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Khachatryan N, Pistilli M, Maguire MG, Chang AY, Samuels MR, Mulvihill K, Salowe RJ, O'Brien JM. A Review of Studies of the Association of Vision-Related Quality of Life with Measures of Visual Function and Structure in Patients with Glaucoma in the United States. Ophthalmic Epidemiol 2021; 28:265-276. [PMID: 33530788 DOI: 10.1080/09286586.2020.1863992] [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] [Indexed: 10/22/2022]
Abstract
Purpose: To investigate the association of quality of life (QoL) with ocular structure and function in glaucoma patients, and to identify which aspects of QoL are most closely tied to Visual Field (VF) and Visual Acuity (VA).Methods: We conducted a comprehensive review of studies on QoL in glaucoma patients using PubMed, Web of Science, and Google Scholar (from 1 January 1997 to 7 December 2019). A total of 21 studies in the United States that used the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ) or 51-item NEI VFQ were included. A descriptive analysis of data from the selected studies was conducted. The association between QoL scores and visual function and structure was investigated by ranking the strength of association on a scale from 1 (weakest) to 12 (strongest).Results: Studies reported correlations between QoL scores and Visual Structure. Associations were also reported between QoL and Visual Function both cross-sectionally and longitudinally, with a stronger association of VF and VA with distance activities (average ranking 9.1 and 9.6), vision-specific dependency (8.7 and 8.9), and driving (8.6 and 9.7). Vision-specific mental health (6.5 and 4.9), vision-specific social functioning (8.4 and 6.2), and vision-specific role difficulties (7.1 and 6.6) domains were more associated with VF than with VA.Conclusion: Our study was the first to quantify and rank the strength of association between visual function and QoL domains. Driving and psycho-social QoL domains tended to be most affected by glaucoma-related deterioration of visual function. QoL scores could be used for more patient-centered disease management.
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Affiliation(s)
- Naira Khachatryan
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Maxwell Pistilli
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela Y Chang
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Marissa R Samuels
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen Mulvihill
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca J Salowe
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joan M O'Brien
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
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Cimolai N. A review of neuropsychiatric adverse events from topical ophthalmic brimonidine. Hum Exp Toxicol 2020; 39:1279-1290. [DOI: 10.1177/0960327120918307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Brimonidine is a first-line topical medication for increased intraocular pressure and glaucoma which may be used alone or in conjunction with other topical therapies. Its structural and pharmacological comparabilities to clonidine give way to the hypothesis that it may cause neuropsychiatric side effects. The majority of case reports citing brimonidine toxicity, either for topical or peripheral exposure, include pediatric age groups but especially infants. Among the latter, a dose-response phenomenon is evident. Dose-response correlates have also been shown among adults. Case series and prospective double-blind treatment studies also give evidence for the occurrence of several central nervous system adverse reactions. Topical ophthalmic brimonidine use should be followed for the occurrence of neuropsychiatric disturbances generally, and enhanced vigilance should be maintained for at-risk populations.
