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Fenwick EK, Lim B, Man REK, Baskaran M, Nongpiur ME, Sng CCA, Iyer JV, Husain R, Perera SA, Wong TT, Low JR, Shimin OH, Lun K, Aung T, Lamoureux EL. The development of a glaucoma-specific health-related quality of life item bank supporting a novel computerized adaptive testing system in Asia. J Patient Rep Outcomes 2022; 6:107. [PMID: 36219349 PMCID: PMC9554106 DOI: 10.1186/s41687-022-00513-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022] Open
Abstract
Background A glaucoma-specific health-related quality of life (HRQoL) item bank (IB) and computerized adaptive testing (CAT) system relevant to Asian populations is not currently available. We aimed to develop content for an IB focusing on HRQoL domains important to Asian people with glaucoma; and to compare the content coverage of our new instrument with established glaucoma-specific instruments.
Methods In this qualitative study of glaucoma patients recruited from the Singapore National Eye Centre (November 2018-November 2019), items/domains were generated from: (1) glaucoma-specific questionnaires; (2) published articles; (3) focus groups/semi-structured interviews with glaucoma patients (n = 27); and (4) feedback from glaucoma experts. Data were analyzed using the constant comparative method. Items were systematically refined to a concise set, and pre-tested using cognitive interviews with 27 additional glaucoma patients.
Results Of the 54 patients (mean ± standard deviation [SD] age 66.9 ± 9.8; 53.7% male), 67 (62.0%), 30 (27.8%), and 11 (10.2%) eyes had primary open angle glaucoma, angle closure glaucoma, and no glaucoma respectively. Eighteen (33.3%), 11 (20.4%), 8 (14.8%), 12 (22.2%), and 5 (9.3%) patients had no, mild, moderate, severe, or advanced/end-stage glaucoma (better eye), respectively. Initially, 311 items within nine HRQoL domains were identified: Visual Symptoms, Ocular Comfort Symptoms, Activity Limitation, Driving, Lighting, Mobility, Psychosocial, Glaucoma management, and Work; however, Driving and Visual Symptoms were subsequently removed during the refinement process. During cognitive interviews, 12, 23 and 10 items were added, dropped and modified, respectively.
Conclusion Following a rigorous process, we developed a 221-item, 7-domain Asian glaucoma-specific IB. Once operationalised using CAT, this new instrument will enable precise, rapid, and comprehensive assessment of the HRQoL impact of glaucoma and associated treatment efficacy.
Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00513-3.
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Affiliation(s)
- Eva K. Fenwick
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore ,grid.4280.e0000 0001 2180 6431Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Belicia Lim
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore
| | - Ryan E. K. Man
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore ,grid.4280.e0000 0001 2180 6431Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Mani Baskaran
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore ,grid.414795.a0000 0004 1767 4984Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Monisha E. Nongpiur
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore
| | - Chelvin C. A. Sng
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore ,grid.410759.e0000 0004 0451 6143National University Health System, Singapore, Singapore
| | - Jayant V. Iyer
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore
| | - Rahat Husain
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore
| | - Shamira A. Perera
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore
| | - Tina T. Wong
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore ,grid.4280.e0000 0001 2180 6431Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jin Rong Low
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore
| | - Olivia Huang Shimin
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore ,grid.4280.e0000 0001 2180 6431Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Katherine Lun
- grid.414795.a0000 0004 1767 4984Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Tin Aung
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore ,grid.4280.e0000 0001 2180 6431Duke–NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.410759.e0000 0004 0451 6143National University Health System, Singapore, Singapore
| | - Ecosse L. Lamoureux
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856 Singapore ,grid.4280.e0000 0001 2180 6431Duke–NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.1008.90000 0001 2179 088XThe University of Melbourne, Melbourne, Australia
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Cuggino JC, Tártara LI, Gugliotta LM, Palma SD, Alvarez Igarzabal CI. Mucoadhesive and responsive nanogels as carriers for sustainable delivery of timolol for glaucoma therapy. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 118:111383. [PMID: 33254990 DOI: 10.1016/j.msec.2020.111383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/17/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
Topical administration to the eye for the treatment of glaucoma is a convenient route because it increases the patient comfort. Timolol can efficiently diminish the intraocular pressure (IOP) of the eye; however the topical application as a solution of timolol maleate (TM) has poor therapeutic index and presents severe side effects. The encapsulation of timolol in nanomaterials has appeared as a technology to increase its residence time in the eye thus achieving a sustained release and consequently diminishing the doses of this drug and their number. The preparation of nanogels (NGs) based on N-isopropylacrylamide (NIPA) and acrylic acid (AAc), easily synthesized by precipitation/dispersion free radical polymerization, is reported in this paper. Such NGs presented excellent dispersability in eye simulated fluid and ideal size for topical application. NGs can load efficiently timolol through ionic interaction, and the in vitro release showed that NGs deliver timolol in a sustained manner. In vivo sustained efficacy of the NGs-timolol nanoformulations was demonstrated in rabbit's glaucoma model, in which the IOP could be diminished and maintained constant for 48 h with only one application. Overall, the synthesized NGs in combination with timolol have potential as drug delivery system for glaucoma therapy.
