pathophysiology; pilot study; reproducibility; sensitivity and specificity; telemetry; transducer

Use of glaucoma medications: State of the science and directions for observational research - Lu, V.H.; Goldberg, I.; Lu, C.Y. (American Journal of Ophthalmology, 2010)
Purpose: To summarize observational studies that focus on the use of glaucoma medications and to identify gaps in knowledge to guide future investigation. Design: Literature study. Methods: We searched the electronic databases MEDLINE, EMBASE, and PubMed for English language articles published through December 2009 using the search terms physician's practice patterns, drug prescriptions, pharmaceutical services, medication adherence, ophthalmology, glaucoma, and ophthalmic solutions. We categorized studies by areas of focus and extracted and summarized key features: study population, data sources, and main findings. Results: We identified 2224 articles by the search. Fifty-five described glaucoma medication use using large databases. Predominant areas of focus were: trends in prescription choices (n = 13); adherence, persistence, or both (n = 31); rational use of medications (n = 9); and policy-related issues (n = 2). Over the last decade, use of β-blockers and miotics has decreased substantially, whereas new agents, particularly prostaglandin analogs, have become more popular. Nonadherence was an issue in more than 25% of patients. A significant proportion of patients with comorbidities, contraindications, or both had received topical β-blockers. Conclusions: To date, most studies have focused on adherence to glaucoma medications and changes in treatment choices. Major gaps in knowledge include prescribing patterns by prescriber specialty (ophthalmologists, primary care physicians, and optometrists), medication-related problems, and subsequent adverse health outcomes. Well-designed longitudinal observational studies addressing these gaps are warranted to improve patient safety. © 2010 Elsevier Inc. All Rights Reserved.
Keywords: beta adrenergic receptor blocking agent; bimatoprost; brimonidine; carbonate dehydratase inhibitor; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; miotic agent; prostaglandin derivative; travoprost; article; comorbidity; data base; drug contraindication; drug cost; drug substitution; drug withdrawal; electronic medical record; glaucoma; health care policy; human; medical literature; medical research; monotherapy; observational study; patient compliance; prescription; priority journal; treatment duration

Investigation of the effect of glaucoma club on angle-closure glaucoma patients - Shang, Z.; Xiao, H.; Xu, J. (International Journal of Ophthalmology, 2010)
• AIM: To improve the self-nursing ability for patients with angle-closure glaucoma. • METHODS: By means of the form of glaucoma club to achieve this purpose. • RESULTS: Health education of self-nursing could reduce the angle-closure glaucoma onset times, onset level, and the average length of hospitalization. It also could increase treatment compliance, improve therapeutic effects and reduce the damage of visual function, thereby enhancing the life quality. • CONCLUSION: Glucaoma club has a positive impact on treating, preventing and nursing patients with angle-closure glaucoma.
Keywords: article; closed angle glaucoma; human; length of stay; nursing care; nursing education; patient care; patient compliance; quality of life; therapy effect; vision

Efficacy and patient tolerability of travoprost bak-free solution in patients with open-angle glaucoma and ocular hypertension - Mirza, S.K.; Johnson, S.M. (Clinical Ophthalmology, 2010)
The medical treatment of glaucoma has evolved significantly over the past several decades. The main driving forces behind this evolution are the safety profiles and efficacy of these medications. Prostaglandin (PG) analogues are shown to be superior to older drugs in both efficacy and tolerability. Though there are much fewer side effects that manifest after using PG analogues, the adherence and compliance to medication regimens are surprisingly lower than expected. A commonly sited reason is the ocular irritation and inflammation with these medications. Much of this inflammation can be attributed to the preservative, benzalkonium chloride (BAK). The chronic clinical and subclinical inflammation becomes increasingly detrimental when filtration surgery fails from bleb fibrosis secondary to this hypercellularity. A BAK-free formulation of a PG analogues recently became available. BAK-free travoprost is reviewed here. It has demonstrated equal efficacy and less ocular surface toxicity than its preserved counterparts. It is expected to serve as an instrumental resource in managing ocular hypertension and glaucoma in patients who demonstrate significant sensitivity to BAK. More randomized, controlled, double-blind studies are encouraged to evaluate its improved safety and tolerability. © 2010 Mirza and Johnson.
Keywords: alpha adrenergic receptor stimulating agent; antiglaucoma agent; artificial tear; benzalkonium chloride; beta adrenergic receptor blocking agent; bimatoprost; brimonidine; buffer; carbonate dehydratase inhibitor; drug preservative; eye drops; latanoprost; miotic agent; olopatadine; phosphate buffered saline; prostaglandin derivative; prostaglandin F2 alpha; purite; quaternary ammonium derivative; reactive oxygen metabolite; stabilized oxychloro complex; timolol; travoprost; travoprost; tumor necrosis factor; unclassified drug; abnormal sensation; African American; apoptosis; bioaccumulation; burning sensation; Caucasian; cell death; cell viability; chronic inflammation; clinical trial; conjunctival hyperemia; cornea epithelium; cornea thickness; drug contamination; drug cost; drug cytotoxicity; drug efficacy; drug formulation; drug half life; drug mechanism; drug solution; drug tolerability; dry eye; emulsion; eye inflammation; eye irritation; eye stinging; eye stinging; filtering operation; foreign body sensation; foreign body sensation; health care cost; human; hyperemia; inflammation; inflammatory cell; intraocular hypertension; intraocular pressure; microvillus; nonhuman; ocular hyperemia; ocular hyperemia; open angle glaucoma; oxidative stress; patient compliance; prevalence; review; side effect; single drug dose; unspecified side effect; visual acuity; visual analog scale; xerostomia; alphagan; purite; travatan z

Measurement of treatment compliance using a medical device for glaucoma patients associated with intraocular pressure control: A survey - Nordmann, J.-P.; Baudouin, C.; Renard, J.-P.; Denis, P.; Lafuma, A.; Laurendeau, C.; Jeanbat, V.; Berdeaux, G. (Clinical Ophthalmology, 2010)
Objective: To identify and characterize treatment compliance profiles of glaucoma patients and evaluate the association with intraocular pressure (IOP). Methods: A computerized device (Travalert®) that recorded daily instillation times and eye-drop counts was given for 3 months. Patients were declared compliant when at least 2 drops were instilled per day. Compliance rates were calculated for weekdays and weekends, separately, over 8 consecutive weeks. A principal components analysis (PCA) was followed by an ascendant hierarchical classification (AHC) to identify compliance groups. Results: 140 patients were recruited (mean age 65.5 years; 51.8% female) of whom 83.6% had primary open-angle glaucoma with mean IOP 23.9 mmHg before Travalert® use. 60.7% were treated with DuoTrav® (travoprost timolol fixed combination) and 39.3% with travoprost. The PCA identified two axes (compliance and treatment weeks). The AHC identified 3 compliance groups: 'high' (56.6%, approx. 80% compliance), 'medium' (21.2%, approx. 50% compliance), and 'low' (22.1%, approx. 20% compliance). Demographics and glaucoma parameters did not predict low compliance. Final mean IOP was 16.1 mmHg, but higher in the low compliance group (17.7 mmHg, P = 0.02). Conclusions: Compliance measurement by a medical device showed compliance rates <80% by 50% (approx.) of patients, significantly impacting IOP control. No demographic or glaucoma variable was associated with low compliance. © 2010 Nordmann et al.
Keywords: eye drops; timolol plus travoprost; travoprost; age; aged; article; cataract; comorbidity; computer system; computerized bottle holder; diabetic retinopathy; drug dose regimen; drug instillation; female; gender bias; glaucoma surgery; human; intraocular pressure; low level laser therapy; major clinical study; male; medical device; open angle glaucoma; patient compliance; reminder system; retina detachment; risk factor; uveitis; duotrav; travatan; Travalert

Clinical utility and differential effects of prostaglandin analogs in the management of raised intraocular pressure and ocular hypertension - Lee, A.J.; McCluskey, P. (Clinical Ophthalmology, 2010)
Prostaglandin analogs (PGA) are powerful topical ocular hypotensive agents availablefor the treatment of elevated intraocular pressure (IOP). Latanoprost 0.005% and travoprost 0.004%are prodrugs and analogs of prostaglandin F2〈. Bimatoprost 0.03% is regarded as a prostamide,and debate continues as to whether it is a prodrug. The free acids of all 3 PGAs reduce IOP byenhancing uveoscleral and trabecular outflow via direct effects on ciliary muscle relaxation andremodeling of extracellular matrix. The vast majority of clinical trials demonstrate IOP-loweringsuperiority of latanoprost, bimatoprost and travoprost compared with timolol 0.5%, brimonidine0.2%, or dorzolamide 2% monotherapy. Bimatoprost appears to be more efficacious in IOPloweringcompared with latanoprost, with weighted mean difference in IOP reduction documentedin one meta-analysis of 2.59% to 5.60% from 1- to 6-months study duration. PGAs reduce IOPfurther when used as adjunctive therapy. Fixed combinations of latanoprost, bimatoprost or travoprostformulated with timolol 0.5% and administered once daily are superior to monotherapyof its constituent parts. PGA have near absence of systemic side effects, although do have othercommonly encountered ocular adverse effects. The adverse effects of PGA, and also those foundmore frequently with bimatoprost use include ocular hyperemia, eyelash growth, and peri-ocularpigmentary changes. Iris pigmentary change is unique to PGA treatment. Once daily administrationand near absence of systemic side effects enhances tolerance and compliance. PGAs are oftenprescribed as first-line treatment for ocular hypertension and open-angle glaucoma. © 2010 Lee and McCluskey, publisher and licensee Dove Medical Press Ltd.
Keywords: alpha tocopherol; betaxolol; bimatoprost; bimatoprost plus timolol; brimonidine; brinzolamide; dorzolamide; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; pilocarpine; prostaglandin F2 alpha; tafluprost; timolol; timolol plus travoprost; travatanz; travoprost; unclassified drug; unoprostone isopropyl ester; angina pectoris; apnea; aqueous humor flow; area under the curve; arthralgia; article; asthma; backache; bronchospasm; cataract; clinical trial; congestive heart failure; conjunctival hyperemia; conjunctivitis; cornea erosion; cyst; dermatitis; dosage schedule comparison; drug efficacy; drug elimination; drug eruption; drug excretion; drug induced headache; drug metabolism; drug storage; drug tolerability; drug withdrawal; dyspnea; evening dosage; extracellular matrix; eye blood flow; eye discomfort; eye disease; eye inflammation; eye irritation; face edema; forced expiratory volume; heart arrhythmia; herpes simplex keratitis; human; hypertension; hypertrichosis; intraocular hypertension; iridocyclitis; iris cyst; iris cyst; iris disease; iris hyperpigmentation; iris hyperpigmentation; iritis; maximum plasma concentration; migraine; morning dosage; myalgia; nonhuman; ocular pruritus; ocular stinging; ocular stinging; open angle glaucoma; patient compliance; patient satisfaction; periocular skin discoloration; periocular skin discoloration; peripheral edema; pharmacodynamics; plasma half life; quality of life; recommended drug dose; respiratory tract disease; retina macula cystoid edema; macular degeneration; macular edema; rhinopharyngitis; side effect; skin allergy; skin discoloration; tachycardia; thorax pain; unspecified side effect; upper respiratory tract infection; uveitis

Topiramate in the new generation of drugs: efficacy in the treatment of alcoholic patients - Johnson, B.A.; Ait-Daoud, N. (Current Pharmaceutical Design, 2010)
Predicated upon a neuropharmacological conceptual model, there is now solid clinical evidence to support the efficacy of topiramate for the treatment of alcohol dependence. Topiramate treatment can be initiated whilst the alcohol-dependent individual is still drinking - just when crisis intervention is most likely to be needed by a patient with or without his or her family asking the health practitioner for assistance. Because topiramate can be paired with a brief intervention, there is now the exciting possibility of treating most alcohol- dependent individuals in office-based practice or generic treatment settings. Topiramate's additional effects on other impulsedyscontrol disorders make it a particularly interesting compound for the treatment of other comorbid drug or psychiatric disorders. Additionally, future studies should explore whether topiramate can be combined with other putative therapeutic agents to increase its efficacy. One notable clinical challenge in the development of topiramate as a pharmacotherapy to treat alcohol dependence is the determination of the smallest dose that can result in efficacy, thereby achieving the optimum balance between therapeutic benefit and adverse event profile. Animal data do provide support for topiramate's general anti-drinking effects but also indicate that its mechanisms of action might rely on several complex pharmacobehavioral changes. Additional preclinical studies are needed to elucidate more clearly the basic mechanistic processes that underlie topiramate's efficacy as a treatment for alcohol dependence. Preclinical information that topiramate may have differential effects based on genetic vulnerability opens up the possibility of future methods to optimize treatment. © 2010 Bentham Science Publishers Ltd.
Keywords: acamprosate; acetazolamide; alcohol; amitriptyline; barbituric acid derivative; benzodiazepine derivative; carbamazepine; digoxin; disulfiram; haloperidol; lamotrigine; lithium; metformin; naltrexone; opiate derivative; oral contraceptive agent; phenytoin; placebo; progesterone; risperidone; topiramate; tramadol; valproic acid; add on therapy; alcohol consumption; alcohol withdrawal syndrome; alcoholism; anorexia; anticonvulsant activity; article; attention disturbance; blood level; cholelithiasis; clinical trial; closed angle glaucoma; cognitive defect; comorbidity; concentration loss; controlled clinical trial; convulsion; crisis intervention; diabetes mellitus; diarrhea; dizziness; drug bioavailability; drug clearance; drug dose increase; drug dose reduction; drug efficacy; drug excretion; drug half life; drug induced headache; drug mechanism; drug megadose; drug metabolism; drug safety; drug tolerability; drug withdrawal; dyspepsia; epilepsy; fatigue; flu like syndrome; human; hyperthermia; impulse control disorder; injury; insomnia; Lennox Gastaut syndrome; memory disorder; metabolic acidosis; migraine; myalgia; myopia; nausea; nephrolithiasis; nervousness; neuroprotection; nonhuman; obesity; paresthesia; patient compliance; patient satisfaction; posttraumatic stress disorder; priority journal; pruritus; psychomotor retardation; quality of life; randomized controlled trial; relapse; side effect; sinusitis; somnolence; sweating; faintness; taste aversion; tonic clonic seizure; treatment outcome; body weight loss