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Affiliation(s)
- N Cimolai
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Children’s and Women’s Health Centre of British Columbia, Vancouver, BC, Canada
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3
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Alonso RS, Solari HP, de França Damasceno E, Burnier MNN, Ventura MP. The chemotactic properties of various topical brimonidine tartrate ophthalmic preparations. BMC Pharmacol Toxicol 2020; 21:24. [PMID: 32293549 PMCID: PMC7092528 DOI: 10.1186/s40360-020-0401-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background The study aimed to evaluate and compare the leukocyte chemotactic activities of various brimonidine tartrate (BT) eye drop formulations. Methods A 96-well dot-blot platet using a Boyden-style well was used to study the chemotactic effects of BT ophthalmic preparations. A modification was made to create blind wells where the tested agents were placed. Leukocytes were isolated from the peripheral blood of healthy volunteers. As positive controls, we used diluted drugs, benzalkonium chloride solution (BAK), zymosan-activated serum, and formyl-methionine-leucine-phenylalanine peptides. The negative control in our study was a phosphate-buffered saline solution. For each experimental condition, we measured leukocyte migration through a Millipore membrane. The differences in the mean migration distance between groups were compared using the analysis of variance (ANOVA). Results The measured migration distances (in μm ± SD) were 62.14 ± 3.71 for BT 0.2% with BAK (Alcon Laboratories Inc.); 63.61 ± 3.81 for BT 0.2% with BAK (Allergan Inc); 40.36 ± 3.17 for BT 0.15% without BAK; and 41.02 ± 2.17 for BAK alone. The negative controls showed no chemotactic activity, while the positive controls showed the highest neutrophil migration of all experimental conditions. The differences between BT 0.15% without BAK and the other commercial formulations were statistically significant. Conclusion Commercial ophthalmic preparations of BT 0.2% with BAK 0.005% had higher chemotactic properties than the alternative of a lower concentration of BT and without the preservative BAK. Therefore, the latter should be considered for patients with glaucoma or ocular hypertension in order to minimize iatrogenic ocular inflammation.
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Affiliation(s)
- Ruiz Simonato Alonso
- Department of Ophthalmology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil.
| | - Helena Parente Solari
- Department of Ophthalmology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil.,The Henry C. Witelson Ocular Pathology Laboratory, McGill University, Montreal, Canada
| | | | | | - Marcelo Palis Ventura
- Department of Ophthalmology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil.,The Henry C. Witelson Ocular Pathology Laboratory, McGill University, Montreal, Canada
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Haverkamp F, Wuensch S, Fuchs M, Stewart WC. Intraocular Pressure, Safety and Quality of Life in Glaucoma Patients Switching to Latanoprost from Adjunctive and Monotherapy Treatments. Eur J Ophthalmol 2018; 14:407-15. [PMID: 15506603 DOI: 10.1177/112067210401400508] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To evaluate efficacy, safety and quality of life in ocular hypertensive or open-angle glaucoma patients changed to latanoprost from previous therapy. Methods A prospective, multicenter, active-controlled design in which qualified patients had their previous therapy substituted for latanoprost and were followed for at least thee months. Results In 1068 patients, latanoprost was continued 92% throughout the 36-month observation period. Latanoprost treatment reduced the intraocular pressure (IOP)(p < 0.001) when compared to previous monotherapies including: beta-blockers (-4.0 ± 3.7 mmHg, 42%), alpha-antagonists (-3.9 ± 3.0 mmHg, 14%), miotics (-3.8 ± 3.5 mmHg, 2%), or carbonic anhydrase inhibitors (CAI) (-3.8 ± 3.6 mmHg, n = 16%), and adjunctive therapy including: beta-blocker and CAI (-3.7 ± 3.1 mmHg, n = 12%), alpha-agonist (-3.7 ± 3.4 mmHg, n = 5%), or pilocarpine (-3.4 ± 3.7 mmHg, n = 6%), or CAI and alpha-agonist (-4.6 ± 6.4 mm Hg, n = 2%)(p < 0.0017). The most common adverse event with latanoprost was ocular allergy (1.5% incidence). Patients showed a preference for latanoprost for many systemic and ocular quality of life measures on a non-validated questionnaire (p < 0.05). Conclusions In a clinical setting, patients who have their mono- and adjunctive therapy treatment substituted for latanoprost may on average experience reduced IOP, deceased side effects and increased quality of life measures.
