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Lešin Gaćina D, Marčinko D, Kuzman T, Škegro I, Vidas Pauk S, Škegro B, Tomić M, Bulum T, Jandroković S. Personality dimensions and treatment adherence among glaucoma patients: the role of self-transcendence. Curr Med Res Opin 2024; 40:583-590. [PMID: 38404158 DOI: 10.1080/03007995.2024.2323644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Cloninger's psychobiosocial model of personality proposes that consistent patterns of health behavior are determined by the complex interaction of different neurobiological processes of the patient's temperament and character dimensions. Poor medication adherence is a pervasive problem among glaucoma patients and can lead to increased morbidity and disability. The objective of the present study was to investigate the association between Cloninger's personality dimensions and medication adherence among glaucoma patients. METHODS The cross-sectional study was conducted among 113 primary open-angle glaucoma (POAG) patients. The treatment adherence was assessed through a valid and reliable self-administered questionnaire, the Culig Adherence Scale (CAS). Personality dimensions were evaluated using the abbreviated version of the Temperament and Character Inventory-Revised (TCI-140). Statistical analyses were performed using TIBCO Statistica 14.0.1. The study protocol was registered in the DRKS - German Clinical Trials Register; (DRKS-ID: DRKS00022081). RESULTS According to CAS, only 39.8% of patients were adherent to glaucoma treatment. Adherence was significantly negatively related only to the character dimension of Self-Transcendence (p < 0.05). No other TCI-140 dimension was significantly associated with medication adherence (p > 0.05). CONCLUSIONS The results suggest that POAG patients with higher scores on the Self-Transcendent personality dimension are more likely to experience difficulties adhering to medication regimen. The study highlights the importance of a holistic approach to glaucoma treatment, which takes into account not only the biological aspects of disease but also the psychosocial factors that influence patient behavior. Healthcare providers may need to consider glaucoma patients' personality dimensions, beliefs and values when developing treatment plans and strategies to improve medication adherence.
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Affiliation(s)
- Dina Lešin Gaćina
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Darko Marčinko
- Department of Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Kuzman
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Škegro
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sania Vidas Pauk
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | | | - Martina Tomić
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Tomislav Bulum
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Sonja Jandroković
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Alwazae M, Alhumud A, Alsarhan S, Ali Aljasim L. Acceptance of Selective Laser Trabeculoplasty as a First-Line Treatment for Primary Open-Angle Glaucoma in Saudi Arabia. Cureus 2024; 16:e52360. [PMID: 38361705 PMCID: PMC10868151 DOI: 10.7759/cureus.52360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Glaucoma is the second leading cause of blindness worldwide. Early detection and timely treatment are crucial to reducing disease progression. Selective laser trabeculoplasty (SLT) has proven efficacious as a primary treatment for primary open-angle glaucoma. This study aims to evaluate the acceptance among Saudi ophthalmologists of using SLT as a primary treatment for glaucoma. METHODS This cross-sectional study enrolled 128 ophthalmologists practicing in Saudi Arabia. Data collection was conducted using a structured online questionnaire, which evaluated sociodemographic data, current glaucoma practice, the technology acceptance model (TAM), and potential barriers to incorporating SLT as the primary treatment for glaucoma. RESULTS The mean age of the participants was 40 ± 9.6 years, with 65.6% being male. Almost one-third were glaucoma specialists, and 89% followed the American Academy of Ophthalmology recommendations for managing glaucoma patients. The majority (96.1%) used medical treatment as the initial therapy, 72.7% agreed that SLT is safe, and 59.4% agreed that it rapidly controls intraocular pressure. Nearly half of the participants were willing to use SLT as the primary treatment, yet only 42.2% considered themselves experienced enough to do so. The most reported barriers were inadequate training (47.7%), non-availability of SLT equipment (41.4%), and low efficacy as reported by 27.3% of participants. CONCLUSION Despite the good overall acceptance of SLT as a first-line treatment for glaucoma, most participants still preferred medical therapy as the primary treatment. To overcome the barriers to incorporating SLT, Saudi ophthalmologists require more training and access to equipment to effectively implement this modality in their practices.
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Affiliation(s)
- Manal Alwazae
- Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | | | - Shrouq Alsarhan
- General Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
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3
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Moore SG, Richter G, Modjtahedi BS. Factors Affecting Glaucoma Medication Adherence and Interventions to Improve Adherence: A Narrative Review. Ophthalmol Ther 2023; 12:2863-2880. [PMID: 37698824 PMCID: PMC10640536 DOI: 10.1007/s40123-023-00797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/15/2023] [Indexed: 09/13/2023] Open
Abstract
Glaucoma is a leading cause of vision loss. First line therapy for primary open angle glaucoma (POAG) are topical ocular hypotensive drops. Patient adherence with topical therapy for glaucoma is a significant challenge with a reported adherence of 60%. The purpose of this review is to discuss factors associated with glaucoma adherence (including demographic factors, cost, patient education, health beliefs, treatment burden and regimen, and physical limitations) and to explore potential interventions to improve medication adherence. Articles included in this review were found by searching PubMed and Google Scholar using the key words "Glaucoma Treatment Adherence" and "Glaucoma Treatment Compliance." Data from this review demonstrates that higher medication cost, lower patient education/literacy levels, and being of African and Hispanic descent are associated with lower medication adherence rates. The data is inconclusive on whether medication regimen complexity lowers patient medication adherence rates. Interventions that have successfully improved medication adherence rates for minority patients have focused on building trust and addressing fears and false beliefs. For cost, explicit physician communication to patients regarding medication cost is important and can help the physician determine any patient concerns about cost. Outside the USA, adherence has been improved through adherence-contingent rebate systems and government subsidies. Most interventions that aim to increase adherence target patient education and literacy with the following interventions demonstrating efficacy: written instructions targeting glaucoma-specific health literacy, literacy level appropriate glaucoma education videos, and interactive and personalized educational programs. More clinic infrastructure and programs that utilize patient reminder tools and patient educators could help physicians and patients in support of these personalized action plans.
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Affiliation(s)
- Shannan G Moore
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, 91101, USA
| | - Grace Richter
- Department of Ophthalmology, Southern California Permanente Medical Group, Los Angeles Medical Center, Los Angeles, CA, USA
- Eye Monitoring Center, Kaiser Permanente Southern California, 1011 Baldwin Park Boulevard, Balwin Park, CA, 91706, USA
| | - Bobeck S Modjtahedi
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, 91101, USA.
- Eye Monitoring Center, Kaiser Permanente Southern California, 1011 Baldwin Park Boulevard, Balwin Park, CA, 91706, USA.
- Department of Research and Evaluation, Southern California Permanente Medical Group, N Los Robles Avenue, Pasadena, CA, 91101, USA.
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Tan JCK, Kalloniatis M, Phu J. Frontloading SITA-Faster Can Increase Frequency and Reliability of Visual Field Testing at Minimal Time Cost. Ophthalmol Glaucoma 2023; 6:445-456. [PMID: 36958625 DOI: 10.1016/j.ogla.2023.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE To report the outcomes of frontloaded visual field (VF) testing (2 tests per eye on the same visit) over 2 longitudinal, consecutive visits using SITA-Faster (SFR) in terms of global indices, reliability metrics, and test duration. DESIGN Prospective longitudinal study. SUBJECTS A total of 902 eyes of 463 subjects with normal, suspect, or manifest glaucoma. METHODS Two intravisit SFR VF tests (T1 and T2) per eye at an initial (Ti) and follow-up (Tf) visit. MAIN OUTCOME MEASURES Intra- and intervisit global indices, reliability metrics, and test durations. RESULTS The mean age of the subjects was 63.6 years, and 58.3% were male. Seven hundred ninety eyes (87.4%) had a diagnosis of glaucoma or glaucoma suspicion. The mean duration between visits was 265.0 (standard deviation 98.8) days. In total, 3608 VF tests were analyzed, with the correlation of mean deviation (MD) values of the frontloaded tests at each visit high (T1/T2 MD correlation at initial visit r = 0.83, root mean squared error [RMSE] = 1.26, follow-up visit r = 0.83, RMSE = 1.25, P < 0.0001) and greater than the correlation of MD between visits (Ti1/Tf1 MD correlation r = 0.72, RMSE = 1.31). There was a significant intra-visit decrease in rates of abnormally high sensitivity in the glaucoma hemifield test (3.2% vs. 1.6%, P = 0.0023) and rates of unreliable test results (15.4% vs. 9.2%, P = 0.002) from T1 to T2 in both visits, with a corresponding significant decrease in MD (-1.28 dB vs. -1.68 dB, P < 0.0001) and VF index (P = 0.03). The mean duration of each SFR test was 132.6 (SD 27.2) seconds. CONCLUSIONS Frontloading VFs using SFR produced sets of repeatable perimetric data with significant improvement of reliability indices from the first to second test. This may help increase testing frequency at minimal time cost to meet recommended guidelines and for evaluating patients prone to high variability. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jeremy C K Tan
- Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia; Department of Ophthalmology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia; School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
| | - Jack Phu
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Eye Health, UNSW, Sydney, NSW, Australia; Concord Clinical School, Concord Repatriation General Hospital, Concord, NSW, Australia.