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Affiliation(s)
- Julio C Cuggino
- Instituto de Desarrollo Tecnológico para la Industria Química (INTEC), CONICET-UNL, Güemes 3450, 3000 Santa Fe, Argentina
| | - Luis I Tártara
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA), CONICET and Departamento de Farmacia, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Ciudad Universitaria, X5000HUA Córdoba, Argentina
| | - Luis M Gugliotta
- Instituto de Desarrollo Tecnológico para la Industria Química (INTEC), CONICET-UNL, Güemes 3450, 3000 Santa Fe, Argentina
| | - Santiago D Palma
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA), CONICET and Departamento de Farmacia, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Ciudad Universitaria, X5000HUA Córdoba, Argentina.
| | - Cecilia I Alvarez Igarzabal
- Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada (IPQA), CONICET and Departamento de Química Orgánica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Ciudad Universitaria, X5000HUA Córdoba, Argentina.
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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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Phua JL, Hou A, Lui YS, Bose T, Chandy GK, Tong L, Venkatraman S, Huang Y. Topical Delivery of Senicapoc Nanoliposomal Formulation for Ocular Surface Treatments. Int J Mol Sci 2018; 19:E2977. [PMID: 30274277 PMCID: PMC6213297 DOI: 10.3390/ijms19102977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 01/22/2023] Open
Abstract
Topical ophthalmologic treatments have been facing great challenges with main limitations of low drug bioavailability, due to highly integrative defense mechanisms of the eye. This study rationally devised strategies to increase drug bioavailability by increasing ocular surface residence time of drug-loaded nanoliposomes dispersed within thermo-sensitive hydrogels (Pluronic F-127). Alternatively, we utilized sub-conjunctival injections as a depot technique to localize nanoliposomes. Senicapoc was encapsulated and sustainably released from free nanoliposomes and hydrogels formulations in vitro. Residence time increased up to 12-fold (60 min) with 24% hydrogel formulations, as compared to 5 min for free liposomes, which was observed in the eyes of Sprague-Dawley rats using fluorescence measurements. Pharmacokinetic results obtained from flushed tears, also showed that the hydrogels had greater drug retention capabilities to that of topical viscous solutions for up to 60 min. Senicapoc also remained quantifiable within sub-conjunctival tissues for up to 24 h post-injection.
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Affiliation(s)
- Jie Liang Phua
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore.
| | - Aihua Hou
- Singapore Eye Research Institute, Singapore 169856, Singapore.
- Duke-NUS Medical School, Singapore 169856, Singapore.
| | - Yuan Siang Lui
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore.
| | - Tanima Bose
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.
| | | | - Louis Tong
- Singapore Eye Research Institute, Singapore 169856, Singapore.
- Duke-NUS Medical School, Singapore 169856, Singapore.
- Singapore National Eye Center, Singapore 168751, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
| | - Subbu Venkatraman
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore.
| | - Yingying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore.
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Goyal R, Macri LK, Kaplan HM, Kohn J. Nanoparticles and nanofibers for topical drug delivery. J Control Release 2016; 240:77-92. [PMID: 26518723 PMCID: PMC4896846 DOI: 10.1016/j.jconrel.2015.10.049] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 01/11/2023]
Abstract
This review provides the first comprehensive overview of the use of both nanoparticles and nanofibers for topical drug delivery. Researchers have explored the use of nanotechnology, specifically nanoparticles and nanofibers, as drug delivery systems for topical and transdermal applications. This approach employs increased drug concentration in the carrier, in order to increase drug flux into and through the skin. Both nanoparticles and nanofibers can be used to deliver hydrophobic and hydrophilic drugs and are capable of controlled release for a prolonged period of time. The examples presented provide significant evidence that this area of research has - and will continue to have - a profound impact on both clinical outcomes and the development of new products.
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Affiliation(s)
- Ritu Goyal
- New Jersey Center for Biomaterials, Rutgers, The State University of New Jersey, 145 Bevier Road, Piscataway, NJ 08854, USA
| | - Lauren K Macri
- New Jersey Center for Biomaterials, Rutgers, The State University of New Jersey, 145 Bevier Road, Piscataway, NJ 08854, USA
| | - Hilton M Kaplan
- New Jersey Center for Biomaterials, Rutgers, The State University of New Jersey, 145 Bevier Road, Piscataway, NJ 08854, USA
| | - Joachim Kohn
- New Jersey Center for Biomaterials, Rutgers, The State University of New Jersey, 145 Bevier Road, Piscataway, NJ 08854, USA.
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