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Affiliation(s)
- F Haverkamp
- Children Hospital at the University of Bonn, Bonn
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5
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Gupta SK, Niranjan D G, Agrawal SS, Srivastava S, Saxena R. Recent advances in pharmacotherapy of glaucoma. Indian J Pharmacol 2011; 40:197-208. [PMID: 20040958 PMCID: PMC2792620 DOI: 10.4103/0253-7613.44151] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 02/25/2008] [Accepted: 10/14/2008] [Indexed: 11/04/2022] Open
Abstract
Glaucoma is a slow progressive degeneration of the retinal ganglion cells (RGCs) and the optic nerve axons, leading to irreversible blindness if left undiagnosed and untreated. Although increased intraocular pressure is a major risk factor of glaucoma, other factors include increased glutamate levels, alterations in nitric oxide (NO) metabolism, vascular alterations and oxidative damage caused by reactive oxygen species. Glaucoma is the second leading cause of blindness globally, accounting for 12.3% of the total blindness. Glaucoma has been broadly classified as primary or secondary open-angle or angle-closure glaucoma. The primary goal in management of glaucoma is to prevent the risk factor, especially elevated intraocular pressure (IOP), using medications, laser therapy or conventional surgery. The first-line treatment of glaucoma usually begins with the use of a topical selective or nonselective blocker or a prostaglandin analog. Second-line drugs of choice include alpha-agonists and topical carbonic anhydrase inhibitors. Cholinergic agonists are considered third-line treatment options. When a single therapy is not sufficient to lower the IOP, a combination therapy is indicated. To enhance the patient compliance, drug delivery systems like electronic devices, ocular inserts, tansdermal and mechanical drug delivery systems have been developed. Use of viscoelastic agents in ophthalmic formulations, emulsions and soluble ophthalmic drug inserts (SODI) enhance patience compliance and ocular drug delivery in patients in long-term glaucoma therapy. For patients who do not respond to antiglaucoma medications, laser trabeculoplasty and incisional surgery are recommended. Several nutrients and botanicals hold promise for the treatment of glaucoma, but most studies are preliminary, and larger, controlled studies are required. Future directions for the development of a novel therapy glaucoma may target glutamate inhibition, NMDA receptor blockade, exogenously applied neurotrophins, open channel blockers, antioxidants, protease inhibitors and gene therapy.
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Affiliation(s)
- S K Gupta
- Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, India
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Noecker RJ. The management of glaucoma and intraocular hypertension: current approaches and recent advances. Ther Clin Risk Manag 2011; 2:193-206. [PMID: 18360593 PMCID: PMC1661659 DOI: 10.2147/tcrm.2006.2.2.193] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the last decade, numerous novel ocular hypotensive agents have been introduced for the control of intraocular pressure (IOP). Clinicians now have more options than ever in the selection of medical therapy for the treatment of glaucoma and ocular hypertension. When selecting an ocular hypotensive medication for their patients, clinicians should consider not only the IOP-lowering efficacy of an agent, but also the ability of the drug to allow patients to achieve target levels of IOP that are low enough to stop the progression of glaucomatous damage. Other considerations should include how well the drug controls diurnal IOP, the likelihood of serious adverse events, the versatility of the medication for use as an adjunctive agent, as well as other potential attributes (ie, neuroprotection).
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Affiliation(s)
- Robert J Noecker
- University of Pittsburgh Medical Center, Eye and Ear Institute Pittsburgh, PA, USA
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[Quantification of subjective visual quality of life in glaucoma patients : first results of a German version of the GQL-15 questionnaire]. Ophthalmologe 2011; 108:745-52. [PMID: 21503819 DOI: 10.1007/s00347-011-2360-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is an increasing interest in assessing the quality of life as an additional guide for therapeutic choices, especially in patients with chronic diseases, e.g. glaucoma. Most standardized questionnaires are available in English making them inapplicable for daily use in non-English-speaking environments. The "Glaucoma Quality of Life 15 Questionnaire" (GQL-15) is a test designed for glaucoma patients in English and was translated into German in order to analyze its practicability in a daily clinical setting. PATIENTS AND METHODS The GQL-15 was handed out to glaucoma patients during the hospital stay. The questionnaires were analyzed retrospectively and correlated to clinical indices, such as age, visual acuity, visual field, parametric mean deviation (MD) and frequency of pharmacologic treatment. RESULTS A total of 31 patients were evaluated. It could be demonstrated that the quality of life summary scores correlated with visual field loss. Evaluation of subscale scores of visual function revealed that glare and dark adaptation were correlated with glaucoma severity especially in the early stages of the disease. CONCLUSIONS The German translation of the GQL-15 was well accepted by glaucoma patients. In our analysis disability of vision-related activities as expressed in the translated GQL-15 correlated with glaucoma severity. This first use of the translated GQL-15 encourages further studies in German glaucoma patients and their quality of life.