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Kinast RM, Sanchez FG, Rees JP, Yeh K, Gardiner SK, Dawes J, Johnston ML, Porter JD, Klei V, Mansberger SL. Eye Drop Adherence With an Eye Drop Bottle Cap Monitor. J Glaucoma 2023; 32:369-373. [PMID: 37053080 PMCID: PMC10132997 DOI: 10.1097/ijg.0000000000002166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/21/2022] [Indexed: 04/14/2023]
Abstract
PRCIS An eye drop bottle cap monitor with audio and visual alarms measured eye drop adherence in 50 subjects with glaucoma. Baseline adherence rates were too high to test if the alarms could improve adherence. PURPOSE To determine if an eye drop bottle cap monitor can measure and improve adherence. MATERIALS AND METHODS The Devers Drop Device (D3, Universal Adherence LLC) was designed to measure eye drop adherence by detecting bottle cap removal and replacement, and it can provide text, visual and audio alerts when a medication is due. In Stage 1, we determined baseline adherence for 50 subjects using a nightly eye drop over a 25-day period. Subjects with less than 90% baseline adherence were eligible for Stage 2. In Stage 2, we randomized subjects to receive either no reminder or automated D3 alerts for their nightly eye drop over a subsequent 25-day period. We defined adherence as the proportion of drops administered within 3 hours of the subjects' scheduled dosing time. Subjects completed 3 questions regarding satisfaction with the device and willingness to pay. RESULTS The D3 monitor remained attached to the eye drop bottle cap for the duration of the study and collected adherence data in all 50 patients. In Stage 1, the mean adherence rate was 90 ± 18% (range 32-100%). Forty (80%) subjects had an adherence rate greater than 90%. Adherence rates were too high in Stage 1 to adequately test the effects of reminders in Stage 2. Ninety-eight percent (49/50) and 96% (48/50) of subjects agreed "the device always stayed attached to the bottle cap" and "I was able to use the device to take the drops", respectively. Patients would pay $61±83 (range $0-400) for a similar device to improve adherence. CONCLUSIONS The D3 can measure eye drop adherence. Research subjects reported high satisfaction and willingness to pay for an eye drop bottle cap monitor. Glaucoma patients have high adherence when they are being monitored, and future studies with research subjects screened for poor adherence may further determine the benefit of electronic monitoring of adherence with and without electronic reminders.
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Affiliation(s)
| | | | | | | | | | - Jacob Dawes
- Oregon State University, School of Electrical Engineering and Computer Science
| | - Matthew L Johnston
- Oregon State University, School of Electrical Engineering and Computer Science
| | - J David Porter
- Oregon State University, School of Mechanical Industrial and Manufacturing Engineering, Corvallis, OR
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Erras A, Shahrvini B, Weinreb RN, Baxter SL. Review of glaucoma medication adherence monitoring in the digital health era. Br J Ophthalmol 2023; 107:153-159. [PMID: 33858837 PMCID: PMC8517037 DOI: 10.1136/bjophthalmol-2020-317918] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/19/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
Current glaucoma treatments aim to lower intraocular pressure, often with topical ocular hypotensive medications. Unfortunately, the effectiveness of these medications depends on sustained patient adherence to regimens which may involve instilling multiple medications several times daily. Patient adherence to glaucoma medications is often low. Recent innovations in digital sensor technologies have been leveraged to confirm eyedrop medication usage in real-time and relay this information back to providers. Some sensors have also been designed to deliver medication reminders and notifications as well as assist with correct eyedrop administration technique. Here, we review recent innovations targeted at improving glaucoma medication adherence and discuss their limitations.
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Affiliation(s)
- Alaa Erras
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Bita Shahrvini
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sally L Baxter
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
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Oydanich M, Shah Y, Shah K, Khouri AS. An Analysis of the Quality, Reliability, and Popularity of YouTube Videos on Glaucoma. Ophthalmol Glaucoma 2022; 5:306-312. [PMID: 34637976 DOI: 10.1016/j.ogla.2021.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To evaluate the quality, reliability, and popularity of videos relating to glaucoma on YouTube. DESIGN Retrospective, cross-sectional study of YouTube videos about glaucoma. PARTICIPANTS One hundred YouTube videos were analyzed for this study. METHODS An online YouTube search for glaucoma videos was conducted simulating a user search using the keywords glaucoma, high eye pressure, and high intraocular pressure. The first 100 videos were analyzed, and each video was evaluated by 2 independent reviewers using the modified DISCERN (scale, 1-5), Journal of the American Medical Association (JAMA; scale, 0-4), and Global Quality (GQ; scale, 1-5) criteria to assess quality and reliability. Videos were categorized further into 3 groups depending on the source of their upload. Group 1 comprised videos uploaded by academic or government institutions, group 2 comprised videos uploaded by private medical practices, and group 3 comprised videos uploaded by independent users. MAIN OUTCOME MEASURES Modified DISCERN, JAMA, and GQ scores for quality and reliability of information and video power index (VPI) for video popularity. RESULTS No substantial difference in scoring was observed between the 2 independent reviewers. The overall mean ± standard error (SE) scores were modified DISCERN score, 3.81 ± 0.06; JAMA score, 2.93 ± 0.07; and GQ score, 3.98 ± 0.06. The overall mean ± SE VPI score was 9.9 ± 2.9. Significant positive correlations were found between video popularity and quality of information for all 3 criteria (P < 0.05). The videos in groups 1 and 2 showed higher modified DISCERN scores than those in group 3, but did not score higher with either the JAMA or GQ criteria. Videos in group 3 were the most popular when compared with videos in groups 1 or 2 (P < 0.01). CONCLUSIONS Overall, many of the videos had adequate quality and reliability scores. No difference was found among groups 1 through 3 for 2 of the 3 criteria used, suggesting a similar quality of information provided among academic, private, and independent sources.
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Affiliation(s)
- Marko Oydanich
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Yash Shah
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Khelly Shah
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Albert S Khouri
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
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Rodríguez-Agirretxe I, Loizate E, Astorkiza B, Onaindia A, Galdos-Olasagasti L, Basasoro A. Validation of the SITA faster strategy for the management of glaucoma. Int Ophthalmol 2022; 42:2347-2354. [DOI: 10.1007/s10792-022-02232-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Rykowska I, Nowak I, Nowak R. Soft Contact Lenses as Drug Delivery Systems: A Review. Molecules 2021; 26:5577. [PMID: 34577045 PMCID: PMC8472272 DOI: 10.3390/molecules26185577] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 02/07/2023] Open
Abstract
This review describes the role of contact lenses as an innovative drug delivery system in treating eye diseases. Current ophthalmic drug delivery systems are inadequate, particularly eye drops, which allow about 95% of the active substance to be lost through tear drainage. According to the literature, many interdisciplinary studies have been carried out on the ability of contact lenses to increase the penetration of topical therapeutic agents. Contact lenses limit drug loss by releasing the medicine into two layers of tears on either side of the contact lens, eventually extending the time of contact with the ocular surface. Thanks to weighted soft contact lenses, a continuous release of the drug over an extended period is possible. This article reviewed the various techniques to deliver medications through contact lenses, examining their advantages and disadvantages. In addition, the potential of drug delivery systems based on contact lenses has been extensively studied.
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Affiliation(s)
- Iwona Rykowska
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
| | - Iwona Nowak
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
| | - Rafał Nowak
- Eye Department, J. Strus City Hospital, Szwajcarska 3, 61-285 Poznań, Poland;
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Kompella UB, Hartman RR, Patil MA. Extraocular, periocular, and intraocular routes for sustained drug delivery for glaucoma. Prog Retin Eye Res 2021; 82:100901. [PMID: 32891866 PMCID: PMC8317199 DOI: 10.1016/j.preteyeres.2020.100901] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 08/22/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
Although once daily anti-glaucoma drug therapy is a current clinical reality, most therapies require multiple dosing and there is an unmet need to develop convenient, safe, and effective sustained release drug delivery systems for long-term treatment to improve patient adherence and outcomes. One of the first sustained release drug delivery systems was approved for the reduction of intraocular pressure in glaucoma patients. It is a polymeric reservoir-type insert delivery system, Ocusert™, placed under the eyelid and on the ocular surface for zero-order drug release over one week. The insert, marketed in two strengths, released pilocarpine on the eye surface. While many clinicians appreciated this drug product, it was eventually discontinued. No similar sustained release non-invasive drug delivery system has made it to the market to date for treating glaucoma. Drug delivery systems under development include punctal plugs, ring-type systems, contact lenses, implants, microspheres, nanospheres, gels, and other depot systems placed in the extraocular, periocular, or intraocular regions including intracameral, supraciliary, and intravitreal spaces. This article discusses the advantages and disadvantages of the various routes of administration and delivery systems for sustained glaucoma therapy. It also provides the reader with some examples and discussion of drug delivery systems that could potentially be applied for glaucoma treatment. Interestingly, one intracamerally injected implant, Durysta™, was approved recently for sustained intraocular pressure reduction. However, long-term acceptance of such devices has yet to be established. The ultimate success of the delivery system will depend on efficacy relative to eye drop dosing, safety, reimbursement options, and patient acceptance. Cautious development efforts are warranted considering prior failed approaches for sustained glaucoma drug delivery. Neuroprotective approaches for glaucoma therapy including cell, gene, protein, and drug-combination therapies, mostly administered intravitreally, are also rapidly progressing towards assessment in humans.
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Affiliation(s)
- Uday B Kompella
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Colorado Center for Nanomedicine and Nanosafety, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Rachel R Hartman
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Madhoosudan A Patil
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Iorio-Aranha F, Peleteiro B, Rocha-Sousa A, Azevedo A, Barbosa-Breda J. A Scoping Review of Process Indicators for Measuring Quality of Care in Glaucoma. J Glaucoma 2021; 30:e198-e204. [PMID: 33675335 DOI: 10.1097/ijg.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/13/2021] [Indexed: 11/26/2022]
Abstract
PRCIS There are no standardized process quality indicators (QIs) in glaucoma care. Although they can be inferred from guidelines and trials, they should be designed and standardized to allow better assessment of the quality of care. PURPOSE QIs are crucial for assessing the performance of any health care system. To allow efficiency, effectiveness, and patient-centeredness, there is a need for prompt acquisition of up-to-date information. Among the available QIs, process indicators have the highest sensitivity to frequent changes and could better reflect the implementation outcomes of novel ideas and technology. This study aimed to map the available information regarding process QIs in glaucoma care, identify the current development stage of these indicators, and systematically synthesize them. MATERIALS AND METHODS We performed a scoping review of 4 electronic bibliographic databases for studies reporting on process QIs in glaucoma. We retrieved 7502 references and created a domain list reflecting the core idea underlying each indicator. RESULTS We summarized information from 18 documents and listed 20 domains. The most mentioned domains were follow-up, optic nerve head assessment, visual field test, and intraocular pressure. Indicators regarding the quality of life assessment, patient assistance, or presence of written protocols were less frequently mentioned. CONCLUSIONS There are notable variations among process QIs in glaucoma and significant heterogeneity in their descriptions in published studies. Although novel indicators can be inferred from guidelines and trials, they should be designed and standardized for better assessment of performance in health systems to improve their quality.