The views of compliant glaucoma patients on counselling and social support - Lunnela, J.; Kääriäinen, M.; Kyngäs, H. (Scandinavian Journal of Caring Sciences, 2010)
The purpose of this study was to describe the views of compliant glaucoma patients with good compliance on patient education and social support they received during their illness. The aim was to gain knowledge for developing patient compliance by means of promoting education and support methods. Twelve glaucoma patients with good compliance were interviewed, and the transcripts based on those interviews were analysed using content analysis. In the data, the participants described education and social support they had received from healthcare personnel, relatives and partly from their peers. Patient education emerged as the content, timing and methods of education. Social support emerged as emotional, informational and instrumental support, lack of support as well as patients' activity. Consequently, patients need education and support from healthcare personnel as well as from their relatives to cope with glaucoma. The need for education and support is individual but the most important time for education and support is at the initial stages of the illness. The need for education and support is also evident when the patient's treatment is changed or an operative procedure is performed. To conclude, the individual, patient-centred and properly timed education and support is a huge challenge for healthcare personnel because of the decrease in individual time for each patient. Therefore, new and timesaving methods of education and support should be developed. © 2010 The Authors. Journal compilation © 2010 Nordic College of Caring Science.
Keywords: adaptive behavior; article; counseling; glaucoma; human; patient compliance; patient education; psychological aspect; social support

Bilateral acute angle-closure glaucoma as a complication of facedown spine surgery - Singer, M.S.; Salim, S. (Spine Journal, 2010)
BACKGROUND CONTEXT: Multiple studies have reported that facedown positioning can result in elevation of intraocular pressure (IOP) in individuals susceptible to angle-closure glaucoma. Before advances in diagnostic modalities, prone tests were popularly performed in ophthalmology practices as provocative tests for detecting potentially occludable angles. In patients with a positive test result, direct observation shows that the anterior chamber shallows and the angle closes over time, compromising aqueous humor outflow facility. Furthermore, the degree of angle narrowing is proportional to the rise in IOP. A common scenario involving a prone position is spine surgery, which can last several hours with the patient unconscious. PURPOSE: To report a case of a patient who developed bilateral acute angle-closure glaucoma after facedown spine surgery. STUDY DESIGN: Case report and literature review. METHODS: A 68-year-old Caucasian woman presented with persistent low back and left lower extremity pain. History was remarkable for L5 radicular pain, spinal stenosis, and an L3-L4 laminectomy performed 6 months previously. Plain films showed instability at the L4-L5 level and degenerative disc disease and scoliosis at L2-L4. The patient underwent spinal fusion surgery. RESULTS: Postoperatively, the patient complained of pain in the left eye accompanied with nausea and vomiting. Ophthalmology consultation confirmed the diagnosis of bilateral acute angle-closure glaucoma, requiring medical therapy initially followed by laser iridotomies in both eyes. CONCLUSIONS: Bilateral acute angle-closure glaucoma may occur as a complication of facedown spine surgery. It is essential for anesthesiologists and surgeons to be aware of this complication for accurate diagnosis and timely intervention. A preoperative evaluation by an ophthalmologist should be considered for those individuals who are at increased risk of developing angle-closure glaucoma, such as certain ethnicities, including Asians, Canadians, and Eskimos; female gender; hyperopic eyes with a shorter axial length; family history; history of previous attacks in the subject; and so forth. Prophylactic laser iridotomy in eyes with potentially occludable angles is a simple and safe office procedure that can prevent potentially devastating visual outcomes. © 2010 Elsevier Inc. All rights reserved.
Keywords: steroid; aged; article; case report; Caucasian; closed angle glaucoma; consultation; eye pain; facedown spine surgery; female; history; human; intervertebral disk degeneration; iridotomy; laminectomy; leg pain; low back pain; medical literature; nausea and vomiting; ophthalmology; patient compliance; postoperative period; priority journal; radicular pain; scoliosis; spine fusion; spine instability; spine surgery; vertebral canal stenosis

Effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy for glaucoma - Cho, S.W.; Kim, J.M.; Park, K.H.; Choi, C.Y. (Japanese Journal of Ophthalmology, 2010)
Purpose: To evaluate the effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy in the treatment of patients with glaucoma. Methods: To measure the main treatment effects of a fixed combination of brimonidine 0.2%-timolol 0.5%, we conducted three small studies: (1) a comparison of diurnal intraocular pressure (IOP) at baseline and at 6 months after brimonidine/timolol fixed-combination therapy (n = 81); (2) an assessment of the effects of one drop of the brimonidine/timolol fixed combination on diurnal IOP (n = 25); and (3) the effects of brimonidine/timolol fixed-combination therapy on the anterior ocular segment over time (n = 64). Results: (1) After 6 months of treatment with the brimonidine/timolol fixed combination, the mean diurnal IOP in primary open-angle glaucoma (POAG) decreased from 21.4 ± 2.0 to 14.5 ± 3.1 mmHg (32.2%, P < 0.001), and the mean diurnal IOP in normal-tension glaucoma (NTG) decreased from 13.5 ± 2.8 to 10.9 ± 2.0 mmHg (19.3%, P < 0.001). (2) After instillation with one drop of the brimonidine/timolol fixed combination, the IOP in the instilled eye was lowest at 9:00 p.m. and had decreased by 1.7 mmHg compared with the baseline IOP in the instilled eye. The difference in IOP between the instilled eye and untreated fellow eye was largest at 3:00 p.m., measuring 1.7 mmHg (P = 0.011). (3) Brimonidine/timolol fixed-combination therapy caused significant miosis over time (P = 0.003). Conclusions: The results of this study suggest that brimonidine/timolol fixed-combination therapy has beneficial IOP-lowering effects and significant effects on pupil size. © 2010 Japanese Ophthalmological Society (JOS).
Keywords: brimonidine plus timolol; adult; allergic conjunctivitis; anterior eye segment; article; burning sensation; circadian rhythm; controlled study; drug efficacy; drug safety; drug therapy; drug withdrawal; female; fixed combination therapy; glaucoma; human; intraocular pressure; major clinical study; male; miosis; outcome assessment; patient compliance; priority journal; somnolence; treatment response

Towards integrated care: Australia's new model of care for patients with glaucoma - Lu, C.Y.; Lu, V.H.; Goldberg, I.; Day, R.O. (Medical Journal of Australia, 2010)
Keywords: cardiovascular risk; clinical decision making; editorial; eye care; glaucoma; health care access; health care delivery; health care quality; human; medical expert; patient care planning; patient monitoring; pharmacist; polypharmacy; practice guideline; prescription; responsibility

Controlled transscleral drug delivery formulations to the eye: Establishing new concepts and paradigms in ocular anti-inflammatory therapeutics and antibacterial prophylaxis - Paganelli, F.; Cardillo, J.A.; Dare, A.R.J.; Melo Jr., L.A.S.; Lucena, D.R.; Silva Jr, A.A.; Oliveira, A.G.; Pizzolitto, A.C.; Lavinsky, D.; Skaf, M.; Souza-Filho, A.A.; Hfling-Lima, A.L.; et al. (Expert Opinion on Drug Delivery, 2010)
Importance of the field: The use of topical agents poses unique and challenging hurdles for drug delivery. Topical steroids effectively control ocular inflammation, but are associated with the well-recognized dilemma of patient compliance. Although administration of topical antimicrobials as prophylaxis is acceptable among ophthalmologists, this common practice has no sound evidence base. Developing a new antimicrobial agent or delivery strategy with enhanced penetration by considering the anatomical and physiological constraints exerted by the barriers of the eye is not a commonly perceived strategy. Exploiting the permeability of the sclera, subconjunctival routes may offer a promising alternative for enhanced drug delivery and tissue targeting. Area covered in this review: Ocular drug delivery strategies were reviewed for ocular inflammation and infections clinically adopted for newer class of antimicrobials, which use a multipronged approach to limit risks of endophthalmitis. What the reader will gain: The analysis substantiates a new transscleral drug delivery therapeutic approach for cataract surgery. Take home message: A new anti-inflammatory and anti-infective paradigm that frees the patient from the nuisance of topical therapeutics is introduced, opening a large investigative avenue for future improved therapies. © 2010 Informa UK Ltd.
Keywords: antiinfective agent; antiinflammatory agent; budesonide; ciprofloxacin; corticosteroid; dexamethasone; gatifloxacin; levofloxacin; moxifloxacin; nanoparticle; dexamethasone; quinolone derivative; steroid; triamcinolone; unclassified drug; antibiotic prophylaxis; aqueous humor; cataract extraction; controlled release formulation; drug delivery system; drug penetration; endophthalmitis; eye infection; eye inflammation; human; infection prevention; intraocular hypertension; patient compliance; postoperative infection; postoperative inflammation; postoperative period; prophylaxis; retina; retina surgery; review; sclera; Staphylococcus epidermidis; sustained drug release; transscleral controlled drug delivery; vitreous body; ozurdex

Patient-centred persistence - Rigby, D. (Australian Journal of Pharmacy, 2010)
Poor compliance and failure to persist with chronic long-term medications may substantially reduce their potential clinical benefits. Adherence and persistence to medication regimens is an important challenge for pharmacists to address during HMRs and both issues must be discussed. Improved communication skills, particularly for history taking, can elicit patient preferences more effectively, which can then be incorporated into decision making. Improved communication between patients, prescribers and pharmacists should lead to improved adherence and persistence to long-term therapies.
Keywords: angiotensin receptor antagonist; bisphosphonic acid derivative; corticosteroid derivative; dipeptidyl carboxypeptidase inhibitor; diuretic agent; asthma; chronic obstructive lung disease; decision making; drug efficacy; drug tolerability; glaucoma; health care cost; health care personnel; hospitalization; human; hypertension; osteoporosis; patient attitude; patient compliance; prescription; review; treatment failure; visual impairment

Programs to optimize adherence in glaucoma - Kowing, D.; Messer, D.; Slagle, S.; Wasik, A. (Optometry, 2010)
Purpose: This study was designed to raise awareness of the materials, devices, and Internet resources available to improve adherence to use of medications for the treatment of glaucoma and to review new devices under development. Methods: A review of current indexed literature and Internet resources was conducted. Results: A variety of educational brochures, pamphlets, and fact sheets promoting adherence to ocular hypotensive medications are available through multiple organizations and are easily accessed and ordered on the Internet. Video and Web-based patient educational tools have been designed to support patient adherence to glaucoma management plans and promote open dialogue between patients and providers. Reminder and recall systems that integrate with office software can be sent to cell phones as well as e-mails and personal digital assistant (PDAs), alerting patients to upcoming appointments and reminding them to instill their drops. Bottle devices with dosing support (timers with audible and visual signals and dispensing aids) and electronic monitoring have been shown to promote adherence. New products currently under development to improve the delivery of medications include nanoparticles, punctal plugs, and contact lenses that release glaucoma medications. Conclusions: Many educational materials, services, Internet resources, and devices are available to optometrists to encourage patient adherence to glaucoma treatment and management.
Keywords: eye drops; article; drug delivery system; equipment design; glaucoma; human; devices; Internet; methodology; optometry; patient compliance; patient education; reminder system; videorecording

Attitude influences adherence to anti-glaucoma drugs (Australian Journal of Pharmacy, 2010)
Keywords: antiglaucoma agent; blindness; disease severity; doctor patient relationship; glaucoma; human; interview; patient attitude; patient compliance; quality of life; short survey

Hypotensive medication, statins, and the risk of glaucoma - Owen, C.G.; Carey, I.M.; Shah, S.; de Wilde, S.; Wormald, R.; Whincup, P.H.; Cook, D.G. (Investigative Ophthalmology and Visual Science, 2010)
Purpose. To examine whether treatment with oral blood-pressure-lowering medication or statins influences the risk of glaucoma. Methods. This study was a case- control investigation, nested within a computerized primary care database of 177 general practices across the United Kingdom; 8778 cases diagnosed and/or treated for glaucoma between 2000 and 2007, and 8778 glaucoma-free controls matched for age, sex, and practice. Odds ratios for treatment with oral antihypertensives (including selective β1 and nonselective β-blockers) and statins in the 5 years before diagnosis were calculated by logistic regression, adjusted for a marker of socioeconomic position and number of drug types prescribed (as a measure of health service usage). Results. Prevalence of oral β-blocker use in the 5 years before diagnosis was lower in the cases (22.5%) than in the controls (23.6%), adjusted odds ratio (OR) 0.87 (95% confidence interval [CI], 0.80-0.94). This effect was presence with treatment with β1-selective medications (OR, 0.81; 95% CI, 0.74-0.88) but not with nonselective medications (OR, 1.08; 95% CI, 0.94-1.24). The prevalence of thiazide use was higher among the glaucoma cases than among the controls (OR, 1.13; 95% CI, 1.04-1.23). Neither statins nor other antihypertensive treatments were associated with the risk of glaucoma. Conclusions. Oral β1 β-blockers may protect against development of glaucoma. The current consensus on the relative importance of β2 receptor blockade in treating glaucoma may have to be reviewed. Changes in prescribing oral β-blockers for cardiovascular disorders may affect the number of those who eventually have glaucoma. There is no evidence to suggest that statins have a preventive role in glaucoma. © Association for Research in Vision and Ophthalmology.
Keywords: antihypertensive agent; beta 1 adrenergic receptor blocking agent; beta adrenergic receptor blocking agent; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; diuretic agent; hydroxymethylglutaryl coenzyme A reductase inhibitor; thiazide diuretic agent; adult; article; beta adrenergic receptor blocking; cardiovascular disease; case control study; consensus; controlled study; data base; drug use; female; general practice; glaucoma; health care utilization; human; logistic regression analysis; major clinical study; male; prescription; primary medical care; priority journal; protection; risk assessment; social status; United Kingdom