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Arthur S, Cantor LB. Update on the role of alpha-agonists in glaucoma management. Exp Eye Res 2011; 93:271-83. [PMID: 21524649 DOI: 10.1016/j.exer.2011.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/03/2011] [Accepted: 04/04/2011] [Indexed: 11/19/2022]
Abstract
Glaucoma is the second most common cause of world blindness (following cataract) with estimated cases reaching 79.6 million by 2020. Although the etiology of glaucoma is multi-factorial, intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Among various classes of IOP-lowering medications currently available, alpha-adrenergic receptor agonists are used either as monotherapy, as second-line therapy, or in fixed combination with beta-blockers. Non-selective adrenergic agonists such as epinephrine and dipivefrin are infrequently used today for the treatment of glaucoma or ocular hypertension, and have been replaced by the alpha-2-selective agonists. The use of apraclonidine for IOP reduction in glaucoma or OHT is limited due to a high rate of follicular conjunctivitis. The alpha-2-selective agonist in use today is brimonidine. The brimonidine-purite formulations are preferred to brimonidine-benzalkonium chloride (BAC) formulations due better tolerability while maintaining similar efficacy. Brimonidine is also effective when used in combination with a beta-blocker. Using brimonidine-timolol fixed combination (BTFC) as first-line therapy has an added potential for neuroprotection. This would be a valuable strategy for glaucoma treatment, for patients who are intolerant of prostaglandin analogs, or for patients where prostaglandin analogues are contraindicated as first-line therapy, such as in patients with inflammatory glaucoma.
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Affiliation(s)
- Stella Arthur
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, 702 Rotary Circle, Indianapolis, IN 46202, USA
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Affiliation(s)
- Mamun Q Rahman
- Gartnavel General Hospital, Tennent Institute of Ophthalmology, 1053 Great Western Road, Glasgow, G12 0YN, UK ;
| | - Kanna Ramaesh
- Gartnavel General Hospital, Tennent Institute of Ophthalmology, 1053 Great Western Road, Glasgow, G12 0YN, UK ;
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10
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Denis P, Lafuma A, Jeanbat V, Laurendeau C, Berdeaux G. Intraocular pressure control with latanoprost/timolol and travoprost/timolol fixed combinations : a retrospective, multicentre, cross-sectional study. Clin Drug Investig 2009; 28:767-76. [PMID: 18991470 DOI: 10.2165/0044011-200828120-00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The aim of this study was to confirm randomized clinical trial results showing that a fixed timolol/travoprost combination (TT; DuoTrav) controls intraocular pressure (IOP) better than a fixed timolol/latanoprost combination (TL; Xalacom) in everyday ophthalmic practice, when measured in the morning and >24 hours after instillation. METHODS Patients with ocular hypertension or primary open angle glaucoma stabilized on TT or TL were included in this retrospective cross-sectional study. Data on demographics, medical history and previous treatments were extracted from the patients' medical records. Last treatment instillation times and IOP values were recorded at clinic visits. Treatments were compared by analyses of variance, logistic regressions and propensity scores adjusted for confounding factors. RESULTS Out of 316 patients included, 124 instilled TT, 192 instilled TL and 266 (84.2%) overall had instilled their eye drops within 24 hours. The patients' mean age was 64.5 years and 51.6% were female. Treatment groups were comparable except for longer disease and treatment durations in TL recipients. Worse eye mean IOPs were 25.8 mmHg at diagnosis and 21.9 mmHg on starting their designated fixed combination treatment. The best IOP control was provided by TT instillations (mean IOP 17.1 and 19.0 mmHg in the TT and TL groups, respectively; p < 0.001). This difference was reinforced by results in the subgroup of patients who instilled treatment >24 hours prior to IOP measurement (mean IOP 17.0 and 20.3 mmHg in the TT and TL groups, respectively; p < 0.004). Also, 82.6% of TT patients satisfied their ophthalmologists' IOP targets versus 51.1% of TL patients (p < 0.001). All significant differences persisted after adjustment for confounding factors. CONCLUSION This study, conducted in routine ophthalmic practice, confirmed published clinical trial results showing that TT provides better IOP control than TL when measured in the morning, and that travoprost has longer-lasting residual effects than latanoprost when IOP is measured >24 hours after instillation. However, readers should interpret these findings in the context of a cross-sectional observational study conducted in a naturalistic setting.
