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Kolko M, Faergemann Hansen R, G Dal L, Sabelström E, Brandel M, Hoiberg Bentsen A, Falch-Joergensen AC. Predictors and long-term patterns of medication adherence to glaucoma treatment in Denmark-an observational registry study of 30 100 Danish patients with glaucoma. BMJ Open Ophthalmol 2024; 9:e001607. [PMID: 38626933 PMCID: PMC11029215 DOI: 10.1136/bmjophth-2023-001607] [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: 12/07/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Self-treatment with glaucoma medication (eye drops) has been associated with adherence challenges. Poor adherence results in worse outcomes in terms of visual field loss. OBJECTIVE To investigate patterns in medication adherence among Danish patients with glaucoma in relation to selected predictors of adherence, long-term adherence patterns, and long-term societal economic consequences of poor adherence. METHODS AND ANALYSIS This register-based study included 30 100 glaucoma patients followed for 10 years between 2000 and 2018. Glaucoma was identified from the Danish national registers by diagnosis of Open Angle Glaucoma and/or by redeemed prescriptions of glaucoma medication. Logistic regression models were applied to estimate patient characteristics related to medical adherence. Diagnosis-related group fees were applied to estimate healthcare costs. RESULTS High adherence in the first year(s) of treatment was less likely among men (ORfirst year: 0.78, 95% CI: 0.75 to 0.82), younger individuals and among those with a positive Charlson Comorbidity Index (CCI) score (ORfirst year/CCI≥3: 0.71, 95% CI: 0.63 to 0.80). Adherence in the first year and in the first two years was associated with adherence in the fifth (ORfirst year: 4.55, 95% CI: 4.30 to 4.82/ORfirst two years: 6.47, 95% CI: 6.10 to 6.86) as with adherence in the 10th year with slightly lower estimates. Being medical adherent was related to higher costs related to glaucoma medication after 5 and 10 years comparing with poor adherence, whereas poor adherence was associated with a marked increase in long-term costs for hospital contacts. CONCLUSION Increasing age, female sex and low comorbidity score are correlated with better adherence to glaucoma treatment. Adherence in the first years of treatment may be a good predictor for future adherence. In the long term, patients with poor adherence are overall more expensive to society in terms of hospital contacts.
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Affiliation(s)
- Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
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Ahmed T, Islam MN, Monalisa R, Ehsan F, Huang SW. Polysaccharides polymers for glaucoma treatment-a review. Eur J Ophthalmol 2024; 34:338-356. [PMID: 37231538 DOI: 10.1177/11206721231178057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
One of the major challenges in preventing glaucoma progression is patient compliance with medication regimens. Since conventional ophthalmic dosage forms have numerous limitations, researchers have been intensively working on developing polymers-based delivery systems for glaucoma drugs. Specifically, research and development efforts have increased using polysaccharide polymers such as sodium alginate, cellulose, β-cyclodextrin, hyaluronic acid, chitosan, pectin, gellan gum, galactomannans for sustained release to the eye to overcome treatment challenges, showing promise in improving drug release and delivery, patient experience, and treatment compliance. In the recent past, multiple research groups have successfully designed sustained drug delivery systems, promoting the efficacy as well as the feasibility of glaucoma drugs with single/combinations of polysaccharides to eliminate the drawbacks associated with the glaucoma treatment. Naturally available polysaccharides, when used as drug vehicles can increase the retention time of eye drops on the ocular surface, leading to improved drug absorption and bioavailability. Additionally, some polysaccharides can form gels or matrices that can release drugs slowly over time, providing sustained drug delivery and reducing the need for frequent dosing. Thus, this review aims to provide an overview of the pre-clinical and clinical studies of polysaccharide polymers applied for glaucoma treatment along with their therapeutic outcomes.