Impact of once daily versus twice daily application of adjunctive timolol on the intraocular pressure-lowering effect of latanoprost - Nowroozzadeh, M.H. (Ophthalmic Research, 2010)
Keywords: latanoprost; timolol; dosage schedule comparison; drug mechanism; evening dosage; flow rate; glaucoma; human; intraocular pressure; letter; nonhuman; patient compliance; permeability; priority journal; vasoconstriction; vasodilatation

Compliance, concordance, adherence ... - Urquhart, J.; Demonceau, J.; Vrijens, B. (Therapeutische Umschau, 2010)
Ambulatory pharmacotherapy is marked by many deviations, mostly downward, in drug dosing from prescribed instructions. Soundly compiled dosing histories date from 1977, based on electronic time-stamping of medication 'events': package entry times, done first with eyedrop dispensers for glaucoma drugs. Electronically monitored packages for oral dosage forms date from 1988. Since then, expanding data have brought many surprises, as evidence has replaced eminence in clinical views regarding discrepancies between prescription and reality. Key features of electronic monitoring are: automaticity of time-stamping, inviolable data, and high rates of data-sampling (60/hr vs 2-12/yr with older methods), revealing time-of-day, day-of-week, and white coat effects that facilitate medication management, opening new ways to improve care. © 2010 by Verlag Hans Huber, Hogrefe AG, Bern.
Keywords: drug packaging; glaucoma; health care; human; patient compliance; patient monitoring; prescription; short survey

Clinical investigation of medication adherence of glaucoma patients - Wu, H.-Y.; Yin, J.-F. (Chinese Journal of Ophthalmology, 2010)
Objective To investigate the medication adherence and modulation factors of medication adherence in long-term treated glaucoma patients. Methods It was a cross-sectional study. One hundred glaucoma patients who have been followed-up for more than 6 month in the Second Hospital affiliated to Medical College of Zhejiang University were investigated with questionnaires and interview. The data was analyzed by binary logistic regression and χ2 test. Results In the 100 glaucoma patients being ivestigated, the medication compliance of patients is 61 (61.0%) , the medication non-compliance of patients is 39 (39.0%). Age, gender, habitat, glaucoma types, surgical history, inquesting patient before writing out a prescription and informing them the methods for application of eyedrops were not significantly co-related with medication adherence ( χ2 = 0.718, 0.537, 0.338, 3.797, 0.338, 0.297, 0.157 ; P > 0.05 ) . Intraocular pressure before treatment, types of eyedrops, instillation of eye-drops to the eyelids, request for help during application of eyedrops, rechecking regularly and confidence in glaucoma treatment were found significantly related to medication adherence ( P = 0.013, 0.005, 0.005, 0.012, 0.011, 0.004). However, drug side effect, forgetting application of eyedrops and inconvenience to see a doctor was considered the most important factors by patients in the interview. Conclusions Glaucoma physicians should discuss with patients about the methods for the application of glaucoma medication. This can improve the medication adherence of glaucoma patients and promote the therapeutic effect.
Keywords: adolescent; adult; aged; article; child; cross-sectional study; female; glaucoma; human; male; middle aged; patient compliance; psychological aspect; questionnaire

Scoring and psychometric properties of the Eye-Drop Satisfaction Questionnaire (EDSQ), an instrument to assess satisfaction and compliance with glaucoma treatment. - Regnault, A.; Viala-Danten, M.; Gilet, H.; Berdeaux, G. (BMC ophthalmology, 2010)
BACKGROUND: The objective of this study was to ascertain the scoring and assess the psychometric properties of the Eye-Drop Satisfaction Questionnaire (EDSQ), a 43-item Patient-Reported Outcome instrument developed to assess patients' satisfaction and compliance with glaucoma treatment. METHODS: The EDSQ was administered during an observational, retrospective study to 184 French patients treated for glaucoma. The hypothesized structure, including six dimensions (patient-clinician relationship; patient experience; patient-treatment interaction; apprehension; patient knowledge; travel), was tested by assessing the internal consistency reliability (Cronbach's alpha) and construct-related validity (item convergent and discriminant validity). As unsatisfactory results were demonstrated, another structure was defined using a principal component analysis (PCA) combined with content of items. Psychometric properties of this new structure were assessed. Scores were compared between low, moderate and high compliance profile groups defined using data collected with the Travalert electronic device. RESULTS: Analyses were performed with the 169 patients who completed at least half of the EDSQ items. The hypothesized structure showed a Cronbach's alpha lower than 0.70 for four dimensions out of six and an overall poor construct-related validity (range of item-scale correlations: 0.00-0.68). The new structure obtained with the PCA included six dimensions: concern about treatment (five items); concern about disease (two items); satisfaction with patient-clinician relationship (five items); positive beliefs (three items); treatment convenience (three items); and self-declared compliance (three items). A score ranging from 0 to 100 was calculated for each dimension, with higher scores indicating more of the attribute referred to in the dimension. Internal consistency reliability was good (Cronbach's alpha greater than 0.70 for five dimensions). The structure offered good construct-related validity (range of item-scale correlations: 0.36-0.82). Ceiling effects of 21% and 49%, were observed for the satisfaction with patient-clinician relationship and self-declared compliance scores. Patients in low compliance profile group reported the lowest score for the satisfaction with patient-clinician relationship, positive beliefs, treatment convenience and self-declared compliance dimensions, and the highest score for the concern about treatment dimension. CONCLUSIONS: The scoring of the EDSQ was developed and the questionnaire proved to have satisfactory psychometric properties. EDSQ scores showed a promising relationship to compliance profiles. The EDSQ could be used in future studies.
Keywords: eye drops; adolescent; adult; aged; article; clinical trial; cross-sectional study; doctor patient relationship; drug delivery system; female; human; devices; male; methodology; middle aged; multicenter study; open angle glaucoma; patient compliance; patient satisfaction; principal component analysis; psychometry; questionnaire; reproducibility; retrospective study; statistics

Persistence on prostaglandin ocular hypotensive therapy: an assessment using medication possession and days covered on therapy. - Reardon, G.; Schwartz, G.F.; Kotak, S. (BMC ophthalmology, 2010)
BACKGROUND: Prior research has demonstrated that medication persistence (continued acquisition of therapy over time) is far from optimal among patients with glaucoma. The purpose of the present study was to evaluate persistence with prostaglandin analogs among glaucoma patients in the first therapy year using a modification of a previously published technique. METHODS: This retrospective analysis of medical and pharmacy claims database included treatment-naive patients dispensed bimatoprost, latanoprost, or travoprost between 1/1/04-12/31/04. "Index agent" was defined as the first agent filled; "index date" was defined as the fill date. Follow-up continued for 358 days. Persistence measures for first therapy year were: (1) whether last fill had sufficient days supply to achieve medication possession at year's end, and (2) number of days for which the index agent was available (days covered). Associations between index agent and medication possession (logistic regression) and days covered (linear regression) were evaluated. Models were adjusted for gender, age, and previous ocular hypertension diagnosis. RESULTS: 7873 patients met inclusion criteria (bimatoprost, n = 1464; latanoprost, n = 4994; travoprost, n = 1415). Medication possession was 28% and days covered was 131 when using the unadjusted (pharmacy-reported) days supply estimates and rose to 47-48% and days covered to 228-236 days when days supply was imputed. Compared to latanoprost, odds of achieving medication possession at first year's end were 26-34% lower for bimatoprost and 34-36% lower for travoprost (p <or= 0.001 for all comparisons). Days covered in the first year were 21-29 days lower for bimatoprost and 33-42 days lower for travoprost (p <or= 0.001 for all comparisons). Failure to refill the index agent within the initial 90 days was a strong predictor of poor persistence. CONCLUSIONS: Persistence with ocular prostaglandin therapy remains a problem. Latanoprost users had greater odds of achieving medication possession and had more days covered during the first therapy year.
Keywords: amide; bimatoprost; cloprostenol; drug derivative; latanoprost; prostaglandin derivative; prostaglandin F; travoprost; adult; aged; article; comparative study; drug administration; factual database; female; follow up; glaucoma; human; male; middle aged; patient compliance; retrospective study; statistical model

How New Zealand has contained expenditure on drugs - Cumming, J.; Mays, N.; Daubé, J. (BMJ (Online), 2010)
Keywords: atypical antipsychotic agent; beta interferon; cilazapril; cyclosporine; fluindostatin; fluoxetine; hydroxymethylglutaryl coenzyme A reductase inhibitor; influenza vaccine; morphine; paracetamol; quinapril; simvastatin; tacrolimus; trastuzumab; article; breast cancer; cost effectiveness analysis; drug cost; drug industry; epilepsy; glaucoma; health care access; health care cost; health care management; health care system; health service; human; multiple sclerosis; New Zealand; priority journal; schizophrenia; herceptin

Clinical utility of voriconazole eye drops in ophthalmic fungal keratitis - Al-Badriyeh, D.; Neoh, C.F.; Stewart, K.; Kong, D.C.M. (Clinical Ophthalmology, 2010)
Fungal keratitis is one of the major causes of ophthalmic mycosis and is difficult to treat. The range of common antifungal agents available for fungal keratitis remains inadequate and is generally associated with poor clinical outcomes. Voriconazole is a new generation triazole antifungal agent. Only marketed in systemic formulation and, with broad-spectrum activity and high intraocular penetration, voriconazole has demonstrated effectiveness against fungal keratitis. Systemic voriconazole, however, is not without side effects and is costly. Voriconazole eye drops have been prepared extemporaneously and used for the treatment of ophthalmic fungal keratitis. The current article sought to review the literature for evidence related to the effectiveness and safety of topical voriconazole and its corneal penetration into the aqueous humor of the eye. The voriconazole eye drops used are typically of 1% concentration, well tolerated by the eye, and are stable. Despite existing evidence to suggest that the eye drops are effective in the treatment of fungal keratitis, more studies are needed, especially in relation to using the eye drops as first-line and stand-alone treatment, preparation of higher concentrations, and optimal dosing frequency. © 2010 Al-Badriyeh et al, publisher and licensee Dove Medical Press Ltd.
Keywords: allylamine derivative; amphotericin B; antifungal agent; beta cyclodextrin derivative; caspofungin; echinocandin; eye drops; fluconazole; immunosuppressive agent; itraconazole; ketoconazole; miconazole; natamycin; nystatin; polyene; posaconazole; pyrrole derivative; steroid; terbinafine; voriconazole; alopecia; aqueous humor; clinical feature; clinical trial; disease predisposition; drug absorption; drug bioavailability; drug blood level; drug cost; drug delivery system; drug distribution; drug efficacy; drug megadose; drug metabolism; drug penetration; drug protein binding; drug safety; drug stability; drug substitution; drug tissue level; drug tolerability; drug withdrawal; eye toxicity; fungal strain; gastrointestinal toxicity; gynecomastia; human; impotence; incidence; keratomycosis; liver toxicity; low drug dose; minimum inhibitory concentration; nephrotoxicity; nonhuman; optimal drug dose; patient compliance; review; risk factor; vfend

Vision impairment and eye care utilization among Americans 50 and Older - Mcgwin, G.; Khoury, R.; Cross, J.; Owsley, C. (Current Eye Research, 2010)
Purpose: Few studies have provided population-based estimates of the vision impairment, eye disease and eye care in the United States. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) this study reports the overall and age-race-specific prevalence of self-reported vision impairment, eye diseases, and eye care utilization among older adults. Methods: Between 2005 and 2008 residents aged 50 and older in 17 states responded to BRFSS questions concerning difficulty with distance and near vision-related tasks, self-reported eye diseases and reported eye care insurance and service utilization. Results: The overall prevalence of difficulty with distance and near vision was 16.6 and 32.8%, respectively with no meaningful change with increasing age. The prevalence of cataract, glaucoma, and macular degeneration was 19.6%, 6.4, and 5.8%; all of which increased dramatically with age. Nearly 69% of Whites and Blacks and 65% of Hispanics visited an eye care provider in the past year. Overall, among the approximately one-third of participants who did not visit an eye care provider in the past year, half indicated that they did not have any reason to go and 20% cited it was due to cost/insurance. Conclusion: The continued and expanding use of the BRFSS Visual Impairment and Access to Eye Care module represents a unique opportunity to obtain population-based estimates of vision impairment, eye disease and perhaps most uniquely, eye care utilization. Moreover, the integration of this and other BRFSS modules will provide researchers the opportunity to evaluate the relationship between these estimates and other measures of health status and health care utilization. However, the self-reported nature of the BRFSS data is an important limitation that must be considered when interpreting the results. © 2010 Informa Healthcare USA, Inc.
Keywords: adult; age distribution; article; behavioral risk factor surveillance system; cataract; Caucasian; controlled study; cost of illness; distance perception; eye care; female; glaucoma; health care utilization; health insurance; health survey; Hispanic; human; major clinical study; male; Black person; population research; prevalence; priority journal; race; macular degeneration; self report; task performance; United States; vision; visual impairment