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11
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Pathologies iatrogènes liées aux traitements du glaucome. J Fr Ophtalmol 2009; 32:71-8. [DOI: 10.1016/j.jfo.2008.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 09/25/2008] [Indexed: 11/18/2022]
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Cohen JS, Khatana AK, Greff LJ. Evolving Paradigms in the Medical Treatment of Glaucoma. Int Ophthalmol 2006; 25:253-65. [PMID: 16532287 DOI: 10.1007/s10792-005-7581-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Accepted: 05/18/2005] [Indexed: 10/24/2022]
Abstract
In the last 5 years, numerous novel ocular hypotensive agents have been introduced for the control of intraocular pressure (IOP). Clinicians now have more options than ever in medical therapy for the treatment of glaucoma and ocular hypertension. When selecting an ocular hypotensive medication for their patients, clinicians should consider not only the IOP-lowering efficacy of an agent but also the ability of the drug to achieve target levels of IOP that are low enough to stop the progression of glaucomatous damage. Other considerations should include how well the drug controls diurnal IOP, the likelihood of serious adverse events, the versatility of the medication for use as an adjunctive agent, as well as other potential attributes (e.g., neuroprotection).
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Affiliation(s)
- John S Cohen
- Cincinnati Eye Institute, Cincinnati, OH 45242, USA.
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13
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Rosen PN, Kaplan RM, David K. Measuring outcomes of cataract surgery using the Quality of Well-Being Scale and VF-14 Visual Function Index. J Cataract Refract Surg 2005; 31:369-78. [PMID: 15767161 DOI: 10.1016/j.jcrs.2004.04.043] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the validity and responsiveness of the self-administered Quality of Well-Being Scale (QWB-SA) and the 14-item Visual Function Index (VF-14) to assess patients having cataract surgery. SETTING Large Southern California health maintenance organization. METHODS This study comprised 233 adults who had uneventful small-incision (< 3.0 mm) phacoemulsification cataract extraction under local anesthesia. Patients were assessed before surgery as well as 4 to 6 weeks and 4 months after surgery using the QWB-SA and the VF-14. RESULTS Postoperatively, patients reported significant improvements on QWB-SA (P < .005) and VF-14 (P < .001) measures. Those grouped by visual acuity in the operated eye and unoperated eye and first-eye surgery or second-eye surgery had significant changes in VF-14 results (P < .001). Improvements on the QWB-SA were significant except when the preoperative visual acuity was better than 20/40 in the operated eye or 20/50 in the unoperated eye and when patients had first-eye surgery. The vision-specific VF-14 was more sensitive to improvements after surgery than the more general QWB-SA. Both demonstrated a greater magnitude of change with lower baseline scores and correlated significantly with self-reported satisfaction and trouble with vision. CONCLUSIONS Both the utility-based generic QWB-SA and disease-specific VF-14 profile were responsive to changes in quality of life after cataract surgery. The VF-14 was more sensitive to change but cannot be used for comparison across disease states or for policy analysis. The QWB-SA can be used to estimate the cost/utility of cataract surgery.