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Affiliation(s)
- Tanvir Ahmed
- Food Engineering & Tea Technology, Shahjalal University of Science & Technology, Sylhet 3114, Bangladesh
| | - Md Nazmul Islam
- Deaprtment of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Rina Monalisa
- Deaprtment of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Feroz Ehsan
- Department of Medicine, Aziz Fatimah Hospital, Faisalabad 38000, Pakistan
| | - Shu-Wei Huang
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
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3
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Bharadwaj AD, Kravets S, Hallak J, Bhat P, Lobo-Chan AM. Patient Adherence to Immunosuppressive Therapy in Treatment of Chronic Inflammatory Eye Disease. Ocul Immunol Inflamm 2024; 32:5-10. [PMID: 36442053 DOI: 10.1080/09273948.2022.2145314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
TITLE Patient Adherence to Immunosuppressive Therapy for Chronic Inflammatory Eye Disease. PURPOSE To investigate adherence rates to immunosuppressive therapy (IMT) for treatment of noninfectious inflammatory eye disease (IED), adherence and disease control, and factors associated with nonadherence. METHOD Retrospective review of medical charts from 2015 to 2020 was conducted on patients with IED at 6 months, 1 and 2 years after initiation of IMT. RESULTS Of 183 patients, adherence rates at 6 months and 1 year were 70% and 58% by 2 years. Eighty-two percent, 78%, and 65% of patients with disease quiescence were adherent at 6 months, 1 and 2 years, respectively. Adherent patients have 1.86 (95% CI 1.09, 3.20) times greater likelihood for disease control compared to nonadherent. Primary reason for nonadherence was patient self-discontinuation. No specific factors were associated with nonadherence. CONCLUSION Patients on IMT for IED had steady adherence rates up to 1 year, with decreased adherence at 2 years. Adherence to IMT significantly correlates with disease quiescence.
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Affiliation(s)
- Arthi D Bharadwaj
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sasha Kravets
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joelle Hallak
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- AbbVie, North Chicago, Illinois, USA
| | - Pooja Bhat
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ann-Marie Lobo-Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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4
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Hsueh HT, Chou RT, Rai U, Kolodziejski P, Liyanage W, Pejavar J, Mozzer A, Davison C, Appell MB, Kim YC, Leo KT, Kwon H, Sista M, Anders NM, Hemingway A, Rompicharla SVK, Pitha I, Zack DJ, Hanes J, Cummings MP, Ensign LM. Engineered peptide-drug conjugate provides sustained protection of retinal ganglion cells with topical administration in rats. J Control Release 2023; 362:371-380. [PMID: 37657693 PMCID: PMC10591956 DOI: 10.1016/j.jconrel.2023.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/03/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
Effective eye drop delivery systems for treating diseases of the posterior segment have yet to be clinically validated. Further, adherence to eye drop regimens is often problematic due to the difficulty and inconvenience of repetitive dosing. Here, we describe a strategy for topically dosing a peptide-drug conjugate to achieve effective and sustained therapeutic sunitinib concentrations to protect retinal ganglion cells (RGCs) in a rat model of optic nerve injury. We combined two promising delivery technologies, namely, a hypotonic gel-forming eye drop delivery system, and an engineered melanin binding and cell-penetrating peptide that sustains intraocular drug residence time. We found that once daily topical dosing of HR97-SunitiGel provided up to 2 weeks of neuroprotection after the last dose, effectively doubling the therapeutic window observed with SunitiGel. For chronic ocular diseases affecting the posterior segment, the convenience of an eye drop combined with intermittent dosing frequency could result in greater patient adherence, and thus, improved disease management.
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Affiliation(s)
- Henry T Hsueh
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Renee Ti Chou
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Usha Rai
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patricia Kolodziejski
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Wathsala Liyanage
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jahnavi Pejavar
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ann Mozzer
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charlotte Davison
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew B Appell
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Yoo Chun Kim
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kirby T Leo
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - HyeYoung Kwon
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Maanasa Sista
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Nicole M Anders
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Avelina Hemingway
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Sri Vishnu Kiran Rompicharla
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ian Pitha
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donald J Zack
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Departments of Neuroscience, Molecular Biology and Genetics, and Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin Hanes
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Michael P Cummings
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, College Park, MD, USA
| | - Laura M Ensign
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA.
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Shen Y, Sun J, Sun X. Intraocular nano-microscale drug delivery systems for glaucoma treatment: design strategies and recent progress. J Nanobiotechnology 2023; 21:84. [PMID: 36899348 PMCID: PMC9999627 DOI: 10.1186/s12951-023-01838-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
Glaucoma is a leading cause of irreversible visual impairment and blindness, affecting over 76.0 million people worldwide in 2020, with a predicted increase to 111.8 million by 2040. Hypotensive eye drops remain the gold standard for glaucoma treatment, while inadequate patient adherence to medication regimens and poor bioavailability of drugs to target tissues are major obstacles to effective treatment outcomes. Nano/micro-pharmaceuticals, with diverse spectra and abilities, may represent a hope of removing these obstacles. This review describes a set of intraocular nano/micro drug delivery systems involved in glaucoma treatment. Particularly, it investigates the structures, properties, and preclinical evidence supporting the use of these systems in glaucoma, followed by discussing the route of administration, the design of systems, and factors affecting in vivo performance. Finally, it concludes by highlighting the emerging notion as an attractive approach to address the unmet needs for managing glaucoma.