Impact of glaucoma medication on ocular tissue - Valente, C.; Iester, M. (Expert Review of Ophthalmology, 2010)
Open-angle glaucoma and ocular hypertension require chronic topical treatment whose active ingredients can have some local side effects. Furthermore, different preservatives are present in the bottles to avoid contamination by common pathogens. Among all the preservatives, benzalkonium chloride is the most common and its toxic effects on the ocular tissue are well known. The purpose of this article is to investigate the ocular effects of glaucoma medication on ocular tissue, and in particular the ocular changes caused by preserved antiglaucoma drugs. Moreover, the shift from preservative-containing to preservative-free drugs, or the use of alternative preservatives with a lighter toxicity could be useful to decrease the negative impact of glaucoma medications on ocular tissues and to improve the patients compliance. The outcome of filtering surgery could change on the basis of a previous topical therapy. © 2010 Expert Reviews Ltd.
Keywords: epinephrine; adrenergic receptor stimulating agent; alpha adrenergic receptor stimulating agent; antiglaucoma agent; apraclonidine; artificial tear; befunolol; benzalkonium chloride; benzododecinium; beta adrenergic receptor blocking agent; betaxolol; bimatoprost; brimonidine; brimonidine plus timolol; carbonate dehydratase inhibitor; cholinergic receptor stimulating agent; corticosteroid; dorzolamide; dorzolamide plus timolol; fluorometholone; indometacin; latanoprost; miotic agent; preservative; prostaglandin derivative; purite; refresh tears; sofzia; tafluprost; timolol maleate; travoprost; unclassified drug; allergic conjunctivitis; allergic reaction; blurred vision; burning sensation; cataract; conjunctiva disease; conjunctiva epithelium; conjunctival hyperemia; conjunctivitis; contact dermatitis; cornea injury; drug half life; drug mechanism; drug withdrawal; dry eye; eye discomfort; filtering operation; foreign body reaction; glaucoma; herpes simplex keratitis; human; intraocular hypertension; iridocyclitis; keratopathy; lacrimation; miosis; mydriasis; nonhuman; ocular pruritus; open angle glaucoma; patient compliance; pigment epithelium; punctate keratitis; retina detachment; retina disease; retina macula cystoid edema; macular edema; review; risk reduction; side effect; tear film; trabeculectomy; treatment duration; visual acuity; visual impairment; purite; refresh tears; sofzia; travatan z

Considerations in glaucoma therapy: Fixed combinations versus their component medications - Higginbotham, E.J. (Clinical Ophthalmology, 2010)
Fixed combinations of medications that lower intraocular pressure (IOP) are increasingly used in the treatment of glaucoma and ocular hypertension and offer several potential advantages over combined use of the separate component medications including enhanced convenience, improved adherence, reduced exposure to preservatives, and possible cost savings. This review aims to examine the current role of IOP-lowering fixed combinations in disease management. The results of studies that compared the efficacy and safety of IOP-lowering fixed combinations with their component medications are summarized, including those fixed combinations that consist of a prostaglandin analog and timolol. The fixed combinations currently available for use in the United States are fixed-combination dorzolamide/timolol (FCDT) and fixed-combination brimonidine/timolol (FCBT). Both of these fixed combinations reduce IOP more effectively than their component medications used separately as monotherapy. FCBT therapy also demonstrates a more favorable safety profile and reduced ocular allergy compared to monotherapy with brimonidine, a component medication. Few studies have directly compared the efficacy and safety of FCDT and FCBT, but available evidence suggests that FCBT is at least as effective as FCDT in lowering IOP and is more comfortable and better tolerated. Additional studies are needed to further evaluate the comparative efficacy and tolerability of FCDT and FCBT in the management of glaucoma and ocular hypertension. © 2010 Higginbotham, publisher and licensee Dove Medical Press Ltd.
Keywords: bimatoprost; bimatoprost plus timolol; brimonidine; brimonidine plus timolol; dorzolamide; dorzolamide plus timolol; latanoprost; latanoprost plus timolol; pilocarpine; timolol; timolol plus travoprost; travoprost; allergic conjunctivitis; blurred vision; clinical trial; comparative study; conjunctival hyperemia; conjunctivitis; dosage schedule comparison; dose response; drug approval; drug efficacy; drug safety; drug substitution; drug tolerability; drug withdrawal; evening dosage; eye allergy; eye burning; eye discomfort; eye irritation; eye pain; glaucoma; headache; human; intraocular hypertension; intraocular pressure; monotherapy; morning dosage; night vision; patient care; patient compliance; punctate keratitis; review; side effect; taste disorder; treatment response; combigan; cosopt; duotrav; ganfort

Eye-care utilization among women aged > or =40 years with eye diseases--19 states, 2006-2008. (MMWR. Morbidity and mortality weekly report, 2010)
Diabetic retinopathy (DR), glaucoma, and age-related macular degeneration (ARMD) are major causes of vision loss and blindness. Women have been found to have a higher prevalence of vision loss than men. Early detection and timely treatment by eye-care providers are necessary to delay disease progression and prevent vision loss. To assess the use of professional eye care among women aged > or = 40 years, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for 19 U.S. states for the period 2006-2008. This report summarizes the results of that analysis, which indicated that 21% of women with self-reported DR, 12% of women with self-reported glaucoma, and 8% of women with self-reported ARMD did not visit an eye-care provider in the recommended follow-up period. Women who did not have insurance coverage for eye care or who did not receive routine medical check-ups were more likely to report not having the recommended follow-up eye care. The two most commonly cited reasons for not having an eye-care visit were cost or not having insurance (range across diseases: 40%-46%) and having no reason to go for follow-up (range: 20%-29%). Compliance with obtaining eye examinations at recommended intervals among women aged > or = 40 years with eye diseases might be enhanced by improving access to health care and implementing and expanding existing educational programs to raise awareness regarding the importance of routine follow-up eye examinations.
Keywords: adult; aged; article; behavioral risk factor surveillance system; diabetic retinopathy; female; glaucoma; health care delivery; health service; human; insurance; middle aged; patient; patient compliance; macular degeneration; United States; utilization review; vision test

Adherence to medicines in the older-aged with chronic conditions: Does intervention by an allied health professional help? - Doggrell, S.A. (Drugs and Aging, 2010)
Adherence to medicines is a major determinant of their effectiveness. However, estimates of non-adherence in the older-aged (defined as those aged ≥65 years) with chronic conditions vary from 40 to 75. The problems caused by non-adherence in the older-aged include residential care and hospital admissions, progression of the disease and increased costs to society. The reasons for non-adherence in the older-aged include items related to the medicine (e.g. cost, number of medicines, adverse effects) and those related to the person (e.g. cognition, vision, depression). It is also known that there are many ways adherence can be increased (e.g. use of blister packs, cues).Although it is assumed that interventions by allied health professionals (i.e. other than the prescriberdoctor), including a discussion of adherence, will improve adherence to medicines in the older-aged, the evidence for this has not been reviewed. There is some evidence that telephone counselling concerning adherence by a nurse or pharmacist improves short-and long-term adherence. However, face-to-face intervention counselling at the pharmacy or during a home visit by a pharmacist has shown variable results, with some studies showing improved adherence and some not. Broad-based education programmes during hospital stays have not been shown to improve medication adherence following discharge, whereas education programmes specifically for subjects with hypertension have been shown to improve adherence. In combination with an education programme, both counselling and a medicine review programme have been shown to improve short-term adherence in the older-aged.Thus, there are many unanswered questions about the most effective interventions for promoting adherence. More studies are needed to determine the most appropriate interventions by allied health professionals, and such studies need to consider the disease state, demographics and socioeconomic status of the older-aged subject, and the intensity and duration of intervention required. © 2010 Adis Data Information BV. All rights reserved.
Keywords: acetylsalicylic acid; alpha adrenergic receptor blocking agent; amiodarone; atenolol; beta adrenergic receptor blocking agent; bile acid sequestrant; bisphosphonic acid derivative; calcitonin; calcium channel blocking agent; colestipol; colestyramine; dipeptidyl carboxypeptidase inhibitor; diuretic agent; estradiol; hydroxymethylglutaryl coenzyme A reductase inhibitor; latanoprost; loop diuretic agent; mevinolin; nicotinic acid; tolterodine; age distribution; aged; aging; chronic disease; clinical trial; cost effectiveness analysis; disease course; drug cost; education program; glaucoma; health care cost; health education; heart arrhythmia; heart infarction; hospital admission; human; hypercholesterolemia; hypertension; nursing home; osteoporosis; overactive bladder; paramedical profession; patient compliance; patient counseling; priority journal; residential care; review; teleconsultation; aspirin

Eye Disease in Latinos: Insights From the Los Angeles Latino Eye Study - Aung, T. (American Journal of Ophthalmology, 2010)
Keywords: blindness; cataract; diabetic retinopathy; disease course; editorial; ethnic group; eye disease; follow up; glaucoma; health care access; health insurance; Hispanic; human; minority group; prevalence; priority journal; risk assessment; risk factor; visual impairment

Severe pseudomonal keratitis in an infrequent daily disposable contact lens wearer - Batta, P.; Goldstein, M.H. (Eye and Contact Lens, 2010)
Purpose: To report an unusual case of contact lens-associated pseudomonal keratitis in a compliant daily disposable contact lens wearer. Methods: A case report is presented of a compliant daily disposable contact lens wearer who developed culture-positive pseudomonal keratitis. Results: A 38-year-old woman who reported compliant and infrequent use of daily disposable contact lenses presented with rapid-onset, severe keratitis consistent with pseudomonal infection. Corneal cultures were positive for Pseudomonas aeruginosa. She had no identifiable risk factors, although notably had a remote history of contact lens-associated keratitis in the fellow eye. Conclusions: Although extremely rare, pseudomonal keratitis should still be considered in the differential diagnosis of severe keratitis in daily disposable contact lens wearers. Given the history of a previous contact lens-related bacterial keratitis in this compliant patient, it is possible that host susceptibility factors played a role in the case of pseudomonal keratitis described here. Copyright © Contact Lens Association of Ophthalmologists, Inc.
Keywords: gatifloxacin; prednisolone acetate; tobramycin; vancomycin; adult; anamnesis; article; bacterium culture; case report; contact lens; differential diagnosis; disease severity; eye examination; female; host susceptibility; human; keratitis; patient compliance; priority journal; Pseudomonas aeruginosa; Pseudomonas infection; risk factor

Compliance conundrum - Ayshford, H. (Manufacturing Chemist, 2010)
Keywords: lisinopril; birth control; congestive heart failure; consultation; diabetes mellitus; disease course; education; glaucoma; human; information; outcome assessment; packaging; patient compliance; pharmacist; pharmacy (shop); safety; short survey

Intentional and Unintentional Nonadherence to Ocular Hypotensive Treatment in Patients with Glaucoma - Rees, G.; Leong, O.; Crowston, J.G.; Lamoureux, E.L. (Ophthalmology, 2010)
Objective: To determine the rate of intentional and unintentional nonadherence in glaucoma patients and to identify associations between adherence behavior and patients' beliefs. Design: Cross-sectional study. Participants: One hundred thirty-one glaucoma patients using topical eye drops for at least 6 months. Methods: Interviewer-administered surveys. Main Outcome Measures: 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: Overall, 59 (45%) participants reported some degree of nonadherence, among whom 39 (66.1%) reported unintentional nonadherence (e.g., forgetting), 10 (16.9%) reported intentional nonadherence (deliberate nonadherence), and 10 (16.9%) reported both forms of nonadherence. Compared with adherers, nonadherers were significantly younger, were less likely to have other nonocular health conditions or to use medicines other than their eye drops, and reported lower belief in the necessity of eye drops for glaucoma (P<0.05). Degree of unintentional nonadherence was associated with lower belief in necessity of eye drops, whereas degree of intentional nonadherence was associated with concerns about eye drops. Conclusions: Strategies aimed at improving adherence in glaucoma patients need to address both intentional and unintentional dimensions. Interventions focused on eliciting and addressing patients' beliefs and concerns about their eye drops require evaluation. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2010 American Academy of Ophthalmology.
Keywords: antihypertensive agent; adolescent; adult; age; aged; article; controlled study; cross-sectional study; female; glaucoma; health belief; human; interview; major clinical study; male; patient attitude; patient compliance; priority journal; questionnaire; self report