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Affiliation(s)
- Peter N Rosen
- From the Sharp Rees-Steely Medical Group, Department of Family and Preventive Medicine, University of California, San Diego, California, USA
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Nordmann JP, Auzanneau N, Ricard S, Berdeaux G. Vision related quality of life and topical glaucoma treatment side effects. Health Qual Life Outcomes 2003; 1:75. [PMID: 14667241 PMCID: PMC317367 DOI: 10.1186/1477-7525-1-75] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Accepted: 12/10/2003] [Indexed: 11/10/2022] Open
Abstract
Background Local tolerance of topical glaucoma treatment is important to achieve a good compliance. The aim of this study was to evaluate the consequences of local anti-glaucoma drug side effects on the vision-related quality of life (QoL). Methods A mail survey was sent to 20,000 homes of a panel representative of the French population asking whether one member of the family was suffering from ocular hypertension (OHT) or glaucoma. (POAG) A computer-assisted telephone interviewing system was used to confirm self-reported glaucoma, to describe the disease and its treatment, and medical item consumption. Vision-related QoL was assessed with the NEI-VFQ-25 (National Eye Institute Visual – Function Questionnaire) and local tolerance with the COMTOL (Comparison of Ophthalmic Medications for TOLerability). Results 13,352 homes (66.7%) answered the mail. 581 people declared they were suffering from glaucoma or OHT. Prevalence was 1.8%, increasing with age. 204 patients were selected at random Their NEI-VFQ-25 global score showed an overall good QoL. Two domain scores showed some deterioration: general health and driving. 62.4% of the patients cited at least one local side effect. 25.4% had burning, 20.8% blurred vision and 20.2% tearing. Poor vision related QoL was associated with the presence of local side effects leading to poor perceived treatment satisfaction. Dissatisfied patients visited their ophthalmologist more frequently. Conclusion Based on a representative French sample, poor vision related QoL was associated with topical drug side effects that also impact patient satisfaction and compliance. Longitudinal data collection should be performed to confirm our findings.
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Affiliation(s)
- Jean-Philippe Nordmann
- Quinze-Vingts, Centre Hospitalier National d'Ophtalmologie, 28 Rue de Charenton, F-75571 Paris Cedex 12, France
| | - Nadia Auzanneau
- Taylor Nelson Sofres Santé, 16 rue Barbès, F-92129 Montrouge Cedex, France
| | - Séverine Ricard
- Taylor Nelson Sofres Santé, 16 rue Barbès, F-92129 Montrouge Cedex, France
| | - Gilles Berdeaux
- Alcon France, 4 rue Henri Sainte-Claire Deville, F-92563 Rueil-Malmaison Cedex, France
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Abstract
Normal-tension glaucoma was previously thought to be pressure insensitive, as medical treatment hardly reduced intraocular pressure and it did not prevent visual field loss. In the last decade, however, evidence has shown that the treatment of normal-tension glaucoma by lowering intraocular pressure can slow the deterioration of visual fields, hence the glaucomatous process. It was shown that a reduction of IOP of at least 30% is needed to induce a favorable alteration in the course of normal-tension glaucoma. New agents, such as prostaglandin analogs, the alpha(2)-adrenoceptor agonist brimonidine, and carbonic anhydrase inhibitors, have become available and may be of use in the treatment of normal-tension glaucoma. Monotherapy with prostaglandin analogs may meet the target of a reduction of IOP with 30%, but combination therapy will be needed in many cases. Few studies have been performed with brimonidine, travoprost, and bimatoprost, and it is suggested that more attention should be given to studies with these agents, as about 30% of patients with open angles and glaucomatous visual field defects have normal-tension glaucoma. Although neuroprotection is the goal of the future, no hard data are available yet which demonstrate that treatment with these agents will indeed result in preservation of visual fields.