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Affiliation(s)
- Yuening Shen
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China
| | - Jianguo Sun
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Xinghuai Sun
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China. .,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China. .,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China.
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6
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Chu YC, Chang PY, Wang JK, Huang TL, Hsu YR. The IOP lowering effects of "planning" selective laser trabeculoplasty in open angle glaucoma. Front Med (Lausanne) 2022; 9:1013260. [PMID: 36275811 PMCID: PMC9582459 DOI: 10.3389/fmed.2022.1013260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate whether the planning of selective laser trabeculoplasty (SLT) influences the intraocular pressure (IOP) in patients with open angle glaucoma (OAG). Methods In this retrospective case-control study conducted on patients with OAG who planned to undergo SLT treatment (SLT group) or a visual field examination (VF group), we collected the demographic data, IOP on the planning day and on the scheduled day of the SLT treatment or VF examination. ΔIOP was defined as the IOP change between the planning day and the scheduled day. We used multivariable regression analyses and linear mixed model to evaluate the association between the abovementioned factors and ΔIOP in the VF group and the treatment eye (SLTt) and fellow eye (SLTf) of the SLT group. Results One hundred and fifty-three eyes of 102 patients with OAG were included, of which 51 patients in the SLT group and 51 patients in the VF group. The ΔIOP was −1.92 ± 2.77 mmHg in the SLTt, −0.65 ± 2.47 mmHg in the SLTf and −0.08 ± 1.73 mmHg in the VF group (P < 0.05). Both multivariable regression analysis between the VF and SLTt group and linear mixed model in the SLT group showed significant negative association between the ΔIOP and SLT arrangement (P < 0.05). There was no significant association between ΔIOP and age, gender, baseline IOP, IOP fluctuation, nor SE. Conclusions The IOP was significantly reduced in patients with OAG after “planning” of SLT treatment, even without actual performing the laser treatment in our retrospective case-control study.
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Affiliation(s)
- Yi-Ching Chu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Yao Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan,Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan,Department of Healthcare Administration, Asia University, Taichung, Taiwan,Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan,*Correspondence: Pei-Yao Chang
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan,Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan,Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan,Department of Healthcare Administration and Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Tzu-Lun Huang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan,Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan,Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan,Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
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7
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Muacevic A, Adler JR, Alotaibi NT, Mirza B, Mirza G, Bantan O. Evaluation of Compliance Issues to Anti-glaucoma Medications Before and After a Structured Interventional Program. Cureus 2022; 14:e25943. [PMID: 35844344 PMCID: PMC9282590 DOI: 10.7759/cureus.25943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background Glaucoma is one of the most common eye diseases in the elderly and the major cause of irreversible vision loss worldwide. Adherence to life-long therapies is crucial to prevent glaucoma progression. The current study aims to assess the educational element and its impact on glaucoma medication compliance over short and long periods. Methods This was a survey-based, prospective, interventional study, conducted via interviews of all glaucoma patients presented to the Ophthalmology Center at King Abdullah Medical City (KAMC), Makkah, Saudi Arabia. To achieve the study's aim, a questionnaire with 31 items was utilized, followed by a structured program between September 2019 to June 2021. After that, a second questionnaire was used after a one month to one year to re-evaluate the intervention. Data was automatically collected in Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States) and entered into IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States) for analysis. Results Non-compliance was detected in 15.7% of all recruited patients (n=134). However, the non-compliance percentage dropped to 10 (7.5%) after the structured program (P=0.028). Contributing factors were low educational level, bilateral eye disease, duration of treatment more than two years, and having more than two eye treatment bottles; however, the P-value was insignificant. Conclusions About one-sixth of our glaucoma patients were found to be non-compliant. However, the non-compliance reduced by more than half after the structured educational program. Treatment adherence can be improved by implementing awareness and correcting the beliefs about illness and medicines, thus potentially delaying disease development.