Comparison of the efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg for the treatment of chronic idiopathic urticaria: A multi-centre, double-blind, randomized, placebo-controlled study - Zuberbier, T.; Oanta, A.; Bogacka, E.; Medina, I.; Wesel, F.; Uhl, P.; Antépara, I.; Jáuregui, I.; Valiente, R. (Allergy: European Journal of Allergy and Clinical Immunology, 2010)
Background: Bilastine is a novel nonsedative H1-receptor antagonist, which may be used for the symptomatic treatment of chronic idiopathic urticaria (CU). The aim of this study was to compare the clinical efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg and placebo in CU patients with moderate-to-severe symptoms. Methods: Overall 525 male and female subjects aged 18-70 years were randomized to receive bilastine 20 mg, levocetirizine 5 mg or placebo, once daily for 28 days, in double-blind manner, in 46 centres across Europe and Argentina. Patients rated symptoms of pruritus, number of wheals, and maximum size of wheals (on predefined scales) as reflective (over past 12 h) symptoms twice daily, for assessment of change from baseline in the total symptoms scores (TSS) over 28 days as the primary efficacy measure. Changes in reflective and instantaneous symptoms scores, Dermatology Life Quality Index (DLQI), and CU-associated discomfort and sleep disturbance were assessed as secondary outcomes. Safety was assessed according to adverse events, laboratory tests and electrocardiograms. Results: Bilastine reduced patients' mean reflective and instantaneous TSS from baseline to a significantly greater degree than placebo (P < 0.001); from day 2 onwards of treatment. The DLQI, general discomfort, and sleep disruption were also improved significantly in bilastine-treated patients as compared with placebo-treated patients (P < 0.001 for all parameters). Comparison with levocetirizine indicated both treatments to be equally efficacious as well as equally safe and well tolerated as compared with placebo. Conclusions: Bilastine 20 mg is a novel effective and safe treatment option for the management of CU. © 2009 John Wiley & Sons A/S.
Keywords: antihistaminic agent; bilastine; levocetirizine; placebo; unclassified drug; adult; aged; article; chronic urticaria; chronic urticaria; clinical assessment; clinical trial; controlled clinical trial; controlled study; crossover procedure; diastolic blood pressure; double blind procedure; drug efficacy; drug safety; drug tolerability; drug withdrawal; electrocardiogram; fatigue; female; glaucoma; headache; heart rate; human; idiopathic disease; laboratory test; major clinical study; male; outcome assessment; parallel design; patient compliance; priority journal; prostate hypertrophy; pruritus; Quality of Life Index; rating scale; scoring system; side effect; sleep disorder; somnolence; systolic blood pressure; treatment duration; urticaria

Physicians treatment decisions, patient persistence, and interruptions in the continuous use of prostaglandin therapy in glaucoma - Hahn, S.R.; Kotak, S.; Tan, J.; Kim, E. (Current Medical Research and Opinion, 2010)
Background: Uninterrupted use of ocular hypotensive medication by glaucoma patients is important to prevent vision loss, but medication persistence is poor. Efficacy and tolerability influence physicians decisions and patient persistence, and differences between medications may impact persistence. Objective: To examine differences in physicians decisions to continue, switch, or discontinue therapy across three prostaglandin analogs (PGAs) latanoprost, bimatoprost, and travoprost using claims data supplemented by evaluation of physicians charted therapeutic decisions. Methods: A year of pharmacy claims data for 6271 patients with a first (index) fill between 5/1/2001 and 11/30/2004 for PGA monotherapy were classified as persistent, switched, restarted, or discontinued with initial PGA use. An analysis of index therapy continuation during the first 2 years reflected chart reviews for 223 patients with PGA monotherapy as the index prescription. Results: Ten percent of patients had uninterrupted use of the initial PGA alone or in combination for a year. More than half (56) stopped and then restarted, 16 switched, and 19 discontinued the initial PGA. Patients using latanoprost were more likely to be persistent (11) compared to bimatoprost (9) or travoprost (5; p<0.0001 overall comparison). Overall, 68 of patients on latanoprost persisted or restarted after a gap compared to 61 for bimatoprost and 58 for travoprost (p<0.0001). Patient charts demonstrated a parallel pattern in physicians decisions to continue latanoprost (56), bimatoprost (45), and travoprost (40). Study limitations included the inability to establish causal links between variables, to account for sample use, or to document reasons for patient-driven changes in therapy. The study should be replicated in a more recent database including a larger population. Conclusions: Uninterrupted use of ocular hypotensive therapy for a full year is relatively rare. Differences in physicians decisions to continue, switch, or discontinue PGAs were observed in claims data, and parallel trends were observed in patient medical records. © 2010 Informa UK Ltd All rights reserved.
Keywords: bimatoprost; latanoprost; travoprost; article; controlled study; drug substitution; drug withdrawal; glaucoma; human; major clinical study; medical decision making; monotherapy; patient compliance; retreatment; treatment planning

Editorial: A step in the right direction (Nature Reviews Microbiology, 2010)
Keywords: albendazole; antimalarial agent; azithromycin; emtricitabine plus tenofovir disoproxil; generic drug; ivermectin; tenofovir disoproxil; Wart virus vaccine; developing country; drug cost; drug industry; drug research; editorial; eradication therapy; filariasis; finance; funding; glaucoma; health care access; human; infection; medical device; natural disaster; onchocerciasis; patent; priority journal; gardasil; mectizan; truvada; viread; zithromax

Twelve-Month, Randomized, Controlled Trial of Bimatoprost 0.01%, 0.0125%, and 0.03% in Patients with Glaucoma or Ocular Hypertension - Katz, L.J.; Cohen, J.S.; Batoosingh, A.L.; Felix, C.; Shu, V.; Schiffman, R.M. (American Journal of Ophthalmology, 2010)
Purpose: To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of ophthalmic formulations of bimatoprost 0.01% and 0.0125% compared with bimatoprost 0.03%. Design: Prospective, randomized, double-masked, multicenter clinical trial. Methods: Patients with glaucoma or ocular hypertension were randomized to receive once-daily bimatoprost 0.01% (n = 186), bimatoprost 0.0125% (n = 188), or bimatoprost 0.03% (n = 187) for 12 months. The primary efficacy measure was IOP. Safety measures included adverse events and an objective assessment of conjunctival hyperemia. Results: Baseline mean IOPs were similar among treatment groups. Differences in mean IOP between the bimatoprost 0.01% or 0.0125% groups and the bimatoprost 0.03% group were less than 0.9 mm Hg throughout follow-up. Bimatoprost 0.01%, but not bimatoprost 0.0125%, was equivalent in efficacy to bimatoprost 0.03% based on predetermined criteria (limits of the 95% confidence interval of the between-group difference in mean IOP within ± 1.5 mm Hg at all time points and within ± 1 mm Hg at most time points). The overall incidence of treatment-related adverse events was reduced significantly in the bimatoprost 0.01% and bimatoprost 0.0125% groups compared with the bimatoprost 0.03% group (P ≤ .034). The percentage of patients with a moderate to severe increase from the baseline macroscopic hyperemia score was: bimatoprost 0.01%, 3.2%; bimatoprost 0.0125%, 9.0%; bimatoprost 0.03%, 9.1% (P = .019 for bimatoprost 0.01% vs 0.03%). Conclusions: Bimatoprost 0.01% was equivalent to bimatoprost 0.03% in lowering IOP throughout 12 months of treatment and demonstrated improved tolerability, including less frequent and severe conjunctival hyperemia. Bimatoprost 0.01% demonstrated a better benefit-to-risk ratio than bimatoprost 0.0125%. © 2010 Elsevier Inc. All rights reserved.
Keywords: NCT00300443; bimatoprost; abnormal sensation; adult; aged; article; clinical trial; conjunctival hyperemia; controlled clinical trial; controlled study; disease severity; double blind procedure; drug dosage form comparison; drug efficacy; drug formulation; drug safety; drug tolerability; drug withdrawal; eye irritation; eyelash growth; eyelid erythema; female; foreign body sensation; foreign body sensation; glaucoma; hair growth; human; hyperpigmentation; intraocular hypertension; intraocular pressure; iritis; major clinical study; male; multicenter study; ocular pruritus; patient compliance; priority journal; punctate keratitis; randomized controlled trial; retina macula cystoid edema; risk benefit analysis; side effect; uveitis; lumigan

Supplemental health insurance and equality of access in Belgium - Schokkaert, E.; Van Ourti, T.; De Graeve, D.; Lecluyse, A.; Van De Voorde, C. (Health Economics, 2010)
The effects of supplemental health insurance on health-care consumption crucially depend on specific institutional features of the health-care system. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. Within this institutional background, we find only weak evidence of adverse selection in the coverage of supplemental health insurance. We find much stronger effects of socio-economic background. We estimate a bivariate probit model and cannot reject the assumption of exogeneity of insurance availability for the explanation of health-care use. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spells, but a negative effect on the number of nights per spell. We comment on the implications of our findings for equality of access to health care in Belgium. Copyright © 2009 John Wiley & Sons, Ltd.
Keywords: age distribution; allergy; asthma; Belgium; binomial distribution; bivariate analysis; bladder disease; bronchitis; cardiovascular disease; cataract; chronic disease; day care; demography; dentistry; depression; educational status; employment status; gastrointestinal disease; general practitioner; glaucoma; health care access; health care policy; health care utilization; health status; hip fracture; hospital charge; hospital patient; human; hypertension; kidney disease; lifestyle; liver disease; medical specialist; mental disease; musculoskeletal disease; neoplasm; neurologic disease; outpatient; Parkinson disease; pharmaceutical care; Poisson distribution; priority journal; public health insurance; regression analysis; reproductive health; review; risk assessment; sex ratio; sinusitis; skin disease; socioeconomics; thyroid disease; wrist fracture

Post-traumatic fungal keratitis caused by carpoligna sp. - Chew, H.F.; Jungkind, D.L.; Mah, D.Y.; Raber, I.M.; Toll, A.D.; Tokarczyk, M.J.; Cohen, E.J. (Cornea, 2010)
Purpose: To report the first case of fungal keratitis caused by presumed Carpoligna species. Methods: A 37-year-old gardener sustained a full-thickness, stellate corneal laceration while cutting wood outdoors with a circular saw. Two months after surgical repair, he developed a severe infectious keratitis with descemetocoele at the apex of the original stellate laceration. Results: Culture results confirmed fungal elements without evidence of bacteria. Oral and topical voriconazole were initiated. Due to compliance and cost issues, voriconazole was replaced with natamycin 5% prior to discharge from hospital. The patient improved and healed without perforation. The patient was left with a central stromal scar. DNA extraction from the fungal colony allowed PCR amplification of the 28s ribosomal RNA region of the fungus that led to the diagnosis of Carpoligna pleurothecii. Corticosteroids were never used during the patient's treatment. Conclusion: This is the first reported case of infectious keratitis caused by presumed Carpoligna species. The treatment for Carpoligna pleurothecii keratitis includes voriconazole, natamycin, and possibly amphotericin B. © 2010 Lippincott Williams & Wilkins.
Keywords: atropine; bacitracin; cefazolin; ceftazidime; doxycycline; gentamicin; moxifloxacin; natamycin; polymyxin; tobramycin; vancomycin; voriconazole; adult; article; aspiration biopsy; B scan; bacterium culture; Carpoligna pleurothecii; case report; cornea injury; disease course; disease severity; drug dose reduction; drug substitution; drug withdrawal; eye inflammation; eye pain; follow up; fungus; fungus culture; fungus growth; glaucoma; Gram staining; human; intraocular pressure; keratomycosis; lensectomy; male; patient compliance; priority journal; visual acuity; vitrectomy

Adherence to glaucoma therapy - Renard, J.P.; Giraud, J.M.; Fenolland, J.R.; May, F. (Journal Francais d'Ophtalmologie, 2010)
Adherence to glaucoma therapy is a major factor of therapeutic efficacy. It reflects the patient's perception of the glaucoma disease and its treatment. Evaluation of adherence, often underestimated, is simple with a four-step strategy underscoring the importance of informing and educating the patient. The quality of the physician-patient relationship is essential for a good adapted assessment with every patient and at all stages of the disease so as to enhance adherence to glaucoma treatment and help patients. © 2010 Elsevier Masson SAS. All rights reserved.
Keywords: article; attitude to health; doctor patient relationship; glaucoma; human; motivation; motor performance; patient compliance; patient education; social environment; treatment outcome

Monitoring adherence rates in glaucoma patients using the Travatan Dosing Aid. A 6-month study comparing patients on travoprost 0.004% and patients on travoprost 0.004%/timolol 0.5% fixed combination - Rossi, G.C.M.; Pasinetti, G.M.; Scudeller, L.; Tinelli, C.; Milano, G.; Bianchi, P.E. (Expert Opinion on Pharmacotherapy, 2010)
Objective: To assess adherence in glaucoma patients using the Travatan Dosing Aid (TDA); to record differences in adherence by age, sex, therapy, systemic therapies, years from diagnosis, type of therapy and intraocular pressure (IOP). Research Design and Methods: Sixth-month cohort study; fifty-six Caucasian, primary open-angle glaucoma patients on travoprost (T) or travoprost/timolol fixed combination (TTFC) monotherapy were submitted to four visits: at baseline and months 1, 3 and 6 (M1, M3, M6). Adherence was recorded with TDA and classified as 'high' if greater than 90%. Self-reported and physician-presumed adherence data were collected. Kruskall-Wallis and Fisher's exact tests were applied. Results: Thirty-two patients (54.2%) were treated with T. Age, sex, level of schooling, presence of systemic comorbidities, duration of current therapy and IOP were similar between T and TTFC. Seventeen subjects (30.3%) recorded high adherence at every visit, 13 (23.2%) at two visits, 26 (46.4%) otherwise. Adherence was maintained over time with a slight decrease from month 1 to month 6 without statistical differences within and between groups. Adherence was statistically influenced by age (p Combining double low line 0.007) and duration of therapy (p Combining double low line 0.004). Conclusion: The typical nonadherent patient is elderly. TDA records indicate that only a minority of patients are really adherent: predictive models to screen for poor adherence are needed. © 2010 Informa UK Ltd.
Keywords: timolol plus travoprost; travoprost; academic achievement; adult; aged; article; clinical article; controlled study; female; groups by age; human; intraocular pressure; male; medical record; monotherapy; open angle glaucoma; patient compliance; self report; sex difference; systemic therapy; treatment duration

