To assess patient adherence and behaviors with topical once-daily therapy for glaucoma.
Prospective, observational cohort study.
One hundred ninety-six patients with glaucoma who were being treated ...with a prostaglandin analog in 1 or both eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007.
Detailed medical history was obtained from each patient. All subjects used the Travatan Dosing Aid (DA; Alcon, Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months and the data of drop usage was downloaded using software provided with the dosing aid. Data were analyzed for the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit.
Assessment of adherence and patterns of drop usage as indicated by the DA.
A total of 282 subjects consented to be in the study and 86 (30%) withdrew before study completion or had device errors, leaving 196 subjects (70%) with evaluable data at 3 months. The overall mean (+/-standard deviation) adherence rate was 0.71 (+/-0.24), ranging from 0.02 to 0.97. One hundred nine of these patients (55.6%) took greater than 75% of the expected doses. Those with adherence of less than 50% of expected doses showed substantially increased dose taking immediately after the office visit and just before the return visit at 3 months (P = 0.03). The mean adherence rate estimates of the physician and patient self-report were 0.77 and 0.95, respectively. The agreement between the physician assessment and DA-recorded adherence rate showed poor correlation for individual cases (intraclass correlation coefficient, 0.09; 95% confidence interval, 0.00-0.19).
Nearly 45% of patients using an electronic monitoring device who knew they were being monitored and were provided free medication used their drops less than 75% of the time. Patients reported far higher medication use than their actual behavior. The ability of the physician to identify which persons are poorly adherent from their self-report or from other subjective clues is poor.
Proprietary or commercial disclosure may be found after the references.
Rho kinase inhibitors, such as netarsudil, are a relatively new class of medications recently introduced into the market for the treatment of glaucoma, the leading cause of irreversible blindness in ...the world. Previous clinical trials have studied netarsudil's efficacy when used as a first- or second-line agent but limited studies have investigated its effectiveness in the real world where it is more commonly used as a third, fourth, or fifth agent in combination with other topical medications. Equally important, prior studies have not compared its effectiveness to its peer medications in these settings.
To compare intraocular pressure (IOP) lowering after initiation of netarsudil or brimonidine therapy in patients with glaucoma using >2 medications for IOP management.
A chart review of 369 eyes from 279 patients followed at a single academic tertiary practice was performed with an institutional review board waiver of consent to compare IOP lowering after prescription of netarsudil (n = 176) versus brimonidine (n = 193) as a third, fourth, or fifth IOP-lowering agent. Patients were identified by querying the electronic medical record for those with a glaucoma-related diagnosis who were prescribed either medication. Five sequential IOP measurements were obtained to determine the mean change in IOP before and after treatment (ΔIOP = mean IOP4,5 – mean IOP1,2,3). A multilevel linear mixed-effects model assessed the influence of medication (independent variable) on ΔIOP (dependent variable). Additional independent variables of interest included the number of glaucoma medications at baseline, age, sex, glaucoma type and severity, race, and pretreatment IOP. Bootstrap analysis was performed to remove sampling bias and confirm mixed-effects model findings. Kaplan-Meier survival analysis evaluated the probability of requiring additional intervention within 3 years following the date of medication prescription.
The unadjusted mean (SD) ΔIOP for netarsudil and brimonidine was −2.20 (4.11) mm Hg and −2.21 (3.25) mm Hg, respectively (P = 0.484). The adjusted linear mixed-effects models and bootstrap analysis demonstrated that there was no statistical difference in IOP-lowering effectiveness between the medications. Netarsudil and brimonidine failed to adequately control IOP at similar rates with 42% and 47% probabilities of survival respectively by the 3-year follow-up (P = 0.520).
When escalating pharmacologic therapy, the IOP-lowering effect of netarsudil appeared to be similar to that produced by brimonidine. (Curr Ther Res Clin Exp. 2023; 84:XXX–XXX)
To determine if glaucoma is associated with driving limitation or cessation.
Cross-sectional analysis within a longitudinal, population-based cohort study.
One thousand one hundred thirty-five ...ever-drivers between 73 and 93, including 70 subjects with unilateral and 68 subjects with bilateral glaucoma.