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Hwang IC, Suh HS, Choi S. Factors Associated with Non-Adherence to Glaucoma Treatment in a Korean Nationwide Survey. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:1259-1264. [PMID: 36447979 PMCID: PMC9659527 DOI: 10.18502/ijph.v51i6.9669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/10/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Glaucoma is a main cause of blindness despite the effectiveness of treatments, and adherence to treatment is a critical aspect of glaucoma management. We aimed to identify the factors associated with non-adherence to treatment among Korean glaucoma patients. METHODS Data were collected from 4,833 glaucoma patients during the Korea Community Health Survey (KCHS) in 2008 and 2011 regarding current treatment for glaucoma, demographics, comorbidities, perceived health status, and health-related behaviors were subjected to analysis. A multivariable regression model was applied to identify factors related to non-treatment for glaucoma. RESULTS Approximately, half of the 4,883 patients failed to adhere to treatment. Compared to the treatment group, the non-treatment group had lower social status, fewer comorbid conditions, were more optimistic about their health statuses, and more likely to adopt unhealthy behaviors. Stepwise regression analysis showed that poor social status (low level of education and unmarried), self-perception of a satisfactory health status, and unhealthy behaviors (smoking and no flu-vaccination) were significantly associated with non-adherent to treatment. CONCLUSION More attention should be paid to glaucoma patients with low social status or that are overconfident about their health. Future prospective studies that more comprehensively assess treatment compliance, are needed to confirm our findings.
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Affiliation(s)
- In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Heuy Sun Suh
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
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9
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Conrady CD, Yeh S. A Review of Ocular Drug Delivery Platforms and Drugs for Infectious and Noninfectious Uveitis: The Past, Present, and Future. Pharmaceutics 2021; 13:1224. [PMID: 34452185 PMCID: PMC8399730 DOI: 10.3390/pharmaceutics13081224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Uveitis refers to a broad group of inflammatory disorders of the eye that often require medical and surgical management to improve or stabilize vision and prevent vision-threatening pathological changes to the eye. Drug delivery to the eye to combat inflammation and subsequent complications from uveitic conditions is complex as there are multiple barriers to absorption limiting availability of the needed drug in the affected tissues. As such, there has been substantial interest in developing new drugs and drug delivery platforms to help reduce intraocular inflammation and its complications. In this review, we discuss the challenges of drug delivery, novel technologies recently approved for uveitis patient care and promising drug delivery platforms for uveitis and sequelae of ocular inflammation.
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Affiliation(s)
- Christopher D. Conrady
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Center, University of Nebraska Medical Center, Omaha, NE 68105, USA
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Center, University of Nebraska Medical Center, Omaha, NE 68105, USA
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10
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Khaled A, Makki S, Almaghaslah D, Al-Qahtani M, Siddique A. Patients’ adherence to topical antiglaucoma medications in a tertiary care hospital. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
Adherence to glaucoma medications is a central factor to control intraocular pressure and manage glaucoma effectively. This study aims to assess the level of adherence of glaucoma patients to ocular hypotensive agents and determine factors contributing to non-adherence in the Aseer region.
Methods
This was a single-centre, prospective cross-sectional study carried out in Aseer Hospital, Saudi Arabia. Data were collected through a customized questionnaire adapted from the Morisky, Green and Levine Medication Adherence Questionnaire (MGLS).
Key findings
Of the 102 glaucoma patients, 63 (61.8%) were non-adherent to their glaucoma medications. About 48 (76.2%) of them reported that they have no background information about glaucoma. Older participants (37, 58.7%; >50 years) showed a low adherence level compared with the younger individuals. Contributing factors to non-adherence include forgetting the dose time (32, 50.8%), illiteracy (31, 49.2%; P = 0.313), economic problems (26, 41.3%; P = 0.286) and lack of information about prescribed medications (15, 23.8%; P = 0.188).
Conclusions
No significant relationship was found between medication adherence and patient’s demographic data or their background knowledge about glaucoma. Despite the need for improving the glaucoma patient’s knowledge of their disease and the importance of medication adherence, an additional strategy as alerts by smartwatches should be encouraged to improve the adherence level.