Drug attitude and adherence to anti-glaucoma medication - Hong, S.; Kang, S.Y.; Yoon, J.U.; Kang, U.; Seong, G.J.; Kim, C.Y. (Yonsei Medical Journal, 2010)
Purpose: The purpose of this study is to assess patient attitudes towards anti-glaucoma medication and their association with adherence, visual quality of life, and personality traits. Materials and Methods: One hundred and forty-seven glaucoma patients were enrolled this study. The participants were divided into 'pharmacophobic' and 'pharmacophilic' groups according to their scores on the Modified Glaucoma Drug Attitude Inventory (MG-DAI). To establish a correlation with patient drug attitude, each group had their subjective drug adherence, visual quality of life, and personality traits examined. For personality traits, the Myers-Briggs Type Indicator (MBTI) was used to sub-classify each group. Results: Among the patients analyzed, 91 (72.80%) patients showed a 'pharmacophobic' attitude and 34 (27.20%) patients showed a 'pharmacophilic' attitude. The pharmacophobic group tended to have worse adherence than the pharmacophilic group. Personality dichotomies from the MBTI also showed different patterns for each group. Conclusion: In glaucoma patients, pharmacological adherence was influenced by their attitude towards drugs; an association might exist between drug attitude and underlying personality traits. © Copyright: Yonsei University College of Medicine 2010.
Keywords: antiglaucoma agent; adult; article; controlled study; cross-sectional study; female; glaucoma; human; major clinical study; male; patient attitude; patient compliance; personality; quality of life; questionnaire

Contact lens cases: The missing link in contact lens safety? - Hall, B.J.; Jones, L. (Eye and Contact Lens, 2010)
Purpose: To summarize a variety of issues associated with contact lens case contamination and discuss appropriate methods that can limit this. Methods: A literature review was undertaken investigating the major factors associated with case contamination, with specific reference to the major pathogens associated with contamination, the role of bacterial biofilms, and methods that can limit contamination. Results: The use of antimicrobial cases, regular case cleaning and case replacement, avoidance of topping up solutions, and not using tap water to rinse cases all appear to be important in avoidance of significant case contamination. Conclusions: Contact lens case contamination is a significant public health concern and may contribute significantly to the development of microbial keratitis in contact lens wearers. Patients should be reminded that they must clean and disinfect their lens cases daily, should avoid the use of tap water for rinsing them, must not top up their solutions, must take into careful consideration where and how the cases are stored during the time that lenses are being worn and that they must be replaced regularly. The adoption of these methods will substantially reduce the levels of contamination of cases with pathogenic microbes. © 2010 Lippincott Williams & Wilkins.
Keywords: tap water; article; biofilm; cleaning; contact lens; disinfection; human; hygiene; keratitis; nonhuman; patient compliance; patient safety; priority journal; storage

Microbial contamination of contact lenses, lens care solutions, and their accessories: A literature review - Szczotka-Flynn, L.B.; Pearlman, E.; Ghannoum, M. (Eye and Contact Lens, 2010)
Purpose: A contact lens (CL) can act as a vector for microorganisms to adhere to and transfer to the ocular surface. Commensal microorganisms that uneventfully cohabitate on lid margins and conjunctivae and potential pathogens that are found transiently on the ocular surface can inoculate CLs in vivo. In the presence of reduced tissue resistance, these resident microorganisms or transient pathogens can invade and colonize the cornea or conjunctiva to produce inflammation or infection. Methods: The literature was reviewed and used to summarize the findings over the last 30 years on the identification, enumeration, and classification of microorganisms adherent to CLs and their accessories during the course of normal wear and to hypothesize the role that these microorganisms play in CL infection and inflammation. Results: Lens handling greatly increases the incidence of lens contamination, and the ocular surface has a tremendous ability to destroy organisms. However, even when removed aseptically from the eye, more than half of lenses are found to harbor microorganisms, almost exclusively bacteria. Coagulase-negative Staphylococci are most commonly cultured from worn lenses; however, approximately 10% of lenses harbor Gram-negative and highly pathogenic species, even in asymptomatic subjects. In storage cases, the incidence of positive microbial bioburden is also typically greater than 50%. All types of care solutions can become contaminated, including up to 30% of preserved products. Conclusions: The process of CL-related microbial keratitis and inflammation is thought to be preceded by the presence or transfer or both of microorganisms from the lens to the ocular surface. Thus, this detailed understanding of lens-related bioburden is important in the understanding of factors associated with infectious and inflammatory complications. Promising mechanisms to prevent bacterial colonization on lenses and lens cases are forthcoming, which may decrease the incidence of microbially driven CL complications. © 2010 Lippincott Williams & Wilkins.
Keywords: contact lens solution; bacterial colonization; bacterial transmission; bacterium contamination; coagulase negative Staphylococcus; commensal; contact lens; Gram negative bacterium; human; hygiene; keratitis; nonhuman; patient compliance; priority journal; review; storage

The role of topiramate and other anticonvulsants in the treatment of alcohol dependence: A clinical review - De Sousa, A. (CNS and Neurological Disorders - Drug Targets, 2010)
Alcohol dependence is a major health problem worldwide. Various pharmacological agents have been used in the management of alcohol dependence. This review looks at the role of topiramate and other anticonvulsants in the management of alcohol dependence. Topiramate is the most widely used anticonvulsant in the treatment of alcohol dependence. The literature on topiramate is reviewed and critically analyzed, along with its proposed mechanism of action in alcohol dependence. A review of data available on other anticonvulsants like carbamazepine, oxcarbazepine, sodium valproate, gabapentin and levetiracetam are presented and their potential in the treatment of alcohol dependence is considered, together with future research directions. © 2010 Bentham Science Publishers Ltd.
Keywords: acamprosate; anticonvulsive agent; buspirone; carbamazepine; disulfiram; etiracetam; gabapentin; lorazepam; naltrexone; oxcarbazepine; placebo; topiramate; valproic acid; alcohol abstinence; alcohol withdrawal syndrome; alcoholism; clinical trial; closed angle glaucoma; cognitive defect; cognitive therapy; drug binding; drug bioavailability; drug dose increase; drug efficacy; drug excretion; drug half life; drug mechanism; drug safety; drug tolerability; drug withdrawal; human; kidney tubule acidosis; myopia; nephrolithiasis; paresthesia; patient compliance; psychosocial care; quality of life; review; time to maximum plasma concentration; titrimetry; withdrawal seizure

Treatment adherence in ophthalmology and astrophysics - Novack, G.D. (Ocular Surface, 2010)
Keywords: antihypertensive agent; antilipemic agent; azithromycin; eye drops; latanoprost; pilocarpine; pirenzepine; prostaglandin; timolol; travoprost; valproate semisodium; article; glaucoma; health care cost; intraocular pressure; myopia; ophthalmology; patient compliance; pharmacist; physics; pill; prescription; depakote; xalatan; Travalert; Xal-Ease

Factors related to glaucoma treatment compliance: Patients' opinions from a university hospital - Silva, L.R.; de Paula, J.S.; Rocha, E.M.; Rodrigues, M.L.V. (Arquivos Brasileiros de Oftalmologia, 2010)
Purpose: Considering that noncompliance to glaucoma treatment is one of the risk factors associated with diseasés progression, the purpose of the present study was to evaluate: 1) knowledge and feelings about the disease; 2) self-reported noncompliance to treatment and related factors; and 3) influence of disease in lifestyle. Methods: Interviews, with application of a semi-structured questionnaire, of 50 patients with primary open-angle glaucoma. The analysis was performed using Lefèvre's technique (Collective Subject Speech - CSS, qualitative/quantitative research). Results: Thirty-eight percent of patients did not consider themselves well informed about glaucoma. The percentage of patients that reported noncompliance was 20%. The main causes of noncompliance are: side effects of antiglaucomatous drugs (24%); lack of information about the disease (22%); difficulty in understanding information and communication problems with the physician (14%); difficulties in administering the eye drops (14%); poverty, with impossibility to pay for the eye drops (10%); patientś attitudes and beliefs (10%). Eighteen percent of the participants informed that the disease affected their life quality. Conclusion: In the studied population, most of the problems related to noncompliance to glaucoma treatment pointed out different factors that may decrease with education about POAG, interventions on attitudes and behavior, improvement of doctor-patient relationship and anti-glaucoma drugs supply.
Keywords: aged; article; attitude to health; doctor patient relationship; female; human; male; middle aged; open angle glaucoma; patient compliance; psychological aspect; quality of life; questionnaire; statistics; university hospital

Cost benefit analysis of bimatoprost compared with other prostaglandin analogues in patients with primary open angle glaucoma (POAG) in the United States: A payer's perspective - Berenson, K.; Arora, S.; Kymes, S.; Hollander, D.A.; Fiscella, R.; Burk, C.; Patel, V. (Journal of Managed Care Pharmacy, 2010)
BACKGROUND:Glaucoma is a slowly progressive disease that can lead to blindness. Multiple, prospective, randomized clinical trials have demonstrated that bimatoprost achieves greater intraocular pressure (IOP) lowering compared with other prostaglandin analogues (PGA). However, few studies have evaluated the associated cost savings of lower IOP and its impact on glaucomatous progression. OBJECTIVE: To develop a cost benefit model from a payer's perspective to compare glaucomatous progression and costs among POAG patients treated with bimatoprost, latanoprost, or travoprost in the United States. METHODS: A health economic model was used to estimate glaucomatous progression for a cohort of POAG patients (baseline IOP 26 mm Hg) over 7 years. The absolute reduction in IOP from baseline secondary to treatment with a PGA was based on a systematic review of the literature; the base case model assumed a 1 mm Hg advantage of bimatoprost over latanoprost or travoprost. IOP was used to estimate the baseline mean deviation (MD) score in the worst eye and to determine the proportion of patients with MD score progression each year. Patients who progressed were assumed to progress at a mean rate of 0.6 decibels (dB) per year. Medical, pharmacy, and indirect costs associated with categories of MD scores from the published literature were applied to each treatment cohort to calculate the expected 7-year costs of treating patients with the different PGAs. Visual impairment costs were applied solely to severe disease patients. Costs were discounted at 3% per year. RESULTS: The results of the base case in this analysis showed that for a managed care plan of 1,000,000 members with 19,000 glaucoma patients, treatment with bimatoprost would prevent progression in 130 more patients compared with treatment with travoprost or latanoprost. The preservation of vision with bimatoprost resulted in cost savings of office visits, medication use, and surgeries, estimated at $796 per patient.There was an additional cost savings of $28 and $171 per treated patient in direct bimatoprost pharmacy costs compared with latanoprost and travoprost, respectively. The total cost savings with bimatoprost for a plan with 1,000,000 members, due to delayed/avoided progression, were estimated to be $103,480. CONCLUSIONS: Results from this model demonstrate that greater reduction in IOP from treatment with bimatoprost is associated with lower rates of glaucomatous progression and increased cost savings compared with latanoprost or travoprost. SPONSORSHIP: This research was funded by Allergan, Inc., Irvine, CA.
Keywords: bimatoprost; prostaglandin; travoprost; latanoprost; adrenalin hydrogen tartrate; promethazine; open angle glaucoma; patient; pharmacy (shop); cost benefit analysis; United States; managed care; cost control; model; glaucoma; statistical model; health; intraocular pressure; clinical trial; blindness; systematic review; eye; visual impairment; preservation; ambulatory care; drug therapy; surgery

A randomized, 36-month, post-marketing efficacy and tolerability study in Sweden and Finland of latanoprost versus non-prostaglandin therapy in patients with glaucoma or ocular hypertension - Friström, B.; Uusitalo, H. (Acta Ophthalmologica, 2010)
Purpose: To compare the effect of time on therapy, efficacy, tolerability and resource utilization of latanoprost or non-prostaglandin analogues (non-PGs) in patients who required a change in intraocular pressure (IOP)-lowering monotherapy. Methods: This open-label, multicentre study (Sweden, 19 sites; Finland, seven sites) included adults with glaucoma or ocular hypertension with mean diurnal IOP ≥ 21 mmHg on ocular hypotensive monotherapy. Patients were randomized to latanoprost monotherapy or non-PG therapy (commercially available therapy other than a PG) and followed for 36 months. End-points included: time to treatment failure (baseline to visit with a change in/addition to treatment); diurnal IOP (mean of 08.00, 12.00 and 16:00 hr measurements) at months 6, 12, 24 and 36; tolerability; and resource utilization, where analyses used Swedish and Finnish 2006 unit costs. Results: Three hundred and twenty-six patients received ≥ 1 dose of latanoprost (n = 162) or non-PGs (n = 164). Median time to treatment failure was longer for latanoprost (36 months) than for non-PGs (12 months; p < 0.001); 51% and 24% of patients remained on randomized therapy after 36 months, respectively (p < 0.001). Decreases in mean diurnal IOP from baseline were significantly greater for latanoprost than for non-PGs at months 6 and 12 (p < 0.01). No serious adverse events were judged to be treatment-related. Mean total 36-month direct costs were similar in patients initiated with latanoprost and non-PGs. Conclusion: Patients who failed previous monotherapy remained on therapy longer when switched to latanoprost. Latanoprost's IOP-reducing effect and tolerability were sustained over the long term. Resource utilization and costs were generally similar in those initiating latanoprost or non-PG therapy. © 2009 Acta Ophthalmol.
Keywords: NCT00140062; brimonidine; brinzolamide; dorzolamide plus timolol; latanoprost; adult; aged; article; clinical trial; controlled clinical trial; controlled study; drug cost; drug efficacy; drug marketing; drug tolerability; female; Finland; glaucoma; health care utilization; human; intraocular hypertension; intraocular pressure; major clinical study; male; monotherapy; multicenter study; priority journal; randomized controlled trial; Sweden; treatment failure; unspecified side effect