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Affiliation(s)
- Flavio Iorio-Aranha
- EPIUnit, Institute of Public Health, Universidade do Porto
- Department of Ophthalmology, Faculty of Medicine, Universidade de Brasilia, Brasilia, Brasil
| | - Bárbara Peleteiro
- EPIUnit, Institute of Public Health, Universidade do Porto
- Departments of Public Health and Forensic Sciences and Medical Education
- Hospital Epidemiology Center
| | - Amândio Rocha-Sousa
- Surgery and Physiology and Cardiovascular R&D Center, Faculty of Medicine, Universidade do Porto
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana Azevedo
- EPIUnit, Institute of Public Health, Universidade do Porto
- Departments of Public Health and Forensic Sciences and Medical Education
- Hospital Epidemiology Center
| | - João Barbosa-Breda
- Surgery and Physiology and Cardiovascular R&D Center, Faculty of Medicine, Universidade do Porto
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Neurosciences, Research Group Ophthalmology, KULeuven, Leuven, Belgium
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Sanchez FG, Mansberger SL, Kung Y, Gardiner SK, Burgoyne CF, Cunningham ET, Rees JP, Jones EP, Kinast RM. Novel Eye Drop Delivery Aid Improves Outcomes and Satisfaction. Ophthalmol Glaucoma 2021; 4:440-446. [PMID: 33444854 DOI: 10.1016/j.ogla.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare a nose-pivoted drop delivery device (NPDD) with traditional eye drop delivery in glaucoma subjects. DESIGN Repeated-measures case series. PARTICIPANTS Fifty glaucoma subjects (100 eyes) who reported difficulty self-administering eye drops. METHODS We compared eye drop delivery using a NPDD against traditional delivery techniques at baseline (baseline traditional) and after standardized teaching (post-teaching traditional). Subjects used a 1-to-10 scale (10 being easiest) to rate the ease of delivery with each technique and completed a satisfaction survey. Two graders used digital video to independently review eye drop delivery and recorded: (1) accurate placement: the eye drop reached the ocular surface; (2) no contact: no bottle tip contact against the ocular or periocular surface; and (3)number of eye drops dispensed. We defined primary success as accurate placement and no contact; secondary success as primary success with only 1 drop dispensed. MAIN OUTCOME MEASURES We used logistic-transformed generalized estimating equation (GEE) regression to compare technique satisfaction, accuracy, no contact, and primary and secondary success. Number of drops dispensed was compared using a Cox model. RESULTS Forty-seven of 50 subjects (94%) preferred the NPDD over traditional eye drop delivery. The mean score for ease of use was higher for the NPDD (8.9 ± 1.1) than baseline traditional (6.7 ± 2.1; P < 0.001) and post-teaching traditional (7.0 ± 2.0; P < 0.001). Forty-nine of 50 (98%) subjects thought the NPDD was comfortable to use and would recommend the device. The eye drop reached the ocular surface in a similar percentage of subjects (>90%) with each method. The bottle tip contacted fewer eyes with the NPDD (10 eyes) than baseline traditional (33 eyes; P < 0.001) and post-teaching traditional (25 eyes; P = 0.009). The number of drops dispensed was lower with the NPDD (1.7 ± 1.2) than baseline traditional (2.2 ± 1.6; P = 0.017) and post-teaching traditional (2.4 ± 1.8; P = 0.006). The NPDD increased primary and secondary success of eye drop delivery (86% and 54%, respectively) compared to baseline traditional (66% [P = 0.001] and 28% [P < 0.001]) and post-teaching traditional (70% [P = 0.005] and 40% [P = 0.018]). CONCLUSIONS Eye drop users preferred the NPDD over traditional eye drop delivery. The NPDD improved eye drop delivery success, reduced bottle tip contact, and decreased the number of eye drops wasted.
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Affiliation(s)
- Facundo G Sanchez
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Steven L Mansberger
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | | | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; The Francis I. Proctor Foundation, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Jack P Rees
- Legacy Devers Eye Institute, Portland, Oregon
| | | | - Robert M Kinast
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon.
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13
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Hollenhorst CN, Elliott V, Heisler M, Schneider K, Resnicow K, Newman-Casey PA. Patient Experience during the Support, Educate, Empower Glaucoma Coaching Program to Improve Medication Adherence: A Pilot Study. Ophthalmol Glaucoma 2020; 3:238-252. [PMID: 33008556 DOI: 10.1016/j.ogla.2020.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To understand patients' qualitative experiences with the Support, Educate, Empower (SEE) personalized glaucoma coaching program, provide a richer understanding of the components of the intervention that were useful in eliciting behavior change, and understand how to improve the SEE Program. DESIGN A concurrent mixed-methods process analysis. PARTICIPANTS Thirty-nine patients with a diagnosis of any kind of glaucoma or ocular hypertension who were aged ≥40 years, were taking ≥1 glaucoma medication, spoke English, self-administered their eye drops, and had poor glaucoma medication adherence (defined as taking ≤80% of prescribed medication doses assessed via electronic medication adherence monitors) who completed the 7-month SEE Program. METHODS All participants who completed the study were interviewed in-person using a semistructured interview guide after the intervention. Coders conducted qualitative analysis of transcribed interviews using Grounded Theory. Participants were then stratified into groups based on change in adherence, and thematic differences between groups were examined. MAIN OUTCOME MEASURES Themes that emerged from interviews categorized by the number of participants who expressed a theme and the number of representative citations. RESULTS Participants expressed positive views toward the program overall (95%, n = 37/39). They perceived program components as working together to improve their medication adherence. Interactions with the glaucoma coach (38 participants, 184 citations), motivation to aid personal change (38 participants, 157 citations), personalized glaucoma education (38 participants, 149 citations), electronic reminders, and hearing their adherence score (37 participants, 90 citations) were most commonly cited by participants as helpful program elements contributing to improved adherence. Patients expressed a desire for personalized education to be a standard part of glaucoma care. Participants who demonstrated more improvement in adherence had a more trusting attitude toward the adherence score and a greater magnitude of perceived personal need to improve adherence. CONCLUSIONS Participants reported a highly positive response to the in-person glaucoma education and motivational interviewing intervention used in conjunction with automated adherence reminders.
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Affiliation(s)
- Cecilia N Hollenhorst
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Kevin Schneider
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ken Resnicow
- Department of Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
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14
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Abstract
Glaucoma is an optical neuropathy associated to a progressive degeneration of retinal ganglion cells with visual field loss and is the main cause of irreversible blindness in the world. The treatment has the aim to reduce intraocular pressure. The first therapy option is to instill drugs on the ocular surface. The main limitation of this is the reduced time of the drug staying on the cornea. This means that high doses are required to ensure its therapeutic effect. A drug-loaded contact lens can diffuse into the post lens tear film in a constant and prolonged flow, resulting in an increased retention of the drug on the surface of the cornea for up to 30 min and thus providing a higher drug bioavailability, increasing the therapeutic efficacy, reducing the amount of administered drug, and thereby provoking fewer adverse events. Several different systems of drug delivery have been studied in recent decades; ranging from more simple methods of impregnating the lenses, such as soaking, to more complex ones, such as molecular imprinting have been proposed. Moreover, different drugs, from those already commercially available to new substances such as melatonin have been studied to improve the glaucoma treatment efficacy. This review describes the role of contact lenses as an innovative drug delivery system to treat glaucoma.
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15
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Compliance With Primary Open-angle Glaucoma and Primary Open-angle Glaucoma Suspect Preferred Practice Patterns in a Retail-based Eye Clinic. J Glaucoma 2019; 27:1068-1072. [PMID: 30234750 DOI: 10.1097/ijg.0000000000001093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the level of adherence to the American Academy of Ophthalmology preferred practice pattern (PPP) guidelines for quality primary open-angle glaucoma (POAG) and POAG suspect (POAGS) care among retail-based optometrists. METHODS Patients with a diagnosis of POAG or POAGS who participated in a telemedicine pilot project were included. Patients' charts were evaluated for 15 elements of PPP guidelines for glaucoma care. Results were further stratified by number of follow-up visits and diagnosis. RESULTS Of 360 identified patients, 10 elements were documented in over 98%. Documentation of the remaining 5 components was as follows: dilated fundus examination 91.1%, central corneal thickness (CCT) 88.6%, visual field 78.9%, gonioscopy 47.5%, and target intraocular pressure (IOP) 15.6%. in total, 32.8% of patients were seen once, whereas the remaining 67.2% had multiple visits. In patients with multiple visits, providers were more likely to document systemic history (100.0% vs. 97.5%; P=0.0346), review of systems (100.0% vs. 97.5%; P=0.0346), gonioscopy (60.0% vs. 22.0%; P<0.001), CCT (94.2% vs. 77.1%; P<0.001), visual field (97.5% vs. 40.7%; P<0.001), and target IOP (22.4% vs. 1.7%; P<0.001) compared with single visit patients. In stratifying results by diagnosis, POAG patients more often received visual field testing (92.7% vs. 68.9%; P<0.001) and had an established target IOP (35.1% vs. 1.4%; P<0.001) compared with POAGS patients. CONCLUSIONS Compliance with PPP guidelines for glaucoma care was very high for most elements but lower for performing dilated fundus examination, CCT, visual field, gonioscopy, and target IOP. This study highlights deficiencies in care likely to hamper the detection of glaucoma progression.