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Affiliation(s)
- Philip F J Hoyng
- Netherlands Ophthalmic Research Institute, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
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Katz LJ. Twelve-month evaluation of brimonidine-purite versus brimonidine in patients with glaucoma or ocular hypertension. J Glaucoma 2002; 11:119-26. [PMID: 11912359 DOI: 10.1097/00061198-200204000-00007] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the efficacy and safety of brimonidine-Purite (Alphagan; Allergan, Irvine, CA) 0.15% and 0.2% three times daily with brimonidine (Alphagan) 0.2% three times daily in patients with glaucoma or ocular hypertension. PATIENTS AND METHODS In this 12-month, randomized, multicenter, double-masked, parallel-group study, patients were randomly assigned to receive brimonidine-Purite 0.15% (n = 381), brimonidine-Purite 0.2% (n = 383), or brimonidine 0.2% (n = 383) three times daily. Visits were conducted before the study, at baseline, at weeks 2 and 6, and at months 3, 6, 9, and 12. Diurnal intraocular pressure was measured at 8 am, 10 am, 3 pm, and 5 pm at baseline, week 6, and at months 3, 6, and 12. Intraocular pressure was also measured at 8 and 10 am at week 2 and month 9. Safety was evaluated by adverse events and other ocular and systemic measures. RESULTS At baseline, mean intraocular pressure was similar in the three treatment groups. During follow-up, there were no statistically significant among-group differences in mean intraocular pressure or mean changes from baseline intraocular pressure (at peak or trough). The difference in mean intraocular pressure between the brimonidine-Purite-0.15% and brimonidine-0.2% treatment group was less than 1 mm Hg at all time points. The relative percent difference in allergic conjunctivitis was 41% lower in the brimonidine-Purite 0.15% group compared with the brimonidine 0.2% group. The comfort and satisfaction rating significantly favored brimonidine-Purite 0.15%. CONCLUSIONS Over 12-months, brimonidine-Purite 0.15% and 0.2% provided intraocular pressure lowering comparable with brimonidine 0.2% in patients with glaucoma or ocular hypertension. Brimonidine-Purite 0.15% showed the most favorable safety and tolerability profile with a reduced incidence of allergic conjunctivitis and better satisfaction and comfort rating.
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Affiliation(s)
- L Jay Katz
- Brimonidine-Purite Study Groups 1 and 2, Wills Eye Hospital, Philadelphia, Pennsylvania 19107-5599, USA.
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Ruiz Lapuente C, Ruiz Lapuente A, Link B. Influence of topical brimonidine on visual field in glaucoma. Eur J Ophthalmol 2001; 11 Suppl 2:S67-71. [PMID: 11592534 DOI: 10.1177/112067210101102s09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We evaluated the efficacy of topical brimonidine in visual field preservation and/or improvement in eyes undergoing controlled glaucoma. METHODS Seventy eyes of patients were trained with two different visual field test strategies: The Octopus Tendency Oriented Perimetry (TOP) G1 and the Frequency Doubling Technology (FDT) 30 degrees. Following 2-4 months of brimonidine treatment, there were significant improvements in visual field, as assessed using the TOP G1 strategy (p = 0.003). The FDT 30 degrees test revealed no statistically significant differences. CONCLUSIONS These data support the results of other studies, which indicate that brimonidine may increase mean sensitivity in visual field tests. Since it is known that the control of intraocular pressure does not fully protect glaucomatous eyes from visual field loss, it is possible that the neuroprotective qualities of brimonidine may contribute to visual field preservation in glaucomatous eyes.
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Abstract
The early information on the clinical efficacy, safety, and tolerability of brimonidine 0.2% were obtained from studies that compared brimonidine monotherapy with timolol and betaxolol. These studies showed its intra-ocular pressure lowering efficacy to be comparable with timolol and superior to betaxolol. The data from the timolol studies showed consistent results after four years. These findings have been confirmed by additional studies in the clinical setting. More recently, several clinical trials have been completed investigating the role of brimonidine as adjunctive medication to beta-blockers and as replacement therapy to other intraocular pressure lowering compounds. When added to beta-blockers, brimonidine is superior to dorzolamide, similar in efficacy but better tolerated than pilocarpine, and more predictable than latanoprost. Data from replacement studies have indicated that there may be advantages in replacing rather than adding medications in the treatment of glaucoma.
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Affiliation(s)
- R David
- Ophthalmology Clinical Research, Allergan, Irvine, CA 92612, USA
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