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Affiliation(s)
- Arwa Khaled
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
- Department of Clinical Pharmacy, Beni-Suef University Hospital, Beni-Suef University, Beni-Suef, Egypt
| | - Soha Makki
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Dalia Almaghaslah
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Masoud Al-Qahtani
- Department of Ophthalmology, Aseer Central Hospital, Ministry of Health, Abha, Saudi Arabia
| | - Ayesha Siddique
- Department of Ophthalmology, Aseer Central Hospital, Ministry of Health, Abha, Saudi Arabia
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11
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Kim YC, Hsueh HT, Shin MD, Berlinicke CA, Han H, Anders NM, Hemingway A, Leo KT, Chou RT, Kwon H, Appell MB, Rai U, Kolodziejski P, Eberhart C, Pitha I, Zack DJ, Hanes J, Ensign LM. A hypotonic gel-forming eye drop provides enhanced intraocular delivery of a kinase inhibitor with melanin-binding properties for sustained protection of retinal ganglion cells. Drug Deliv Transl Res 2021; 12:826-837. [PMID: 33900546 DOI: 10.1007/s13346-021-00987-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/22/2022]
Abstract
While eye drops are the most common ocular dosage form, eye drops for treating diseases of the posterior segment (retina, choroid, optic nerve) have yet to be developed. In glaucoma, eye drops are used extensively for delivering intraocular pressure (IOP)-lowering medications to the anterior segment. However, degeneration of retinal ganglion cells (RGCs) in the retina may progress despite significant IOP lowering, suggesting that a complementary neuroprotective therapy would improve glaucoma management. Here, we describe a hypotonic, thermosensitive gel-forming eye drop for effective delivery of sunitinib, a protein kinase inhibitor with activity against the neuroprotective targets dual leucine zipper kinase (DLK) and leucine zipper kinase (LZK), to enhance survival of RGCs after optic nerve injury. Further, binding of sunitinib to melanin in the pigmented cells in the choroid and retinal pigment epithelium (RPE) led to prolonged intraocular residence time, including therapeutically relevant concentrations in the non-pigmented retinal tissue where the RGCs reside. The combination of enhanced intraocular absorption provided by the gel-forming eye drop vehicle and the intrinsic melanin binding properties of sunitinib led to significant protection of RGCs with only once weekly eye drop dosing. For a chronic disease such as glaucoma, an effective once weekly eye drop for neuroprotection could result in greater patient adherence, and thus, greater disease management and improved patient quality of life.
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Affiliation(s)
- Yoo Chun Kim
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Henry T Hsueh
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Matthew D Shin
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Cynthia A Berlinicke
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Hyounkoo Han
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Nicole M Anders
- The Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Avelina Hemingway
- The Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Kirby T Leo
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Renee Ti Chou
- Department of Computational Biology, Bioinformatics, and Genomics, Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD, 20742, USA
| | - HyeYoung Kwon
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Matthew B Appell
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Usha Rai
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Patricia Kolodziejski
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Charles Eberhart
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Ian Pitha
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Donald J Zack
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA.,Departments of Neuroscience, Molecular Biology and Genetics, and Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Justin Hanes
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA.,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA.,The Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins University, Baltimore, MD, 21287, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Laura M Ensign
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA. .,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA. .,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA. .,The Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins University, Baltimore, MD, 21287, USA. .,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA. .,Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA. .,Departments Gynecology and Obstetrics and Infectious Diseases, Johns Hopkins University, Baltimore, MD, 21287, USA.
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12
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Mendieta N, Suárez J, Barriga N, Herrero R, Barrios B, Guarro M. How Do Patients Feel About Visual Field Testing? Analysis of Subjective Perception of Standard Automated Perimetry. Semin Ophthalmol 2021; 36:35-40. [PMID: 33587671 DOI: 10.1080/08820538.2021.1884270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE A high rate of unreliability is an issue in visual field (VF) testing, especially in elderly patients, and warrants patient education. We assessed whether subjective perception of the visual field test (VFT) is a good predictor of its reliability in different age groups and examined age differences in patients' awareness of VF damage. METHODS This cross-sectional study investigated 107 VFT results of 54 patients with glaucoma or ocular hypertension. Subjective perceptions were compared to reliability indices for cooperation analysis and to mean deviation results for VF damage analysis, and an age-segregated sub-analysis was performed. RESULTS Kappa coefficients showed poor agreement between subjective and objective parameters. Nevertheless, there were age differences. Younger patients had a higher positive predictive value and sensitivity in cooperation analysis and a higher negative predictive value in VF damage analysis. CONCLUSIONS Patients' perception of cooperation in VFT is a poor predictor of its reliability. Although young cooperative patients may be aware of their good cooperation, even the youngest are unaware of their poor performance. This emphasizes the importance of giving proper directions to all patients during VFT to obtain better reliability indices. Younger, healthy patients are more aware of their health status, than those with a damaged VF, regardless of age. Therefore, illness education is crucial in all glaucoma patients.