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16
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Affiliation(s)
- Alan L. Robin
- Department of Ophthalmology, Johns Hopkins School of Medicine and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Ophthalmology, The University of Michigan, Ann Arbor, MI, USA
| | - Kelly W. Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
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17
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Quigley HA. 21st century glaucoma care. Eye (Lond) 2018; 33:254-260. [PMID: 30305707 DOI: 10.1038/s41433-018-0227-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 11/09/2022] Open
Abstract
Glaucoma care has evolved dramatically over the past generation, with changes that have incorporated new technology and improved understanding of the disease process. A major need is to construct a useful definition of glaucomatous optic neuropathy that can be used to compare data across clinical research studies. The treatment of glaucoma should now be based on achievement of a goal target for intraocular pressure, unique to each patient. Adherence with eye drop treatment is far from ideal and can be improved using reminder systems. Sustained delivery of glaucoma medication is on the horizon. New surgical approaches to glaucoma are being actively studied but have not as yet found their place in its care, with rigorous testing against present treatments needed.
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Affiliation(s)
- Harry A Quigley
- Department of Ophthalmology, Wilmer Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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18
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Lindén C, Heijl A, Jóhannesson G, Aspberg J, Andersson Geimer S, Bengtsson B. Initial intraocular pressure reduction by mono- versus multi-therapy in patients with open-angle glaucoma: results from the Glaucoma Intensive Treatment Study. Acta Ophthalmol 2018; 96:567-572. [PMID: 30242986 PMCID: PMC6221046 DOI: 10.1111/aos.13790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/21/2018] [Indexed: 01/06/2023]
Abstract
Purpose To study newly diagnosed glaucoma patients given mono‐ or multi‐therapy regarding differences in initial intraocular pressure (IOP) reduction, target IOP levels reached and influence of untreated baseline IOP on IOP reduction. Methods Patients newly diagnosed with manifest primary open‐angle glaucoma and included in the Glaucoma Intensive Treatment Study (GITS) were randomized to immediate intensive treatment with any of three different IOP‐lowering substances supplied in two bottles plus 360° laser trabeculoplasty or to conventional stepwise treatment starting with a single‐drug. Intraocular pressure reduction was analysed 1 month after initiation of treatment. Results One hundred eighteen patients (143 eyes) received mono‐therapy and 122 patients (152 eyes) multi‐therapy. Median baseline IOP was 24.0 (min: 9.7, max: 56.0) mmHg in mono‐therapy eyes and 24.0 (min: 12.3, max: 48.5) mmHg in multi‐therapy eyes (p = 0.56). After 1 month in the two groups, respectively, values for median IOP reduction were 6.3 (range: −5.3–31.0) and 11.0 (range: 0.7–34.5) mmHg, and for mean relative decline 26.8 (range: −32.0–55.4) and 46.0 (range: 4.6–81.6) % (p = 0.000). A larger proportion of the multi‐therapy patients reached each target IOP level (p = 0.000). The higher the baseline IOP, the larger the observed pressure reduction, considering both absolute and relative figures. The effect was more pronounced in eyes with multi‐therapy than in those with mono‐therapy (p = 0.000). For every mmHg higher IOP at baseline, the IOP was reduced by an additional 0.56 (mono‐therapy) or 0.84 (multi‐therapy) mmHg. Conclusion Intensive treatment led to considerably greater IOP reduction than mono‐therapy. Among patients with IOP ≥30 mmHg at diagnosis an IOP of <16 was reached in 2/3 of those with multi‐therapy but in none with mono‐therapy. The IOP reduction was highly dependent on the untreated IOP level.
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Affiliation(s)
- Christina Lindén
- Department of Clinical Sciences; Ophthalmology; Umeå University; Umeå Sweden
| | - Anders Heijl
- Department of Clinical Sciences in Malmö; Ophthalmology; Lund University; Malmö Sweden
| | - Gauti Jóhannesson
- Department of Clinical Sciences; Ophthalmology; Umeå University; Umeå Sweden
- Wallenberg Centre for Molecular Medicine; Umeå University; Umeå Sweden
| | - Johan Aspberg
- Department of Clinical Sciences in Malmö; Ophthalmology; Lund University; Malmö Sweden
| | | | - Boel Bengtsson
- Department of Clinical Sciences in Malmö; Ophthalmology; Lund University; Malmö Sweden
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19
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Pitha I, Kimball EC, Oglesby EN, Pease ME, Fu J, Schaub J, Kim YC, Hu Q, Hanes J, Quigley HA. Sustained Dorzolamide Release Prevents Axonal and Retinal Ganglion Cell Loss in a Rat Model of IOP-Glaucoma. Transl Vis Sci Technol 2018; 7:13. [PMID: 29616152 PMCID: PMC5879766 DOI: 10.1167/tvst.7.2.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/21/2017] [Indexed: 01/13/2023] Open
Abstract
Purpose To determine if one injection of a sustained release formulation of dorzolamide in biodegradable microparticles (DPP) reduces retinal ganglion cell (RGC) loss in a rat model of glaucoma. Methods We injected either DPP or control microparticles intravitreally in rats. Two days later, unilateral ocular hypertension was induced by translimbal, diode laser treatment by a surgeon masked to treatment group. IOP and clinical exams were performed until sacrifice 6 weeks after laser treatment. RGC loss was measured by masked observers in both optic nerve cross-sections and RGC layer counts from retinal whole mounts. Results Cumulative IOP exposure was significantly reduced by DPP injection (49 ± 48 mm Hg × days in treated versus 227 ± 191 mm Hg × days in control microparticle eyes; P = 0.012, t-test). While control-injected eyes increased in axial length by 2.4 ± 1.7%, DPP eyes did not significantly enlarge (0.3 ± 2.2%, difference from control, P = 0.03, t-test). RGC loss was significantly less in DPP eyes compared with control microparticle injection alone (RGC axon count reduction: 21% vs. 52%; RGC body reduction: 25% vs. 50% [beta tubulin labeling]; P = 0.02, t-test). Conclusions A single injection of sustained release DPP protected against RGC loss and axial elongation in a rat model of IOP glaucoma. Translational Relevance Sustained release IOP-lowering medications have the potential to stop glaucoma progression.
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Affiliation(s)
- Ian Pitha
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Nanomedicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth C Kimball
- Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ericka N Oglesby
- Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Ellen Pease
- Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jie Fu
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Nanomedicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie Schaub
- Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yoo-Chun Kim
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Nanomedicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Qi Hu
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Nanomedicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin Hanes
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Nanomedicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harry A Quigley
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Nanomedicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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Kaji H, Nagai N, Nishizawa M, Abe T. Drug delivery devices for retinal diseases. Adv Drug Deliv Rev 2018; 128:148-157. [PMID: 28690136 DOI: 10.1016/j.addr.2017.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 06/29/2017] [Accepted: 07/04/2017] [Indexed: 12/16/2022]
Abstract
Retinal degenerative diseases are a leading cause of irreversible blindness and visual impairment, affecting millions of people worldwide. Although intravitreal injection can directly deliver drugs to the posterior segment of the eye, it is invasive and associated with serious side effects. The design of drug delivery systems targeting the posterior segment of the eye in a less invasive manner has still been challenging because of various anatomical and physiological barriers. In this review, we provide an overview of the current implant device-based approaches used for treating retinal degenerative diseases. We then offer our perspectives on future directions and challenges that remain for developing more effective device-based therapies for retinal diseases.
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Affiliation(s)
- Hirokazu Kaji
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki, Aoba-ku, Sendai 980-8579, Japan.
| | - Nobuhiro Nagai
- Division of Clinical Cell Therapy, United Centers for Advanced Research and Translational Medicine (ART), Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai 980-8575, Japan
| | - Matsuhiko Nishizawa
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - Toshiaki Abe
- Division of Clinical Cell Therapy, United Centers for Advanced Research and Translational Medicine (ART), Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai 980-8575, Japan
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21
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Schaefer JL, Meyer AM, Rodgers CD, Rosenberg NC, Leoncavallo AJ, Lukowski ZL, Greer AB, Martorana GM, Zou B, Shuster JJ, Katz LJ, Schuman JS, Kass MA, Sherwood MB. Comparing glaucomatous disc change using stereo disc viewing and the MatchedFlicker programme in glaucoma experts and trainees. Br J Ophthalmol 2018; 102:358-363. [PMID: 28814418 PMCID: PMC8610365 DOI: 10.1136/bjophthalmol-2017-310336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/17/2017] [Accepted: 06/19/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The objective of this study is to evaluate the accuracy and speed of trainees and experienced glaucoma specialists using the MatchedFlicker software against the manual examination of stereoscopic disc photographs for detecting glaucomatous optic disc change. METHODS Three experienced glaucoma specialists, two resident ophthalmologists and one glaucoma fellow from multiple institutions independently evaluated the same 140 image pairs from 100 glaucomatous/ocular hypertensive eyes using a handheld stereo viewer and the MatchedFlicker programme. Fifty had progression to glaucoma as determined by the Ocular Hypertension Treatment Study (OHTS) Optic Disc Reading Group and endpoint committee, and 50 more were negative controls for progression with photos taken a few minutes apart. Twenty photo pairs from each of the two groups were duplicated for reviewer variability analysis. The initial viewing method was randomised and then alternated for each group of 70 image pairs. Reviewer accuracy and evaluation time for each method were measured. RESULTS Evaluators averaged 8.6 s faster per image pair (26%) with the MatchedFlicker programme than with the stereo viewer (p=0.0007). Evaluators correctly identified more image pairs when using the MatchedFlicker software over the stereo viewer (p=0.0003). There was no significant difference between the expert and trainee group in speed or overall accuracy for either method. Experts were significantly more consistent than trainees with the duplicate image pairs (p=0.029). Trainees appeared more reluctant to designate eyes as showing glaucoma progression than experts. CONCLUSIONS Both expert glaucoma specialists and ophthalmologists in various stages of training had greater accuracy and speed with the MatchedFlicker programme than with a handheld stereoscopic viewer.