All subjects reported their driving habits during each of 4 study rounds. During the fourth and final study round, subjects were assessed systematically for the presence of glaucoma.
Self-reported driving cessation or driving limitation, including cessation of night driving, driving fewer than 3000 miles annually, or cessation of driving in unfamiliar areas.
Fifteen percent of subjects without glaucoma no longer were driving at the end of the cohort study, compared with 21% of unilateral glaucoma subjects (P = 0.2) and 41% of bilateral glaucoma subjects (P<0.001). Multivariate regression analysis showed that bilateral (odds ratio OR, 2.6; P = 0.002), but not unilateral (OR, 1.5; P = 0.3), glaucoma subjects were more likely no longer to be driving when compared with subjects without glaucoma. The odds that bilateral glaucoma subjects no longer were driving doubled for every 5 dB of visual field (VF) worsening in the better eye (P<0.001). Driving cessation within the previous 2 years was analyzed using separate multiple regression models, and both bilateral (OR, 3.6; P = 0.004) and unilateral (OR, 2.4; P = 0.06) glaucoma subjects were more likely to stop driving over this period than subjects without glaucoma. Driving cessation associated with bilateral glaucoma was present in 0.82% of the population, or 1 in every 122 individuals. Greater numbers of driving limitations were not more likely among subjects with glaucoma than subjects without glaucoma. However, bilateral glaucoma subjects did attribute more driving limitations to difficulties with their vision than subjects without glaucoma (OR, 2.2; P = 0.02).
Bilateral, and possibly unilateral, glaucoma is associated with significantly higher rates of driving cessation among the elderly. The substantial difference in driving patterns seen with different degrees of better-eye VF damage suggests that minimizing VF loss in the better-seeing eye is associated with better functional outcomes.
To provide an evidence-based summary of the outcomes, repeatability, and safety of laser trabeculoplasty for open-angle glaucoma.
A search of the peer-reviewed literature in the PubMed and the ...Cochrane Library databases was conducted in June 2008 and was last repeated in March 2010 with no date or language restrictions. The search yielded 637 unique citations, of which 145 were considered to be of possible clinical relevance for further review and were included in the evidence analysis.
Level I evidence indicates an acceptable long-term efficacy of initial argon laser trabeculoplasty for open-angle glaucoma compared with initial medical treatment. Among the remaining studies, level II evidence supports the efficacy of selective laser trabeculoplasty for lowering intraocular pressure for patients with open-angle glaucoma. Level III evidence supports the efficacy of repeat use of laser trabeculoplasty.
Laser trabeculoplasty is successful in lowering intraocular pressure for patients with open-angle glaucoma. At this time, there is no literature establishing the superiority of any particular form of laser trabeculoplasty. The theories of action of laser trabeculoplasty are not elucidated fully. Further research into the differences among the lasers used in trabeculoplasty, the repeatability of the procedure, and techniques of treatment is necessary.
Proprietary or commercial disclosure may be found after the references.
To provide an evidence-based summary of commercially available aqueous shunts currently used in substantial numbers (Ahmed New World Medical, Inc., Rancho Cucamonga, CA, Baerveldt Advanced Medical ...Optics, Inc., Santa Ana, CA, Krupin Eagle Vision, Inc, Memphis, TN, Molteno Molteno Ophthalmic Ltd., Dunedin, New Zealand) to control intraocular pressure (IOP) in various glaucomas.
Seventeen previously published randomized trials, 1 prospective nonrandomized comparative trial, 1 retrospective case-control study, 2 comprehensive literature reviews, and published English language, noncomparative case series and case reports were reviewed and graded for methodologic quality.
Aqueous shunts are used primarily after failure of medical, laser, and conventional filtering surgery to treat glaucoma and have been successful in controlling IOP in a variety of glaucomas. The principal long-term complication of anterior chamber tubes is corneal endothelial failure. The most shunt-specific delayed complication is erosion of the tube through overlying conjunctiva. There is a low incidence of this occurring with all shunts currently available, and it occurs most frequently within a few millimeters of the corneoscleral junction after anterior chamber insertion. Erosion of the equatorial plate through the conjunctival surface occurs less frequently. Clinical failure of the various devices over time occurs at a rate of approximately 10% per year, which is approximately the same as the failure rate for trabeculectomy.