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Affiliation(s)
- Núria Mendieta
- Glaucoma Department, Hospital De l'Esperança, Barcelona, Spain.,Glaucoma Department, Institut Oftalmològic Creu Groga, Calella, Barcelona, Spain.,Glaucoma Department, Oftalmologia Mèdica I Quirúrgica, Barcelona, Spain
| | - Joel Suárez
- Glaucoma Department, Institut Oftalmològic Creu Groga, Calella, Barcelona, Spain.,Glaucoma Department, Hospital General De Granollers, Barcelona, Spain
| | - Noelia Barriga
- Glaucoma Department, Institut Oftalmològic Creu Groga, Calella, Barcelona, Spain.,Glaucoma Department, Hospital General De Granollers, Barcelona, Spain
| | - Roger Herrero
- Glaucoma Department, Hospital De Mollet, Barcelona, Spain
| | - Begoña Barrios
- Glaucoma Department, Hospital De Mollet, Barcelona, Spain
| | - Mercè Guarro
- Glaucoma Department, Oftalmologia Mèdica I Quirúrgica, Barcelona, Spain.,Glaucoma Department, Hospital General De Granollers, Barcelona, Spain
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13
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Shirai C, Matsuoka N, Nakazawa T. Comparison of adherence between fixed and unfixed topical combination glaucoma therapies using Japanese healthcare/pharmacy claims database: a retrospective non-interventional cohort study. BMC Ophthalmol 2021; 21:52. [PMID: 33478408 PMCID: PMC7818918 DOI: 10.1186/s12886-021-01813-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background Adherence to chronic therapies is crucial to prevent the progression of disease, such as glaucoma. However, only a limited number of studies have investigated them using real-world data in Japan. This study aimed to evaluate Japanese patients’ adherence to fixed- and unfixed-combination eye drops as a second-line therapy for glaucoma in real-world practice. Methods This retrospective, non-interventional cohort study utilized a commercially available Japanese healthcare database (MinaCare database). Medical/pharmacy claims data were collected from 2011 to 2016. The primary endpoint was adherence to medications, assessed by proportion of days covered (PDC) with medication during a 12-month post-index period. Meanwhile, the secondary endpoints included the persistence rate. Results A total of 738 patients were included in this study: 309 and 329 in the fixed- and unfixed-combination cohorts, respectively. Prostaglandin analog (PG)/β-blocker (BB) was most commonly claimed in 241/309 (78.0%) patients in the fixed-combination cohort. In the unfixed-combination cohort, PG and BB were claimed in 130/329 (39.5%) patients, whereas PG and α2-agonist were claimed in 87/329 (26.4%) patients. Patients were more adherent to the fixed-combination than the unfixed-combinations (mean PDCs [SD], 79.1% [32.1] vs. 62.2% [38.0]; P < 0.0001). The proportion of patients with good adherence (PDC ≥ 80%) was also higher in the fixed-combination cohort (69.6%) than in the unfixed-combination cohort (48.6%) (P < 0.0001). During the 12-month post-index period, the persistence rate was higher in the fixed-combination cohort than in the unfixed-combination cohort (47.6% [95% confidence intervals (CI): 41.9–53.0] vs. 24.9% [95% CI: 20.4–29.7], P < 0.0001). Conclusions Japanese patients with glaucoma preferred the fixed-combination therapies over the unfixed-combination therapies. Hence, fixed-combination therapies would contribute to the improvement of adherence.