Shunts to divert aqueous humor to distant epithelialized cavities after keratoprosthesis surgery - Dohlman, C.H.; Grosskreutz, C.L.; Chen, T.C.; Pasquale, L.R.; Rubin, P.A.D.; Kim, E.C.; Durand, M. (Journal of Glaucoma, 2010)
PURPOSE: Glaucoma is a frequent and often severe problem in patients needing keratoprosthesis (KPro) surgery. Standard glaucoma shunts in these cases often develop a very dense capsule that obstructs flow and causes intraocular pressure elevation. Therefore, we developed shunts that deliver aqueous to distant epithelialized cavities where an obstructing capsule is less likely to form. In this retroactive study of such shunts, the risk of postoperative infection (especially endophthalmitis) has been assessed. METHODS: Ahmed shunts were connected with a tube to the lacrimal sac or ethmoid sinuses. In subsequent designs the polypropylene plate was eliminated, the valve was enclosed and a distal tube added (New World Medical Inc, Rancho Cucamonga, CA). The latter shunts were connected to the maxillary sinus or lower lid fornix. Between 2001 and 2005 the devices were implanted in 34 patients with very severe ocular disease. (31 had KPro implanted). Thus, the distal tube was led to the lacrimal sac (2 cases), to the ethmoid sinuses (6), to the maxillary sinus (16 cases), and to the lower lid fornix (10 cases). The patients were followed for cumulatively 145 shunt years, with a mean follow-up of 4 years and 3 months. They were instructed to administer low-dose topical antibiotics indefinitely. RESULTS: Only 1 case of acute bacterial endophthalmitis occurred, thus an incidence of 0.7% per shunt year. A slow-growing Mycobacterium was cultured in a disintegrating eye and 1 bacterial maxillary sinusitis occurred, both in autoimmune diseases. Three valves became exposed and had to be removed (1 replaced). Four eyes developed hypotony, probably from valve failure. CONCLUSIONS: The shunt arrangement, which connects the anterior chamber to potentially microbe-populated cavities or to the lower lid fornix and its flora, might be suspected to allow rapid retrograde invasion of infective agents, resulting in endophthalmitis. In this series of KPro patients, however, the incidence of severe infection was very low, in fact comparable to that after standard trabeculectomy. © 2010 Lippincott Williams & Wilkins, Inc.
Keywords: antibiotic agent; prednisolone acetate; quinoline derived antiinfective agent; vancomycin; anterior eye chamber; aphakia; aqueous humor; article; bacterium culture; case report; cellulitis; clinical article; endophthalmitis; ethmoid sinus; follow up; glaucoma; glaucoma drainage implant; human; keratoprosthesis; lacrimal sac; maxilla sinusitis; maxillary sinus; Mycobacterium; neodymium laser; nonhuman; patient compliance; priority journal

Are You Compliant With Addressing Glaucoma Adherence? - Mansberger, S.L. (American Journal of Ophthalmology, 2010)
Keywords: antiglaucoma agent; eye drops; accuracy; blindness; cataract extraction; disease course; disease severity; doctor patient relationship; drug cost; drug monitoring; editorial; eye care; glaucoma; health behavior; Health Belief Model; health care cost; health care personnel; hospitalization; human; intraocular hypertension; intraocular pressure; patient compliance; patient education; pharmacy (shop); priority journal; productivity; travel; visual impairment

An exploratory study of factors influencing glaucoma treatment adherence - Stryker, J.E.; Beck, A.D.; Primo, S.A.; Echt, K.V.; Bundy, L.; Pretorius, G.C.; Glanz, K. (Journal of Glaucoma, 2010)
Purpose: To understand the factors that influence glaucoma treatment adherence with medication taking, prescription refills, and appointment keeping to develop an intervention for a specific population. Patients and methods: In-depth interviews were conducted with 80 individuals diagnosed with open-angle glaucoma, glaucoma suspect, or ocular hypertension. Additional eligibility requirements were that all participants were: between the ages of 18 to 80; white or African American; spoke and understood English; and were taking daily doses of topical glaucoma treatments for at least the past year. Cross-tabulations and χ tests were conducted to compare adherent and nonadherent individuals, classified as such based on self-report and medical chart/pharmacy data. Results: Compared with adherent participants, nonadherent participants were less likely to: believe their eye doctors spent sufficient time with them; ask their eye doctor if they had any questions; know of benefits to taking their glaucoma medication regularly; and have someone help them take their glaucoma medications or drive them to eye appointments. Conversely, compared with adherent individuals, nonadherent participants were more likely to have difficulty remembering to take their medications and to believe their glaucoma would affect their eye sight in the future. Conclusions: Nonadherent glaucoma patients struggle with a variety of issues related to consistent use of glaucoma medicine and routine eye care. Interventions are needed to address these modifiable factors related to glaucoma treatment adherence. © 2010 by Lippincott Williams&Wilkins.
Keywords: antiglaucoma agent; adult; African American; aged; article; controlled study; education; European American; eye care; female; human; interview; intraocular hypertension; major clinical study; male; memory; open angle glaucoma; patient attitude; patient compliance; patient education; priority journal; race difference; self concept; self report; social status; social support

Combination therapy in hypertension: A focus on angiotensin receptor blockers and calcium channel blockers - Meka, N.; Katragadda, S.; Cherian, B.; Arora, R.R. (American Journal of Therapeutics, 2010)
Every third adult in the United States has hypertension. Hypertension is a continuous, independent, potent risk factor for cardiovascular events like stroke, myocardial infarction, and heart failure. The blood pressure control achieved with most hypertensives is way below the recommended goal. Recent trials suggest that for nearly half of hypertensive patients, a monotherapy regimen is not adequate to control blood pressure. Investigators recommend from randomized, controlled studies that combination therapy be considered when blood pressure is above the goal of 20/10 mm Hg. In this review we discuss clinical trials that establish the need for combination therapy, with the primary focus on a new combination: calcium channel blockers (CCBs) and angiotensin receptor blockers (ARBs). ARBs and CCBs in combination can complement each other in lowering blood pressure, with a lower incidence of adverse effects, as compared with individual monotherapy components at high doses. © 2010 Lippincott Williams & Wilkins.
Keywords: adrenergic receptor blocking agent; alpha adrenergic receptor blocking agent; amlodipine; angiotensin receptor antagonist; atenolol; beta adrenergic receptor blocking agent; calcium channel blocking agent; clonidine; diltiazem; dipeptidyl carboxypeptidase inhibitor; doxazosin; guanabenz; guanfacine; hydralazine; labetalol; loop diuretic agent; losartan; methyldopa; minoxidil; nifedipine; placebo; potassium sparing diuretic agent; prazosin; propranolol; terazosin; thiazide diuretic agent; unindexed drug; valsartan; vasodilator agent; verapamil; alopecia; angina pectoris; angioneurotic edema; asthenia; blood pressure; bradycardia; bronchospasm; cardiovascular disease; clinical trial; constipation; coughing; depression; diastolic blood pressure; dizziness; drug contraindication; drug efficacy; drug half life; drug hypersensitivity; drug induced headache; drug megadose; drug potentiation; drug safety; dry cough; dry cough; dyslipidemia; eclampsia; edema; essential hypertension; fatigue; fluid retention; flushing; glaucoma; gynecomastia; heart block; heart failure; heart infarction; heart muscle ischemia; heart palpitation; heart supraventricular arrhythmia; hirsutism; human; hyperkalemia; hypertension; hypertension retinopathy; impotence; kidney failure; lifestyle modification; lupus like syndrome; migraine; monotherapy; morbidity; mortality; muscle cramp; neutropenia; opiate addiction; orthostatic hypotension; patient compliance; perioperative period; peripheral edema; pharyngitis; positional dizziness; pregnancy; priority journal; prostate hypertrophy; Raynaud phenomenon; review; rhinopharyngitis; side effect; cerebrovascular accident; faintness

The impact of anti-inflammatory therapy on intraocular pressure reduction following selective laser trabeculoplasty - Realini, T.; Charlton, J.; Hettlinger, M. (Ophthalmic Surgery Lasers and Imaging, 2010)
BACKGROUND AND OBJECTIVE: To determine whether the use of postoperative topical anti-inflammatory therapy affects the intraocular pressure (IOP)-lowering efficacy of selective laser trabeculoplasty in eyes with primary open-angle glaucoma. PATIENTS AND METHODS: In this prospective, randomized, observer-masked study, 25 participants with primary open-angle glaucoma following bilateral 360° selective laser trabeculoplasty used prednisolone acetate 1% four times daily in one randomly selected eye for 1 week. IOP was assessed at baseline and 1 week, 1 month, and 3 months after selective laser trabeculoplasty. RESULTS: Baseline IOP and selective laser trabeculoplasty treatment parameters were comparable in both groups. Mean IOP was similar in eyes that did and did not receive steroid therapy at 1 week (17.0 vs 16.3 mm Hg, respectively, P = .613), 1 month (16.8 vs 16.2 mm Hg, respectively; P = .571), and 3 months (16.0 vs 15.8 mm Hg, respectively; P = .819). CONCLUSION: A 1-week course of topical prednisolone acetate 1% four times daily did not affect the IOP-lowering effect of selective laser trabeculoplasty in eyes with primary open-angle glaucoma. Copyright ©SLACK Incorporated.
Keywords: NCT00406042; prednisolone acetate; aged; article; clinical article; clinical trial; controlled clinical trial; controlled study; drug effect; female; human; intraocular pressure; laser surgery; male; open angle glaucoma; patient compliance; postoperative care; postoperative period; pressure measurement; priority journal; randomized controlled trial; selective laser trabeculoplasty; single blind procedure; trabeculoplasty

Effects of switching to SofZia-preserved travoprost in patients who presented with superficial punctate keratopathy while under treatment with latanoprost - Yamazaki, S.; Nanno, M.; Kimura, T.; Suzumura, H.; Yoshikawa, K. (Japanese Journal of Ophthalmology, 2010)
Purpose: To investigate the effects of switching to SofZia-preserved travoprost (TRV) on superficial punctate keratopathy (SPK) observed in patients using benzalkonium chloride (BAC)-preserved latanoprost (LAT). Methods: Patients with either primary open-angle glaucoma or ocular hypertension treated with LAT for at least 1 month who presented with SPK participated in this prospective, multicenter, open-label uncontrolled study. After the switch from LAT to TRV, patients were monitored at 2 weeks and at 1, 2, and 3 months. The use of concomitantly employed ophthalmic solutions was continued during the observation period. The intensity of SPK in each of five areas defined on the cornea was scored on a standard scale. Repeated measurements were tested with a linear mixed model. Results: Of the 48 patients enrolled, 45 patients completed the study. After the switch to TRV, the mean SPK score in the whole cornea decreased significantly at every observation point (P < 0.0001 at each point) while intraocular pressure did not change significantly. Throughout the observation period, the SPK score tended to be higher in patients using a larger number of concomitant medications that contained BAC. Conclusion: Switching to TRV improved SPK observed in a population using LAT, likely because of a decrease in exposure to BAC. © 2010 Japanese Ophthalmological Society (JOS).
Keywords: agents acting on the eye; alpha adrenergic receptor blocking agent; artificial tear; benzalkonium chloride; beta adrenergic receptor blocking agent; carbonate dehydratase inhibitor; eye drops; hyaluronic acid; latanoprost; olopatadine; pirenoxine; preservative; sofzia; travoprost; travoprost; unclassified drug; adult; aged; article; clinical article; clinical trial; controlled clinical trial; controlled study; cornea; disease severity; drug substitution; eye irritation; female; foreign body sensation; foreign body sensation; human; hyperemia; intraocular hypertension; intraocular pressure; keratopathy; male; multicenter study; ocular pruritus; open angle glaucoma; patient compliance; patient monitoring; priority journal; prospective study; rating scale; sensory dysfunction; statistical model; treatment duration; sofzia; travatan z; xalatan

Loteprednol and tobramycin in combination: A review of their impact on current treatment regimens - Comstock, T.L.; Holland, E.J. (Expert Opinion on Pharmacotherapy, 2010)
Importance of the field: The treatment of ocular inflammation continues to be a challenge. Topical corticosteroids are effective in reducing ocular inflammation but are limited by adverse events including elevation of intraocular pressure, development of cataracts, glaucoma and inhibition of wound healing with associated risk of infection. Loteprednol etabonate (LE) is a unique C-20 ester corticosteroid designed to produce a predictable therapeutic effect with a low incidence of side effects. Zylet® (LE/T) a combination of LE and tobramycin (T) is indicated for the treatment of steroid-responsive ocular inflammatory conditions in which there exists either superficial bacterial ocular infection or a potential risk of bacterial infection. Areas covered in this review: The current review of the literature (Medline and the Cochrane Library, 1996 2009) examines the safety and efficacy of LE/T in the treatment of ocular inflammation. What the reader will gain: Studies with either LE or LE/T indicate that LE has a lower risk of IOP elevation compared with C-20 ketone corticosteroids owing to its rapid de-esterification to inactive metabolites. LE also lacks the ability to form Schiff base intermediates with lens proteins, a common first step in cataractogenesis. LE/T was noninferior to dexamethasone 0.1%/tobramycin 0.3% in the treatment of blepharokeratoconjunctivitis. Take home message: LE/T may be a safer treatment option for ocular inflammation in which there is risk of superficial bacterial infections. © 2010 Informa UK Ltd.
Keywords: corticosteroid; dexamethasone; dexamethasone plus tobramycin; fluorometholone; loteprednol etabonate; loteprednol etabonate plus tobramycin; placebo; prednisolone acetate; rimexolone; tobramycin; abnormal sensation; allergic conjunctivitis; aqueous humor; aqueous humor outflow; bactericidal activity; binding affinity; blepharitis; blepharokeratoconjunctivitis; burning sensation; cataract; clinical trial; conjunctivitis; cornea injury; disease course; disease severity; drug binding; drug bioavailability; drug effect; drug efficacy; drug labeling; drug safety; dry eye; eye burning; eye infection; eye inflammation; eye irritation; eye pain; foreign body sensation; giant papillary conjunctivitis; glaucoma; human; incidence; infection resistance; infection risk; intraocular pressure; keratitis; keratoconjunctivitis; nonhuman; ocular pruritus; optimal drug dose; pain; patient compliance; photosensitivity; postoperative inflammation; pruritus; review; risk assessment; seasonal allergic conjunctivitis; side effect; stinging sensation; treatment duration; uveitis; vision; visual acuity; wound healing impairment; tobradex; zylet