Based on level I evidence, aqueous shunts seem to have benefits (IOP control, duration of benefit) comparable with those of trabeculectomy in the management of complex glaucomas (phakic or pseudophakic eyes after prior failed trabeculectomies). Level I evidence indicates that there are no advantages to the adjunctive use of antifibrotic agents or systemic corticosteroids with currently available shunts. Too few high-quality direct comparisons of various available shunts have been published to assess the relative efficacy or complication rates of specific devices beyond the implication that larger-surface-area explants provide more enduring and better IOP control. Long-term follow-up and comparative studies are encouraged.
Objectives/Hypothesis:
Disease recurrence and adverse wound healing in the form of inflammation, polyposis, adhesions, and middle turbinate lateralization may induce suboptimal outcomes following ...sinus surgery. The study objective was to assess the safety and effectiveness of a bioabsorbable, steroid‐eluting implant used following functional endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS).
Study Design:
Prospective, multicenter, single‐cohort trial enrolling 50 patients.
Methods:
The study allowed bilateral or unilateral steroid‐eluting implant placement. Oral and topical steroids were withheld for 60 days postoperatively. Endoscopic follow‐up was performed to 60 days. Patient‐reported outcomes (Sino‐Nasal Outcome Test‐22 Questionnaire, Rhinosinusitis Disability Index) were collected to 6 months. Efficacy was assessed by grading inflammation, polyp formation, adhesions, and middle turbinate position. Safety assessment included ocular exams at baseline and 30 days.
Results:
Implants were successfully placed in all 90 sinuses. Mean inflammation scores were minimal at all time points. At 1 month, the prevalence of polypoid edema was 10.0%, significant adhesions 1.1%, and middle turbinate lateralization 4.4%. Changes from baseline in patient‐reported outcomes were statistically significant (P < .0001). No clinically significant changes from baseline in intraocular pressure occurred.
Conclusions:
This consecutive case series provides clinical evidence of the safety, effectiveness, and clinical utility of a bioabsorbable steroid‐eluting implant for use in CRS patients. The implant was associated with favorable rates of sinus patency. At 1 month, minimal degrees of inflammation and adhesions were observed, suggesting a positive clinical impact of local steroid delivery without evidence of ocular risk. Laryngoscope, 121:2473‐2480, 2011
To examine whether glaucoma status or measures of visual function affected by glaucoma are associated with self-reported difficulty with vision-intensive tasks in a population-based study.
...Cross-sectional study.
One thousand one hundred sixty individuals who participated in the fourth round of the Salisbury Eye Evaluation study and who did not have visual acuity worse than 20/40 due to a primary cause other than glaucoma.
Glaucoma was assessed using optic nerve head appearance, visual field (VF) testing, gonioscopy, and physician opinion. Vision-related quality of life was assessed using the Activities of Daily Vision Scale (ADVS), whose scores were trichotomized into the following categories: the least difficulty with visual tasks, some difficulty, and the most difficulty. Data on confounders were collected by questionnaire and clinical examination. Multinomial logistic regression was used to adjust for demographic and health factors.
Reported difficulty on the ADVS.
Individuals with bilateral glaucoma were more likely to report the most difficulty on the ADVS than those without glaucoma (odds ratio OR, 3.25; 95% confidence interval CI, 1.56-6.76), whereas those with unilateral glaucoma were not more likely to report the most difficulty (OR, 1.05; 95% CI, 0.38-2.91). Worse binocular VF scores were associated with increased odds of the most difficulty on the ADVS after adjusting for acuity and contrast sensitivity (OR, 1.48; 95% CI, 1.29-1.85).
Individuals with bilateral glaucoma reported more difficulty on the ADVS than those without glaucoma. This finding, in conjunction with findings demonstrating decreased mobility in patients with bilateral glaucoma, points to the fact that glaucoma affects the report of difficulty with a variety of visual tasks.
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