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Affiliation(s)
- Chikako Shirai
- Medical Affairs, Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Nobushige Matsuoka
- Biometrics & Data Management, Pfizer R&D Japan G.K, 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
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14
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Rosu AM, Coelho A, Camacho P. Assessment of medication therapy adherence in glaucoma: scoping review. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1842197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Amalia Mihaela Rosu
- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - André Coelho
- ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Pedro Camacho
- ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
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15
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Johnson TV, Jampel HD. Intraocular Pressure Following Prerandomization Glaucoma Medication Washout in the HORIZON and COMPASS Trials. Am J Ophthalmol 2020; 216:110-120. [PMID: 32289292 DOI: 10.1016/j.ajo.2020.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the effectiveness of topical ocular hypotensive medications in patients with open-angle glaucoma and to identify factors associated with postwashout intraocular pressure (IOP) elevation. DESIGN Secondary analysis of prerandomization data from 2 prospective, multicenter, randomized clinical trials. METHODS Fourteen hundred subjects (1,400 eyes, 781 from the HORIZON study of the Hydrus micro-stent and 619 from the COMPASS study of the Cypass micro-stent) with primary open-angle glaucoma who were using 0-4 classes of topical IOP-lowering medication underwent Goldmann applanation tonometry before and after a protocol-defined washout period. RESULTS The mean (standard deviation) age was 70.7 (8.0) years and 55.6% were female. The change in IOP following washout for patients using 0 (n = 100), 1 (n = 705), 2 (n = 355), 3 (n = 214), or 4 (n = 26) medications was 0.2 (2.8), 5.7 (3.3), 6.9 (3.7), 8.8 (5.0), and 9.5 (4.1) mm Hg, respectively (P < .001, Kruskal-Wallis test). Postwashout IOP change was similar between the HORIZON and COMPASS cohorts. No difference in postwashout IOP change was detected among individual prostaglandin analogues in patients on monotherapy. A generalized linear model identified the following factors to be associated with greater IOP rise upon medication washout: greater number of glaucoma medications, higher unmedicated IOP, thinner central corneal thickness (CCT), lack of prior selective laser trabeculoplasty (SLT), and male sex. CONCLUSIONS Cessation of glaucoma medications results in a dose-dependent IOP increase in treated open-angle glaucoma patients. Two independent clinical trial cohorts exhibit similar levels of IOP elevation upon washout, using standardized methodology to estimate real-world medication effectiveness. Thicker CCT and history of SLT may predict reduced response to IOP lowering medications.
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16
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Current Medical Therapy and Future Trends in the Management of Glaucoma Treatment. J Ophthalmol 2020; 2020:6138132. [PMID: 32774906 PMCID: PMC7391108 DOI: 10.1155/2020/6138132] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/29/2020] [Indexed: 01/02/2023] Open
Abstract
Glaucoma is a neurodegenerative disease characterized by progressive loss of retinal ganglion cells and their axons. Lowering of intraocular pressure (IOP) is currently the only proven treatment strategy for glaucoma. However, some patients show progressive loss of visual field and quality of life despite controlled IOP which indicates that other factors are implicated in glaucoma. Therefore, approaches that could prevent or decrease the rate of progression and do not rely on IOP lowering have gained much attention. Effective neuroprotection has been reported in animal models of glaucoma, but till now, no neuroprotective agents have been clinically approved. The present update provides an overview of currently available IOP-lowering medications. Moreover, potential new treatment targets for IOP-lowering and neuroprotective therapy are discussed. Finally, future trends in glaucoma therapy are addressed, including sustained drug delivery systems and progress toward personalized medicine.
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Javidi H, Poonit N, Patel RP, Barry RJ, Rauz S, Murray PI. Adherence to Topical Medication in Patients with Inflammatory Eye Disease. Ocul Immunol Inflamm 2020; 29:890-895. [PMID: 31944132 DOI: 10.1080/09273948.2019.1699122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Hedayat Javidi
- Inflammatory Eye Disease Service, Birmingham & Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Nat Poonit
- Inflammatory Eye Disease Service, Birmingham & Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Radhika P. Patel
- Inflammatory Eye Disease Service, Birmingham & Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Robert J. Barry
- Inflammatory Eye Disease Service, Birmingham & Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing University of Birmingham, Birmingham, UK
| | - Saaeha Rauz
- Inflammatory Eye Disease Service, Birmingham & Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing University of Birmingham, Birmingham, UK
| | - Philip I. Murray
- Inflammatory Eye Disease Service, Birmingham & Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing University of Birmingham, Birmingham, UK
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18
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Beyond intraocular pressure: Optimizing patient-reported outcomes in glaucoma. Prog Retin Eye Res 2019; 76:100801. [PMID: 31676347 DOI: 10.1016/j.preteyeres.2019.100801] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/02/2023]