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Affiliation(s)
- Jamie L Schaefer
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
- Department of Ophthalmology, University at Buffalo, Ross Eye Institute, Buffalo, New York, USA
| | - Alissa M Meyer
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Cooper D Rodgers
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Nicole C Rosenberg
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | | | - Zachary L Lukowski
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Anthony B Greer
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Gina M Martorana
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Baiming Zou
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Jonathan J Shuster
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida, USA
| | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joel S Schuman
- Department of Ophthalmology, New York University, New York City, New York, USA
| | - Michael A Kass
- Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mark B Sherwood
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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22
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Aref AA, Budenz DL. Detecting Visual Field Progression. Ophthalmology 2017; 124:S51-S56. [DOI: 10.1016/j.ophtha.2017.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 10/18/2022] Open
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23
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Chiche A, Martin G, Brasnu de Cenival E, Rousseau A, Giocanti A, Fel A, Kallel S, Lombardi M, Hamard P, Baudouin C, Labbe A. Perception du glaucome et observance thérapeutique : une étude observationnelle multicentrique. J Fr Ophtalmol 2017; 40:477-486. [DOI: 10.1016/j.jfo.2017.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/12/2017] [Accepted: 01/19/2017] [Indexed: 11/25/2022]
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24
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Liang YB, Zhang Y, Musch DC, Congdon N. Proposing new indicators for glaucoma healthcare service. EYE AND VISION 2017; 4:6. [PMID: 28286786 PMCID: PMC5341480 DOI: 10.1186/s40662-017-0071-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/20/2017] [Indexed: 01/17/2023]
Abstract
Glaucoma is the first leading cause of irreversible blindness worldwide with increasing importance in public health. Indicators of glaucoma care quality as well as efficiency would benefit public health assessments, but are lacking. We propose three such indicators. First, the glaucoma coverage rate (GCR), which is the number of people known to have glaucoma divided by the total number of people with glaucoma as estimated from population-based studies multiplied by 100%. Second, the glaucoma detection rate (GDR), which is number of newly diagnosed glaucoma patients in one year divided by the population in a defined area in millions. Third, the glaucoma follow-up adherence rate (GFAR), calculated as the number of patients with glaucoma who visit eye care provider(s) at least once a year over the total number of patients with glaucoma in given eye care provider(s) in a specific period. Regularly tracking and reporting these three indicators may help to improve the healthcare system performance at national or regional levels.
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Affiliation(s)
- Yuan Bo Liang
- Clinical and Epidemiological Eye Research Center, The Eye Hospital of Wenzhou Medical University, Wenzhou, China.,Centre for Public Health, Queens University, Belfast, UK.,Eye Hospital, School of Optometry and Ophthalmology, Wenzhou Medical College, No. 270, Xue Yuan Xi Road, Wenzhou, Zhejiang 3250027 China
| | - Ye Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - David C Musch
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI USA
| | - Nathan Congdon
- Centre for Public Health, Queens University, Belfast, UK
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26
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Abstract
Over the past 10 to 15 years, the availability of new materials and technologies has resulted in revolutionary concepts for contact lenses being proposed that go well beyond correcting vision. These novel uses include their prescribing to deliver topical ocular and systemic drugs, assist with ocular surface disease management, and limit the progression of myopia and novel methods to display visual information. How likely are these concepts to become commercially available, how successful will they be, and what are the potential issues to consider for them to come to market? To answer these questions, a panel of four experts were invited to discuss the benefits and pitfalls of these technologies and what challenges lay ahead of these concepts before their availability. Their responses provide a fascinating insight for the clinician into the likelihood of such revolutionary contact lenses being available in a clinical setting.
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27
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Lowry EA, Hou J, Hennein L, Chang RT, Lin S, Keenan J, Wang SK, Ianchulev S, Pasquale LR, Han Y. Comparison of Peristat Online Perimetry with the Humphrey Perimetry in a Clinic-Based Setting. Transl Vis Sci Technol 2016; 5:4. [PMID: 27486554 PMCID: PMC4959820 DOI: 10.1167/tvst.5.4.4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/09/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose We determined the receiver operating characteristic (ROC) curves for Peristat online perimetry at detecting varying degrees of glaucoma and the correlation between Peristat online perimetry and Humphrey visual field. Methods A prospective, comparative study of Peristat online perimetry (an achromatic static computer threshold testing program) and Humphrey visual field (HVF) 24-2 SITA standard testing was performed by 63 glaucoma patients and 30 healthy controls in random order. The number of total adjacent abnormal test points were identified for each test, and compared with Spearman correlation. Receive operating characteristic curves were generated for Peristat online perimetry detection of mild and moderate-severe glaucoma patients using contrast sensitivity thresholds of −16.7, −21.7, and −26.7 dB. Results The area under the ROC curve for glaucoma detection ranged from 0.77 to 0.81 for mild disease (mean deviation [MD], >−6 dB on HVF) and 0.85 to 0.87 for moderate to severe disease (MD, <−6 dB on HVF) depending on contrast threshold. Peristat online perimetry and Humphrey visual field abnormal points were highly correlated with Spearman rank correlations ranging from 0.55 to 0.77 (all P < 0.001). Conclusions Peristat online perimetry exhibits a reasonable ROC curve without specialized equipment and exhibited significant correlation with the conventional 24° Humphrey visual field test. Translational Relevance Low cost widely available internet-based visual fields may complement traditional office-based visual field testing.
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Affiliation(s)
- Eugene A Lowry
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Jing Hou
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Lauren Hennein
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Robert T Chang
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | - Shan Lin
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Jeremy Keenan
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
| | - Sean K Wang
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | | | - Louis R Pasquale
- Department of Ophthalmology: Harvard Medical School, Boston, MA, USA ; Division of Network Medicine: Brigham and Women's Hospital, Boston, MA, USA
| | - Ying Han
- Department of Ophthalmology, University of California-San Francisco, San Francisco, CA, USA
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Fu J, Sun F, Liu W, Liu Y, Gedam M, Hu Q, Fridley C, Quigley HA, Hanes J, Pitha I. Subconjunctival Delivery of Dorzolamide-Loaded Poly(ether-anhydride) Microparticles Produces Sustained Lowering of Intraocular Pressure in Rabbits. Mol Pharm 2016; 13:2987-95. [PMID: 27336794 DOI: 10.1021/acs.molpharmaceut.6b00343] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Topical medications that inhibit the enzyme carbonic anhydrase (CAI) are widely used to lower intraocular pressure in glaucoma; however, their clinical efficacy is limited by the requirement for multiple-daily dosing, as well as side effects such as blurred vision and discomfort on drop instillation. We developed a biodegradable polymer microparticle formulation of the CAI dorzolamide that produces sustained lowering of intraocular pressure after subconjunctival injection. Dorzolamide was ion paired with sodium dodecyl sulfate (SDS) and sodium oleate (SO) with 0.8% and 1.5% drug loading in poly(lactic-co-glycolic acid) (PLGA), respectively. Encapsulating dorzolamide into poly(ethylene glycol)-co-poly(sebacic acid) (PEG3-PSA) microparticles in the presence of triethylamine (TEA) resulted in 14.9% drug loading and drug release that occurred over 12 days in vitro. Subconjunctival injection of dorzolamide-PEG3-PSA microparticles (DPP) in Dutch belted rabbits reduced IOP as much as 4.0 ± 1.5 mmHg compared to untreated fellow eyes for 35 days. IOP reduction after injection of DPP microparticles was significant when compared to baseline untreated IOPs (P < 0.001); however, injection of blank microparticles (PEG3-PSA) did not affect IOP (P = 0.9). Microparticle injection was associated with transient clinical vascularity and inflammatory cell infiltration in conjunctiva on histological examination. Fluorescently labeled PEG3-PSA microparticles were detected for at least 42 days after injection, indicating that in vivo particle degradation is several-fold longer than in vitro degradation. Subconjunctival DPP microparticle delivery is a promising new platform for sustained intraocular pressure lowering in glaucoma.
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Affiliation(s)
- Jie Fu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Fengying Sun
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Wenhua Liu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Yanfei Liu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Manasee Gedam
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Qi Hu
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Colleen Fridley
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Harry A Quigley
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Justin Hanes
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
| | - Ian Pitha
- Department of Ophthalmology, ‡Center for Nanomedicine, and ∥Glaucoma Center of Excellence, The Johns Hopkins University School of Medicine , Baltimore, Maryland 21287, United States
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Butt NH, Ayub MH, Ali MH. Challenges in the management of glaucoma in developing countries. Taiwan J Ophthalmol 2016; 6:119-122. [PMID: 29018725 PMCID: PMC5525615 DOI: 10.1016/j.tjo.2016.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/04/2016] [Accepted: 01/15/2016] [Indexed: 01/05/2023] Open
Abstract
Glaucoma is the most common optic neuropathy characterized by normal to raised intraocular pressure (IOP), visual field defects, loss of retinal nerve fiber layer, thinning of the neuroretinal rim, and cupping of the optic disc. IOP reduction by medical, laser, or surgical therapies remains the only clinically proven treatment of glaucoma. The challenges in glaucoma management are diverse. They include early detection and diagnosis, setting of appropriate target IOP, choice of treatment, monitoring of quality of life and sight, and compliance with the treatment. Early diagnosis can be made by assessing optic nerve structure using imaging devices and optic nerve function through perimetry. Reducing IOP and controlling its fluctuations are considered to be the most important factors in limiting progression of glaucoma. Selection of the best suitable therapy out of medical, surgical, or laser treatment options is yet another management challenge. Patients suffering from glaucoma experience poor quality of life owing to the diagnosis itself, functional visual loss, inconvenience and cost of treatment, and side effects of treatment. All these factors lead to poor compliance, adherence, and persistence to treatment, and further progression of the disease. It is, therefore, important that ophthalmologists keep all the aforementioned factors in mind when managing patients with glaucoma.