Development of an instrument to measure glaucoma medication self-efficacy and outcome expectations - Sleath, B.; Blalock, S.J.; Robin, A.; Hartnett, M.E.; Covert, D.; Devellis, B.; Giangiacomo, A. (Eye, 2010)
Purpose The Purpose of this study was to develop and evaluate the psychometric properties of (a) a glaucoma medication self-efficacy scale and (b) a glaucoma outcome expectations scale.Patients and MethodsTwo instruments were developed: a glaucoma medication self-efficacy scale and a glaucoma outcome expectations scale. Packets containing (a) the instruments and patient demographic questions and (b) a letter explaining the study were distributed to 225 glaucoma patients from three ophthalmology practices between August and December 2007. The instrument was completed by 191 patients for a response rate of 85%. Principal components factor analysis with a varimax rotation and Cronbach's α reliability were used to analyse the data. To assess discriminant validity, we administered the scales and two self-reported measures of adherence in a separate sample of 43 glaucoma patients who were currently using at least one glaucoma medication.Results Our results yielded a 21-item self-efficacy in overcoming barriers that might interfere with the use of glaucoma medications scale, a 14-item self-efficacy in carrying out specific tasks required to use eye drops correctly scale, and a four-item glaucoma outcome expectations scale. Results of the Cronbach's α reliability indicated that the scales are internally consistent. The self-efficacy scales were both significantly associated with two patient self-reported measures of glaucoma medication adherence, which show discriminant validity.Conclusion sEye care providers and researchers can use these scales to identify patients with low self-efficacy in using their glaucoma medications and patients who do not believe that following their eye care providers advice can help their vision. © 2010 Macmillan Publishers Limited All rights reserved. © 2010 Macmillan Publishers Limited All rights reserved.
Keywords: antiglaucoma agent; eye drops; adult; aged; article; controlled study; discriminant validity; drug use; expectation; female; glaucoma; glaucoma medication self efficacy scale; glaucoma outcome expectation scale; human; internal consistency; major clinical study; male; patient compliance; psychometry; questionnaire; reliability; self concept; self report; treatment outcome

Development of a specific questionnaire measuring patient satisfaction with glaucoma treatment: Glausat - Ruiz, M.A.; Pardo, A.; Martinez De La Casa, J.M.; Polo, V.; Esquiro, J.; Soto, J. (Ophthalmic Epidemiology, 2010)
Objective: Patient satisfaction with glaucoma therapy is one of the aspects that affects adequate adherence to treatment; therefore, it would be interesting to measure the satisfaction properly. We present the development process and psychometric properties of a new instrument for measuring patient satisfaction with glaucoma treatment. Material and methods: After collection and discussion of contents, a 38-item questionnaire was proposed and arranged into seven theoretical domains. The questionnaire was applied to a sample of 194 patients and its length was reduced using an exploratory factor analysis. Psychometric properties were assessed under classic theory. Results: The final questionnaire is formed by 22 items grouped into seven dimensions: expectations and beliefs about treatment, ease of use, efficacy, undesired effects, impact on health-related quality of life, medical care, and general satisfaction with treatment. Some dimensions correlated slightly. The reliability of the dimensions ranged from 0.77 to 0.93. Confirmatory factor analysis revealed an additional support of the proposed structure (χ2 (188)217, P=0.073). Glausat scores were proven to correlate with patients' self rating on medication tolerability, and with clinicians' assessment of tolerability, effectiveness and compliance. Conclusions: The Glausat questionnaire has proven to be reliable and structurally valid. This instrument may be used to assess patients' satisfaction with glaucoma treatment. © 2010 Informa UK Ltd.
Keywords: adult; article; clinical effectiveness; controlled study; expectation; glaucoma; Glausat questionnaire; health belief; human; major clinical study; medical care; patient compliance; patient satisfaction; priority journal; psychometry; quality of life; questionnaire; reliability; self concept

Safety and efficacy of fixed combination travoprost-timolol in the lowering of intraocular pressure - Noecker, R.J.; Pokabla, M.J. (Clinical Medicine Insights: Therapeutics, 2010)
The fixed combination eye drop Duotrav is a combination of travoprost 0.004% and timolol maleate 0.5%. Both travoprost and timolol have been used separately for the treatment of glaucoma by lowering intraocular pressure. Multiple studies have demonstrated the efficacy and safety of the fixed combination travoprost/timolol for the treatment of open-angle glaucoma and ocular hypertension. The once daily dosing of this combination offers multiple potential advantages such as patient adherence, potential cost advantages, and reduction in exposure to preservatives. This article discusses the benefits of fixed combination medications and summarizes past and recent studies listed on the online resource PubMed of the fixed combination travoprost/timolol with comparison to both monotherapy and other similar fixed combination ocular hypotensive preparations. © the author(s), publisher and licensee Libertas Academica Ltd.
Keywords: bimatoprost; bimatoprost plus timolol; brinzolamide; latanoprost; latanoprost plus timolol; placebo; preservative; propranolol; prostaglandin derivative; timolol maleate; timolol plus travoprost; travoprost; bedtime dosage; bradycardia; bronchospasm; clinical trial; comparative study; conjunctival hyperemia; cost benefit analysis; cost effectiveness analysis; depression; dizziness; drug contraindication; drug dosage form comparison; drug efficacy; drug safety; drug substitution; dyspnea; exposure; eye discomfort; eye irritation; fatigue; glaucoma; headache; heart arrhythmia; human; hypercholesterolemia; hypertrichosis; hypesthesia; hypoglycemia; hypotension; intraocular hypertension; intraocular pressure; lacrimation; lung function; morning dosage; open angle glaucoma; patient compliance; review; side effect; skin pigmentation; somnolence; duotrav; travatan; xalatan

Systemic corticosteroid is effective and safe treatment for problematic infantile hemangioma - Greene, A.K. (Pediatric Dermatology, 2010)
Keywords: corticosteroid; prednisolone sodium phosphate; prednisolone; propranolol; unclassified drug; adrenal insufficiency; aseptic necrosis; bradycardia; cataract; diabetes mellitus; drug dose comparison; drug dose reduction; drug efficacy; drug safety; lack of drug effect; glaucoma; hemangioma; human; hypoglycemia; hypotension; capillary hemangioma; long term care; moon face; morbidity; myopathy; note; osteoporosis; patient compliance; personality disorder; priority journal; stomach irritation; treatment response; orapred

Long-term benefit of reduced intraocular pressure in primary open-angle glaucoma patients in Ethiopia - Alemu, A.M.; Kristoffersen, C.J.; Kristoffersen, M.S.; Stewart, J.A.; Stewart, W.C. (European Journal of Ophthalmology, 2010)
PURPOSE. To determine the incidence of progression of primary open-angle glaucoma at individual levels of mean intraocular pressure (IOP) in patients in Ethiopia. METHODS. A retrospective, multicenter, cohort analysis of patient records with at least 5 years of potential follow-up were evaluated for risk factors associated with progressive optic disc and visual field loss. RESULTS. There were 300 patients with the potential of 5 years of follow-up. In total, 166 patients progressed before 5 years and 134 remained stable for the full 5-year follow-up period. Of the total sample, 84% of patients with IOPs ≤19 (n=117/139), 53% of patients with IOPs of 20 (n=9/17), 14% of patients with IOPs of 21-24 (n=9/63), and 0% of the patients with IOPs of ≥25 mmHg (n=0/79) remained stable over at least 5 years. The mean IOP was 17.4±2.1 in the stable group and 25.0±5.9 mmHg in the progressed group (p<0.0001). The highest average peak IOP was 24.5±4.5 in the stable group and 29.0±6.1 mmHg in the progressed group (p<0.0001). A multivariant regression analysis to determine risk factors for progression was positive for mean IOP (p=0.0097). CONCLUSIONS. This study suggests that IOP reduction in a developing country, despite potential limitations in diagnostic techniques, follow-up, and compliance, can be effective in reducing the risk of glaucomatous progression over long-term follow-up. © 2009 Wichtig Editore.
Keywords: aged; article; cohort analysis; controlled study; developing country; disease course; Ethiopia; female; follow up; human; intraocular pressure; major clinical study; male; open angle glaucoma; outcome assessment; priority journal; religion; retrospective study; risk factor; trabeculectomy; visual acuity

Topical treatment of psoriasis - Laws, P.M.; Young, H.S. (Expert Opinion on Pharmacotherapy, 2010)
Importance of the field: The majority of patients with psoriasis can be safely and effectively treated with topical therapy alone, either under the supervision of a family physician or dermatologist. For those requiring systemic agents, topical therapies can provide additional benefit. Optimal use of topical therapy requires an awareness of the range and efficacy of all products. Areas covered in this review: The review covers the efficacy and role of topical therapies including emollients, corticosteroids, vitamin D analogs, calcineurin inhibitors, dithranol, coal tar, retinoids, keratolyics and combination therapy. The report was prepared following a PubMed and Embase literature search up to April 2010. What the reader will gain: The paper provides a broad review of the relevant topical therapeutic options available in routine clinical practice for the management of psoriasis and a recommendation for selection of treatment. Take home message: Topical therapies used appropriately provide a safe and effective option for the management of psoriasis. An awareness of the available products and their efficacy is key to treatment selection and patient satisfaction. © 2010 Informa UK Ltd.
Keywords: amcinonide; antipsoriasis agent; betamethasone dipropionate; betamethasone dipropionate plus calcipotriol; betamethasone valerate; calcineurin inhibitor; calcipotriol; calcitriol; clobetasol; clobetasol propionate; coal tar; corticosteroid derivative; desoximetasone; dithranol; emollient agent; fluocinolone acetonide; fluocinonide; fluticasone propionate; halcinonide; hydrocortisone 17 butyrate 21 propionate; keratolytic agent; pimecrolimus; placebo; retinoid derivative; tacalcitol; tacrolimus; tazarotene; ulobetasol propionate; unindexed drug; vitamin D derivative; abnormal sensation; acne; avascular necrosis; bandage; calcium homeostasis; cataract; chronic disease; clinical assessment tool; clinical practice; clinical trial; contact dermatitis; Cushing syndrome; diabetes mellitus; drug contraindication; drug efficacy; drug formulation; drug potency; drug withdrawal; dry skin; edema; endocrine disease; erythema; folliculitis; glaucoma; human; hypercalcemia; hypercalciuria; hypertension; hypothalamic pituitary adrenal suppression; hypothalamic pituitary adrenal suppression; medical decision making; medical literature; mycosis; osteoporosis; patient compliance; patient education; patient satisfaction; perioral dermatitis; phototherapy; pruritus; psoriasis; psoriasis vulgaris; purpura; quality of life; remission; review; rosacea; skin abrasion; skin atrophy; skin burning sensation; skin irritation; skin manifestation; skin stinging sensation; skin stinging sensation; stria; stria; tachyphylaxis; telangiectasia; topical treatment; treatment duration; treatment outcome; treatment response; ultraviolet B radiation

A review of preserved and preservative-free prostaglandin analogues for the treatment of open-angle glaucoma and ocular hypertension - Hommer, A. (Drugs of Today, 2010)
Glaucoma affects an increasing number of people worldwide and is the second leading cause of blindness. The aim of antiglaucoma therapy is to maintain a patient's visual function and quality of life. Prostaglandin analogues are first-line topical antiglaucoma therapy. They are effective at lowering intraocular pressure (IOP) and are generally well tolerated, with fewer systemic adverse events compared with the other classes. However, the use of prostaglandin analogues can be associated with ocular adverse effects, such as stinging/burning sensation, dry eyes, iris and periocular hyperpigmentation, and eye lash growth, which can affect patient compliance. Preservatives used in antiglaucoma preparations can have dose-dependent toxic effects, which contribute to adverse effects. The development of preservative-free preparations may reduce such adverse effects and therefore improve patient compliance. Tafluprost is a prostaglandin analogue in a preservative-free formulation that was recently approved for the reduction of elevated IOP in open-angle glaucoma and ocular hypertension. Copyright © 2010 Prous Science, S.A.U. or its licensors All rights reserved.
Keywords: bimatoprost; latanoprost; prostaglandin derivative; tafluprost; travoprost; add on therapy; burning sensation; clinical trial; conjunctival hyperemia; drug formulation; drug hypersensitivity; drug safety; drug structure; drug substitution; drug withdrawal; dry eye; epiphora; eyelid disease; foreign body reaction; human; intraocular hypertension; intraocular pressure; iris disease; open angle glaucoma; patient compliance; patient satisfaction; quality of life; review