Abstract
Glaucoma, an irreversible blinding condition affecting 3-4% adults aged above 40 years worldwide, is set to increase with a rapidly aging global population. Raised intraocular pressure (IOP) is a major risk factor for glaucoma where the treatment paradigm is focused on managing IOP using medications, laser, or surgery regimens. However, notwithstanding IOP and other clinical parameters, patient-reported outcomes, including daily functioning, emotional well-being, symptoms, mobility, and social life, remain the foremost concerns for people being treated for glaucoma. These outcomes are measured using objective patient-centered outcome measures (PCOMs) and subjective patient-reported outcome measures (PROMs). Studies using PCOMs have shown that people with glaucoma have several mobility, navigational and coordination challenges; reading and face recognition deficits; and are slower in adapting to multiple real-world situations when compared to healthy controls. Similarly, studies have consistently demonstrated, using PROMs, that glaucoma substantially and negatively impacts on peoples' self-reported visual functioning, mobility, independence, emotional well-being, self-image, and confidence in healthcare, compared to healthy individuals, particularly in those with late-stage disease undergoing a heavy treatment regimen. The patient-centred effectiveness of current glaucoma treatment paradigms is equivocal due to a lack of well-designed randomized controlled trials; short post-treatment follow-up periods; an inappropriate selection or availability of PROMs; and/or an insensitivity of currently available PROMs to monitor changes especially in patients with newly diagnosed early-stage glaucoma. We provide a comprehensive, albeit non-systematic, critique of the psychometric properties, limitations, and recent advances of currently available glaucoma-specific PCOMs and PROMs. Finally, we propose that item banking and computerized adaptive testing methods can address the multiple limitations of paper-pencil PROMs; customize their administration; and have the potential to improve healthcare outcomes for people with glaucoma.
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Abstract
Purpose: Effective glaucoma therapy relies to a great extent on the patients' ability to regularly self-administer eye drops. This study aimed to assess self-reported nonadherence and to identify potential barriers to adherence in glaucoma patients. Methods: Participants completed a 16-item questionnaire, designed to examine nonadherence rate and assess the therapy experience. Inclusion criteria stipulated treatment duration of at least 1 year. Nonadherence was defined as missing ≥5% of the prescribed pressure-lowering eye drops doses. Results: In total, 201 glaucoma patients aged 24-88 years were included. Mean treatment duration was 9.4 years. Nonadherence was reported by 30.3% of participants and 69.7% were reported to be adherent. Individuals who experienced side effects reported higher levels of nonadherence than those who did not (37.6% vs. 18.4%; P = 0.004). Eye drops with preservatives were used by 84.1% of participants, 11.9% were on combined preservative and preservative-free treatment, and 4.0% on preservative-free medication only. Self-reported nonadherence levels were 32.0%, 25.0%, and 12.5%, respectively, for each of these groups. Men reported higher rates of nonadherence than women (36.8% vs. 24.5%; P = 0.066). Age, social status, history of migration, severity of disease, and fear of blindness were not associated with significant differences in nonadherence levels. Conclusions: Nonadherence with glaucoma therapy is a significant barrier to therapeutic success for approximately one-third of patients. Nonadherence may be reduced if side effects are avoided. Preservative-free products may provide adherence benefits. The patient experience should be a key consideration when selecting appropriate treatments, to reduce nonadherence and optimize outcomes.
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Affiliation(s)
- Christian Wolfram
- 1 Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.,2 Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Mainz, Germany
| | - Erik Stahlberg
- 1 Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.,3 Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Luebeck, Mainz, Germany
| | - Norbert Pfeiffer
- 1 Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
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20
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Abstract
PURPOSE OF REVIEW Sustained drug delivery has been recognized as a need for patients with ocular hypertension or glaucomatous optic neuropathy. Several sustained drug delivery systems and devices are currently on the horizon. This review aims to summarize initial results with these platforms, as reported in the literature, and also provide insight into their possible role in the glaucoma treatment paradigm. RECENT FINDINGS Sustained drug delivery systems currently on the horizon include the topical bimatoprost ocular insert, travoprost and latanoprost punctal plugs, latanoprost-eluting contact lenses, bimatoprost and travoprost intraocular implants, as well as several other therapies in earlier stages of development. Delivery strategies differ with respect to ocular site of implantation, ocular hypotensive agent, and duration of efficacy. Efficacy and safety outcomes with these devices are favorable thus far. SUMMARY The glaucoma treatment paradigm is currently in a state of flux as sustained drug delivery systems bring promise to individuals suffering from ocular hypertension or glaucoma. Several options will likely become available in the near future to ease the burden of daily administration of chronic therapy with intraocular pressure-lowering agents.
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