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Affiliation(s)
- Nadeem Hafeez Butt
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Muhammad Hammad Ayub
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Muhammad Hassaan Ali
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
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Clark A, Ng JQ, Morlet N, Semmens JB. Big data and ophthalmic research. Surv Ophthalmol 2016; 61:443-65. [DOI: 10.1016/j.survophthal.2016.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 01/16/2016] [Accepted: 01/25/2016] [Indexed: 02/07/2023]
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Schaefer JL, Lukowski ZL, Meyer AM, Leoncavallo AJ, Greer A, Martorana GM, Zou B, Shuster JJ, Sherwood MB. Comparing Glaucomatous Disc Change Using Stereo Disc Viewing and the MatchedFlicker Software Program in Ophthalmologists-in-Training. Am J Ophthalmol 2016; 167:88-95. [PMID: 27038890 PMCID: PMC5697426 DOI: 10.1016/j.ajo.2016.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the accuracy and speed of using the computerized MatchedFlicker software program (EyeIC Inc, Narberth, Pennsylvania, USA) to evaluate glaucomatous optic disc change against the traditional gold standard of manually examining stereoscopic disc photographs. DESIGN A prospective evaluation of diagnostic technology. METHODS Two resident ophthalmologists and 1 glaucoma fellow at the University of Florida independently evaluated 140 image pairs from 100 glaucomatous/ocular hypertensive patient eyes using a handheld stereo viewer and the MatchedFlicker program. Fifty had progression to glaucoma as determined by the Ocular Hypertension Treatment Study (OHTS) Optic Disc Reading Group and the OHTS Endpoint Committee in the OHTS, and 50 more had photographs taken a few minutes apart, which were negative controls with no progression. Twenty photograph pairs from each group were duplicated to determine reviewer variability. Photographs were examined in alternating blocks of 70 photograph pairs for each method, with the starting viewing method randomized. Reviewer accuracy and time to review for each method were measured. RESULTS Using the handheld stereo viewer, the reviewers correctly identified progression or nonprogression in 76.0% of the slide pairs. Using the MatchedFlicker software, 87.6% were correctly identified (P = .011). Evaluator speed averaged 34.1 seconds per image pair with the stereo viewer vs 24.9 seconds with the MatchedFlicker program (P = .044). Overall, Flicker was significantly more specific but less sensitive than stereo slides. Trainees appeared more reluctant to identify glaucoma progression from slides than from Flicker. For the 2 less experienced trainees Flicker was significantly more accurate. CONCLUSION The MatchedFlicker software had a greater accuracy and was quicker to perform than using a handheld stereoscopic viewer.
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Affiliation(s)
- Jamie L Schaefer
- University of Florida, Department of Ophthalmology, Gainesville, Florida; Ross Eye Institute, University at Buffalo, Department of Ophthalmology, Buffalo, New York
| | - Zachary L Lukowski
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Alissa M Meyer
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | | | - Anthony Greer
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Gina M Martorana
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Baiming Zou
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Jonathan J Shuster
- University of Florida, Department of Ophthalmology, Gainesville, Florida
| | - Mark B Sherwood
- University of Florida, Department of Ophthalmology, Gainesville, Florida.
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Griffith JF, Goldberg JL. The Frequency of Optical Coherence Tomography Testing in Glaucoma at a Single Academic Medical Center. J Glaucoma 2016; 25:e241-7. [PMID: 26372155 PMCID: PMC4885912 DOI: 10.1097/ijg.0000000000000306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the frequency of optical coherence tomography (OCT) examinations compared with clinical examinations and visual field (VF) tests in patients with 5 types of glaucoma. PATIENTS AND METHODS A retrospective, longitudinal cohort study was conducted of 5154 patients treated between 2003 and 2010 at a single academic medical center. Patients were classified using billing records as having primary open-angle glaucoma, low-tension open-angle glaucoma (NTG), pigmentary open-angle glaucoma, chronic angle-closure glaucoma, or pseudoexfoliation glaucoma. Analysis of variance, χ test, and exact χ test were performed to identify associations between glaucoma type and test frequency. RESULTS Pigmentary open-angle glaucoma and NTG patients had a higher rate of undergoing at least 2 VFs (94.4%, 94.9%), and chronic angle-closure glaucoma patients had a lower rate of undergoing at least 2 OCTs (25.3%) than all other glaucoma types. NTG patients also had the highest rate of undergoing at least 2 OCTs and at least 2 VFs (36.6%). Overall, the rate of clinical examinations (2.68 examinations/y) exceeded the rates of OCTs (1.39 examinations/y), which exceeded the rate of VF tests (1.24 tests/y). There were no differences in OCT frequency between glaucoma types (0.91 to 1.63 OCTs/y). Within each glaucoma diagnosis, patients had clinical examinations more frequently than OCTs and clinical examinations more frequently than VFs. Primary open-angle glaucoma and pseudoexfoliation glaucoma patients also had OCTs more frequently than VFs. More patients had at least 2 VF tests than at least 2 OCTs (4481 vs. 1679). CONCLUSION The relative use of clinical examinations, VF testing, and OCT imaging varies among glaucoma diagnoses.
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Affiliation(s)
- Joseph F Griffith
- *Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL †Cole Eye Institute, Cleveland Clinic, Cleveland, OH ‡Shiley Eye Center, University of California San Diego, San Diego, CA
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Owsley C, Rhodes LA, McGwin G, Mennemeyer ST, Bregantini M, Patel N, Wiley DM, LaRussa F, Box D, Saaddine J, Crews JE, Girkin CA. Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) for adults at risk for glaucoma: study rationale and design. Int J Equity Health 2015; 14:135. [PMID: 26582103 PMCID: PMC4652429 DOI: 10.1186/s12939-015-0213-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/03/2015] [Indexed: 12/30/2022] Open
Abstract
Background Primary open angle glaucoma is a chronic, progressive eye disease that is the leading cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about 10 years earlier in African Americans as compared to whites. African Americans are also less likely to receive comprehensive eye care when glaucoma could be detected before irreversible blindness. Screening and follow-up protocols for managing glaucoma recommended by eye-care professional organizations are often not followed by primary eye-care providers, both ophthalmologists and optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care for African Americans. Telemedicine may be an effective solution for improving management and diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically transmitted to remote reading centers where tertiary care specialists can examine the results. We describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY), set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving communities with a large percentage of African Americans. Methods/Design We conducted an observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations and diagnostic testing for glaucoma, followed by the optometrist’s diagnosis and a preliminary management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who completed fellowship training in glaucoma review results and provide feedback to the optometrist, who manages the care of the patient. Patients also receive eye health education about glaucoma and comprehensive eye care. Research questions include diagnostic and management agreement between providers, the impact of eye health education on patients’ knowledge and adherence to follow-up and medication, patient satisfaction, program cost-effectiveness, and EQUALITY’s impact on Walmart pharmacy prescription rates. Discussion As eye-care delivery systems in the US strive to improve quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-risk for chronic blinding diseases.
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Affiliation(s)
- Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA.
| | - Lindsay A Rhodes
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA.
| | - Gerald McGwin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA. .,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1655 University Blvd, Birmingham, AL, 35294-0022, USA.
| | - Stephen T Mennemeyer
- Department of Health Care Organization and Policy, School of Public Health, 1655 University Blvd, Birmingham, 35294-0022, USA.
| | - Mary Bregantini
- Prevent Blindness, 211 West Wacker Drive, Suite 1700, Chicago, Il, 60606, USA.
| | - Nita Patel
- Prevent Blindness, 211 West Wacker Drive, Suite 1700, Chicago, Il, 60606, USA.
| | - Demond M Wiley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA.
| | - Frank LaRussa
- Walmart Vision Center #1481, Birmingham, AL, 35209, USA.
| | - Dan Box
- Walmart Vision Center #715 and Global Eye Care PC, Tuscaloosa, AL, 35405, USA.
| | - Jinan Saaddine
- Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, 30341-3727, USA.
| | - John E Crews
- Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, 30341-3727, USA.
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S. 18th St, Birmingham, AL, 35294-0009, USA.
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Zebardast N, Solus JF, Quigley HA, Srikumaran D, Ramulu PY. Comparison of resident and glaucoma faculty practice patterns in the care of open-angle glaucoma. BMC Ophthalmol 2015; 15:41. [PMID: 25879212 PMCID: PMC4403911 DOI: 10.1186/s12886-015-0027-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/30/2015] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies suggest there are large variations in adherence of ophthalmologists with the American Academy of Ophthalmology’s Preferred Practice Patterns (PPPs). The purpose of this study was to compare rates of compliance with glaucoma care guidelines between resident and glaucoma faculty physicians at a single institution. Methods Charts of resident continuity clinic or glaucoma faculty patients with primary open angle glaucoma (POAG), ocular hypertension (OHTN), or suspicion of glaucoma were reviewed during the 2005–6 academic year. Performance within care measures specified by the 2005 PPP guidelines was compared between resident and faculty physicians using univariate and multivariable logistic regression models. Results 112 resident and 100 faculty charts were reviewed. The mean compliance rate for all 7 care measures for resident physicians was significantly lower than that of faculty physicians (78% vs. 96%, p < 0.001). As compared to glaucoma faculty, resident physicians were less likely to have documented 6 of the 7 individual care measures (p ≤ 0.001 for all); the exception was optic nerve (ON) description. In multivariable analyses, resident patients were more likely to have at least one undocumented care measure than faculty patients (OR = 10.1, 95% CI = 5.1 to 20.0, p < 0.001). Among resident patients, undocumented care measures were more common among patients with poorer visual acuity (VA) in the better eye. Conclusions Though unmeasured differences in clinic structure and patient characteristics may have partially contributed to poorer resident performance, residents were more likely than faculty to omit PPP care measures and significantly underperformed faculty in global assessment of glaucoma care. Resident education should focus on integration of PPPs into residency training and monitoring of resident compliance with evidence-based guidelines.
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Affiliation(s)
- Nazlee Zebardast
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Jason F Solus
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Harry A Quigley
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Divya Srikumaran
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Pradeep Y Ramulu
- Wilmer Eye Institute Johns Hopkins University, 600 North Wolfe St. Maumenee B-110, Baltimore, MD, 21287, USA.
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Tamrat L, Gessesse GW, Gelaw Y. Adherence to topical glaucoma medications in Ethiopian patients. Middle East Afr J Ophthalmol 2015; 22:59-63. [PMID: 25624675 PMCID: PMC4302478 DOI: 10.4103/0974-9233.148350] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Successful outcomes of medical treatment for glaucoma require proper and daily use of medication to prevent disease progression. The aim of this study was to determine the adherence to anti-glaucoma medications and factors associated with non-adherence among patients with ocular hypertension (OHT) or glaucoma at Jimma University Specialized Hospital, Ethiopia. Materials and Methods: A hospital based cross sectional study was conducted on 200 consecutive patients from July to November 2010 at Jimma University Hospital in Southwest Ethiopia. Patients with OHT or glaucoma who were taking topical anti-glaucoma medications for more than six months were included. The study subjects were interviewed and their medical records were reviewed. Non-adherence to glaucoma therapy (NAGT) was defined as self-reported on missed medications or missed appointments, or a physician noting poor adherence. A P < 0.05 was statistically significant. Result: Overall, 135 (67.5%) patients were non adherent to glaucoma therapy. Non adherence was associated with older age (P = 0.04), advanced stage of glaucoma (P = 0.01), longer frequency of follow up (P = 0.00) and financial problem (P = 0.000). Sex (P = 0.53), level of education (P = 0.09), and marital status (P = 0.77) were not statistically significantly associated with non-adherence to anti-glaucoma drug treatment. Conclusion: A relatively high proportion of patients were not adhering to the medications regimen for glaucoma. Older age, advanced glaucoma, lengthier frequency of follow-up and financial hardship were associated with non-adherence. Eye care providers should be aware of the problem of non-adherence to topical medications.
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Affiliation(s)
- Lemlem Tamrat
- Department of Ophthalmology, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yeshigeta Gelaw
- Department of Ophthalmology, Jimma University, Jimma, Ethiopia
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Carvalho I, Marques C, Oliveira R, Coelho P, Costa P, Ferreira D. Sustained drug release by contact lenses for glaucoma treatment—A review. J Control Release 2015; 202:76-82. [DOI: 10.1016/j.jconrel.2015.01.023] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 01/11/2023]
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Crabb DP, Russell RA, Malik R, Anand N, Baker H, Boodhna T, Bronze C, Fung SSM, Garway-Heath DF, Glen FC, Hernández R, Kirwan JF, Lemer C, McNaught AI, Viswanathan AC. Frequency of visual field testing when monitoring patients newly diagnosed with glaucoma: mixed methods and modelling. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02270] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundVisual field (VF) tests are the benchmark for detecting and monitoring the eye disease glaucoma. Measurements from VF tests are variable, which means that frequent monitoring, perhaps over a long period of time, is required to accurately detect true glaucomatous progression. In 2009, guidelines for the diagnosis and management of glaucoma issued by the National Institute for Health and Care Excellence revealed an absence of research evidence about the clinical effectiveness and cost-effectiveness of using different monitoring intervals to detect disease progression. However, the European Glaucoma Society (EGS) guidelines on patient examination recommend that newly diagnosed glaucoma patients should undergo VF testing three times per year in the first 2 years after initial diagnosis.ObjectivesThe primary objective of this project was to explore the clinical effectiveness and cost-effectiveness of using different monitoring intervals to detect VF progression in newly diagnosed glaucoma patients. Other objectives sought to (1) explore glaucoma patients’ views and experiences of monitoring using focus groups; and (2) establish glaucoma subspecialists’ attitudes regarding frequency of VF testing using a five-item questionnaire.DesignThese questions were investigated using a multicentre audit of current practice and existing NHS data (VF records from almost 90,000 patients). New research knowledge was provided through statistical and health economic modelling of these and additional published data.ResultsThe multicentre audit showed that VF monitoring is, on average, carried out annually. Patient focus groups indicated that, although patients do not like VF testing, they accept it as a critical part of their care. Patients raised concerns regarding distracting testing environments, quality of instructions, explanation of results and excessive waiting times. Questionnaires revealed that clinicians’ attitudes towards the frequency of VF testing varied considerably, and many glaucoma specialists believed that current recommendations are impractical. Statistical modelling suggested that EGS recommendations could be clinically effective as progression can be identified sooner than is possible with annual testing. Health economic modelling suggested that increased VF monitoring may also be cost-effective [incremental cost-effectiveness ratio (ICER) was equal to £21,679].ConclusionsStatistical modelling of VF data suggests there is strong rationale for following EGS recommendations with the primary benefit of providing better information about fast-progressing patients. Our health economic model suggested that increasing VF testingmaybe cost-effective (ICER was equal to £21,679), especially when accounting for gains to society. Nevertheless, many clinicians consider increased VF testing of patients impossible with current resources. In addition, patient focus groups raised concerns about the practicalities of delivery of VF tests.Future workResults from this study could inform the design of a prospective randomised comparative trial of different VF monitoring intervals in glaucoma linked to stratifying patients according to risk factors for progression. The statistical model for VF data can be further developed to be used as a practical tool for optimising individualised follow-up. The views of clinicians and patients indicate that service delivery of VF testing is an important issue and worthy of further investigation. Ensuring the confidence and co-operation of the patient should be at the centre of future research into the most efficient strategies for glaucoma monitoring.FundingThis work was funded by the National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - Richard A Russell
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Rizwan Malik
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Nitin Anand
- Department of Ophthalmology, Calderdale and Huddersfield NHS Trust, Calderdale and Huddersfield Royal Infirmaries, Halifax and Huddersfield, UK
| | - Helen Baker
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - Trishal Boodhna
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | | | - Simon SM Fung
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - David F Garway-Heath
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Fiona C Glen
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - Rodolfo Hernández
- Health Services Research Unit, University of Aberdeen and Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - James F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Andrew I McNaught
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, and Cranfield University, Bedford, UK
| | - Ananth C Viswanathan
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Hsu KH, Fentzke RC, Chauhan A. Feasibility of corneal drug delivery of cysteamine using vitamin E modified silicone hydrogel contact lenses. Eur J Pharm Biopharm 2013; 85:531-40. [DOI: 10.1016/j.ejpb.2013.04.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/26/2013] [Accepted: 04/28/2013] [Indexed: 01/18/2023]
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Ong SS, Sanka K, Mettu PS, Brosnan TM, Stinnett SS, Lee PP, Challa P. Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma. Ophthalmology 2013; 120:2462-2469. [PMID: 23916487 DOI: 10.1016/j.ophtha.2013.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. DESIGN Retrospective chart review. PARTICIPANTS One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. METHODS Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. MAIN OUTCOME MEASURES Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. RESULTS The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. CONCLUSIONS Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care.
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Affiliation(s)
- Sally S Ong
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Duke-NUS Graduate Medical School, Singapore, Republic of Singapore
| | - Krishna Sanka
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Eye Centers of Racine and Kenosha, Racine, Wisconsin
| | - Priyatham S Mettu
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | | | - Sandra S Stinnett
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Paul P Lee
- W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Pratap Challa
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina.
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Jung HJ, Chauhan A. Extended release of timolol from nanoparticle-loaded fornix insert for glaucoma therapy. J Ocul Pharmacol Ther 2012. [PMID: 23205896 DOI: 10.1089/jop.2012.0114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We have developed a cylindrical insert that can be inserted in the fornix for extended release of glaucoma drug timolol. The insert is prepared by incorporating timolol-loaded nanoparticles into a poly hydroxyl ethyl methacrylate (p-HEMA) matrix. A 1-mm diameter, 7.5-mm long insert with 25% (w/w) particles can release timolol for about 10 days at an average rate of about 15 μg/day, which may be therapeutically effective. The increase in particle fraction increases drug loading, but also increases the release duration. The net effect of increasing the particle fraction is a significant increase in release duration, but a decrease in daily drug release rates, in the first few weeks. The release duration increases to about 1 and 3 months on increasing the particle fraction to 50% and 75%, respectively. The average daily release rates in the first 3 weeks are 15, 9, and 3 μg/day for the inserts with 50%, 75%, and 100% (w/w) particles, respectively. The mechanism of release is hydrolysis of the ester bond that links timolol to the propoxylated glyceryl triacrylate matrix, and thus the release profiles fit a first order reaction model. The water content of the inserts decreases from 31% to almost zero on increasing the particle loading from 25% to 100%. The rate constant for the hydrolysis decreases with an increase in particle loading in the insert most likely due to the reduction in the water content. The inserts can be packaged in wet conditions and stored in a refrigerator, but the inserts will exhibit a burst release caused by release of the drug from the particles into the p-HEMA matrix during the shelf life. Also, the magnitude of drug release after the initial burst is reduced due to the storage. The burst effect could potentially be avoided by packaging the inserts in a dry state, with hydration before insertion.
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Affiliation(s)
- Hyun Jung Jung
- Department of Chemical Engineering, University of Florida, Gainesville, FL 32611, USA
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Swamy L, Smith S, Radcliffe NM. Optic nerve complex imaging in glaucoma Medicare beneficiaries. Ophthalmic Epidemiol 2012; 19:249-55. [PMID: 22775282 DOI: 10.3109/09286586.2012.691601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the frequency of fundus photography and scanning computerized ophthalmic diagnostic imaging (SCODI) on patients receiving glaucoma care under Medicare. METHODS In this retrospective, observational, Medicare claims-based study, we used a 5% random sample, from 2006-2008, of Medicare beneficiaries, selected for International Classification of Diseases, 9th Revision (ICD-9) diagnoses of glaucoma or glaucoma suspect, who had greater than one year of follow up (N = 143,374). The proportion of patients with an ICD-9 diagnosis of glaucoma or glaucoma suspect who received fundus photography (Physicians' Current Procedural Terminology, CPT 99250) or scanning computerized ophthalmic diagnostic imaging (SCODI; CPT 92135) was determined. RESULTS A total of 48% of patients did not have any form of imaging during the study period. Among those who were imaged, 27% were imaged only once. The use of fundus photography was significantly lower than the use of SCODI (p < 0.00005). A total of 75% of those imaged once received SCODI while only 25% were photographed. Analysis of optic nerve complex imaging over time revealed that 20% received SCODI and 6% were photographed in the first quarter of appearance of the glaucoma or suspect diagnosis code in the dataset, with a decline thereafter. CONCLUSIONS Optic disc imaging in patients diagnosed with glaucoma or glaucoma suspect may not meet guidelines set by the American Academy of Ophthalmology. While both modalities are underused, optic disc photos are performed less often and repeated less frequently when compared to SCODI. Underuse of imaging may negatively impact detection of disease progression over time in glaucoma patients.
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Affiliation(s)
- Lakshmi Swamy
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10021, USA
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Peng CC, Burke MT, Carbia BE, Plummer C, Chauhan A. Extended drug delivery by contact lenses for glaucoma therapy. J Control Release 2012; 162:152-8. [DOI: 10.1016/j.jconrel.2012.06.017] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/29/2012] [Accepted: 06/09/2012] [Indexed: 12/31/2022]
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Regional Variations and Trends in the Prevalence of Diagnosed Glaucoma in the Medicare Population. Ophthalmology 2012; 119:1342-51. [DOI: 10.1016/j.ophtha.2012.01.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 01/15/2012] [Accepted: 01/17/2012] [Indexed: 11/23/2022] Open
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Abstract
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.
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Abstract
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.
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Peng CC, Ben-Shlomo A, Mackay EO, Plummer CE, Chauhan A. Drug Delivery by Contact Lens in Spontaneously Glaucomatous Dogs. Curr Eye Res 2012; 37:204-11. [DOI: 10.3109/02713683.2011.630154] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Stein JD, Talwar N, Laverne AM, Nan B, Lichter PR. Trends in use of ancillary glaucoma tests for patients with open-angle glaucoma from 2001 to 2009. Ophthalmology 2012; 119:748-58. [PMID: 22218146 DOI: 10.1016/j.ophtha.2011.09.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 09/24/2011] [Accepted: 09/26/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To assess trends in the use of ancillary diagnostic tests in the evaluation of patients with open-angle glaucoma (OAG) and glaucoma suspects over the past decade. DESIGN Retrospective, longitudinal cohort analysis. PARTICIPANTS A total of 169 917 individuals with OAG and 395 721 individuals with suspected glaucoma aged ≥40 years enrolled in a national United States managed care network between 2001 and 2009. METHODS Claims data were analyzed to assess trends in visual field (VF) testing, fundus photography (FP), and other ocular imaging (OOI) testing for patients with OAG or suspected glaucoma between 2001 and 2009. Repeated-measures logistic regression was performed to identify differences in the odds of undergoing these procedures in 2001, 2005, and 2009 and whether differences exist for patients under the exclusive care of optometrists versus ophthalmologists. MAIN OUTCOME MEASURES Odds and annual probabilities of undergoing VF testing, FP, and OOI for OAG from 2001 to 2009. RESULTS For patients with OAG, the odds of undergoing VF testing decreased by 36% from 2001 to 2005, by 12% from 2005 to 2009, and by 44% from 2001 to 2009. By comparison, the odds of having OOI increased by 100% from 2001 to 2005, by 24% from 2005 to 2009, and by 147% from 2001 to 2009. Probabilities of undergoing FP were relatively low (13%-25%) for both provider types and remained fairly steady over the decade. For patients cared for exclusively by optometrists, the probability of VF testing decreased from 66% in 2001 to 44% in 2009. Among those seen exclusively by ophthalmologists, the probability of VF testing decreased from 65% in 2001 to 51% in 2009. The probability of undergoing OOI increased from 26% in 2001 to 47% in 2009 for patients of optometrists and from 30% in 2001 to 46% in 2009 for patients of ophthalmologists. By 2008, patients with OAG receiving care exclusively by optometrists had a higher probability of undergoing OOI than VF testing. CONCLUSIONS From 2001 to 2009, OOI increased dramatically whereas VF testing declined considerably. Because OOI has not been shown to be as effective at detecting OAG or disease progression compared with VF testing, increased reliance on OOI technology, in lieu of VF testing, may be detrimental to patient care.
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Affiliation(s)
- Joshua D Stein
- W.K. Kellogg Eye Center, University of Michigan, Department of Ophthalmology and Visual Sciences, 1000 Wall Street, Ann Arbor, MI 48105, USA.
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Boland MV, Quigley HA, Lehmann HP. The impact of physician subspecialty training, risk calculation, and patient age on treatment recommendations in ocular hypertension. Am J Ophthalmol 2011; 152:638-645.e1. [PMID: 21742305 DOI: 10.1016/j.ajo.2011.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/15/2011] [Accepted: 03/17/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine whether glaucoma subspecialty training, formal risk estimation, or patient age has an impact on physician treatment recommendations in cases of ocular hypertension. DESIGN Experimental study. METHODS Members of the American Academy of Ophthalmology (118) and American Glaucoma Society (58) were recruited. Each physician was first asked how many young and old patients with ocular hypertension he or she would treat to prevent someone from progressing to glaucoma (number needed to treat). The physicians then reviewed 100 simulated cases of patients with ocular hypertension and reported their likelihood to treat each case. Half of these cases were presented with an estimated risk of conversion to glaucoma within 5 years and half were presented without an estimate. The treatment recommendations were analyzed to determine whether subspecialty status or the presence of a risk calculation had any impact on treatment recommendations. RESULTS Both glaucoma specialists and non-glaucoma specialists were more likely to recommend treatment in cases for which a risk calculation was provided (P = .001). Furthermore, non-glaucoma specialists were more likely to recommend treatment for ocular hypertensive patients than were glaucoma specialists (P < .001). Finally, both groups indicated they were more likely to treat young patients than old. CONCLUSIONS Both provision of a risk estimate and lack of glaucoma subspecialty training were associated with physicians being more likely to treat ocular hypertension. These findings have implications with regard to ways in which the treatment of ocular hypertensive patients could be modified and possibly made more consistent with available evidence.
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Fain JM, Kotak S, Mardekian J, Bacharach J, Edward DP, Rauchman S, Brevetti T, Fox JL, Lovelace C. A multicenter, retrospective chart review study comparing index therapy change rates in open-angle glaucoma or ocular hypertension patients newly treated with latanoprost or travoprost-Z monotherapy. BMC Ophthalmol 2011; 11:13. [PMID: 21668980 PMCID: PMC3136403 DOI: 10.1186/1471-2415-11-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 06/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because latanoprost and the original formulation of travoprost that included benzalkonium chloride (BAK) have been shown to be similar with regard to tolerability, we compared initial topical intraocular pressure (IOP)-lowering medication change rates in patients newly treated with latanoprost or travoprost-Z monotherapy. METHODS At 14 clinical practice sites, medical records were abstracted for patients with a diagnosis of open-angle glaucoma or ocular hypertension and who were ≥40 years of age, had a baseline and at least one follow-up visit, and had no prior history of ocular prostaglandin use. Data regarding demographics, ocular/systemic medical histories, clinical variables, therapy initiations and reasons for changes, adverse events, and resource utilization were recorded from randomly chosen eligible charts. Primary outcomes were rates of and reasons for changing from the initial therapy within six months and across the full study period (1000 days). RESULTS Data from 900 medical charts (latanoprost, 632; travoprost-Z, 268) were included. For both cohorts, average follow-up was >1 year. Cohorts were similar with regard to age (median ~67 years), gender distribution (>50% female), and diagnosis (~80% with open-angle glaucoma). Within six months, rates of index therapy change for latanoprost versus travoprost-Z were 21.2% (134/632) and 28.7% (77/268), respectively (p = 0.0148); across the full study period, rates were 34.5% (218/632) and 45.2% (121/268), respectively (p = 0.0026). Among those who changed their index therapy, insufficient IOP control was the most commonly reported reason followed by adverse events; hyperemia was the most commonly reported adverse event at index therapy change. CONCLUSIONS In this "real world" study of changes in therapy in patients prescribed initial monotherapy with latanoprost with BAK or travoprost-Z with SofZia, medication changes were common in both treatment groups but statistically significantly more frequent with travoprost-Z.
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Hermann MM, Papaconstantinou D, Muether PS, Georgopoulos G, Diestelhorst M. Adherence with brimonidine in patients with glaucoma aware and not aware of electronic monitoring. Acta Ophthalmol 2011; 89:e300-5. [PMID: 21106046 DOI: 10.1111/j.1755-3768.2010.02050.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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 enrolled 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.
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