青光眼患者局部用药依从性及影响因素的调查

目的 调查使用局部降眼压药物的青光眼患者的用药依从性及影响因素,为更好地使用青光眼药物提供有用的信息.设计问卷调查.研究对象北京同仁医院就诊的(门诊和病房)使用局部降眼压药物治疗的青光眼患者236例.方法 面对面问卷调查.将没有严格按照医生处方要求用药定义为不依从.调查青光眼患者局部用药总体不依从率,及不同人口社会环境因素、不同青光眼认知水平及青光眼治疗方面等各个因素的依从率,X2检验和Logistic回归统计分析不依从率的相关影响因素.主要指标不依从率及相关因素.结果 236例局部用药的青光眼患者完成问卷调查,总体不依从率62.3%,联合用药的患者占大多数(83.0%).最常见的不依从原因是忙或忘记(61.9%),其次是离家外出不方便用药(14.3%).青光眼患者局部用药依从性与发病时症状的轻重、用药持续时间以及是否每天在固定时间用药有显著相关性(P均＜0.05);与年龄、性别、文化程度、经济状况、青光眼类型及病情轻重、认知程度、用药种类、用药次数、是否有人提醒用药、是否独居以及是否患有其他疾病等凶素无关.结论 所调查的青光眼患者使用局部降眼压药物治疗的依从性较差,症状轻、长期用药及没有固定的用药时间的患者更易出现不依从.     

健康教育对社区青光眼患者局部用药依从性影响的分析

目的：调查社区青光眼患者对青光眼知识的了解情况及健康教育对社区青光眼患者局部用药依从性和规范性的影响。方法：应用自行设计的调查表对上海宝山区庙行镇社区190例确诊为青光眼的患者进行局部降眼压药物6mo以上使用规范情况,及对青光眼知识的了解情况,健康教育对青光眼患者局部用药依从性等九项指标的影响。结果：健康教育使患者的依从性、青光眼知识知晓率、用药情况（点液前洗手率、点液后闭眼时间、眼液污染率、眼液漏点率）和患者复查情况（视野定期复查率、眼压定期复查率）均有显著性提高（P〈0.05）,对用药种类影响不明显（P〉0.05）。结论：对社区青光眼健康教育与治疗于一体,定期进行用药指导、提供方便可行的健康教育及干预措施很有必要。     

武汉市青光眼患者局部药物治疗依从性调查

目的：：调查武汉市青光眼患者局部使用降眼压药物的依从性及影响因素。方法：一对一应用调查表对2014-07/2015-06在我院已确诊并接受局部青光眼药物治疗6 mo以上的武汉市区及周边城区的366例青光眼患者,进行用药依从性调查,并对影响因素进行分析。结果：青光眼患者局部用药依从性为44.3%(162/366)。患者较好眼的病情程度、发病时症状轻重、持续用药时间及是否每天固定时间用药与用药依从性相关( OR=5.700,0.554,0.336,0.558,P<0.05),患者年龄、性别、婚姻状态、文化程度、经济状况、居住地、青光眼知识的了解程度、需要治疗的全身疾病情况、青光眼类型、用药种类、用药次数等因素与局部用药依从性无相关。结论：武汉市青光眼患者局部用药治疗依从性较差,定期进行相关健康教育和干预措施尤为重要。     

青光眼患者局部用药依从性及其影响因素

目的调查青光眼患者局部用药依从性及其影响因素，以期为青光眼患者设计更好的治疗方案。方法调查研究。应用局部药物的青光眼门诊患者120例，采用调查问卷的形式，依照Morisky推荐的评价依从性的标准评定患者的依从性，用单因素logistic回归和两分类变量的关联性检验分析青光眼患者局部用药依从性的影响因素。结果获得有效问卷108份，青光眼患者局部用药依从率为63．9％，不依从率为36．1％；年龄、月收入情况、用药次数、用药方法和医生是否告知对青光眼患者局部用药依从性有影响（X^2=18．752、17．783、13．530、9．022、14．831，P〈0．05）。结论所调查的青光眼患者局部用药的依从性较好：60岁以上、月收入600元以上、每天用药3次、用药方法正确、医生告知的患者，局部用药依从性好：简单、合理的治疗方案以及加强对青光眼患者的宣传教育，可以提高青光眼患者局部用药的依从性。     

青光眼患者局部用药依从性调查分析

目的 研究青光眼患者局部用药依从性及其影响因素.方法 横断面研究.对2012年1～6月在解放军第180医院眼科门诊确诊为原发性青光眼并局部用药超过半年的110例患者,通过问卷调查方式进行研究,了解其用药依从性及其影响因素.采用SPSS 16.0统计学软件,对患者用药依从性的影响因素进行单因素logistic回归分析.结果 在110例青光眼患者中,用药依从者72例(65.5％),不依从者38例(34.5％).统计分析结果表明,患者性别、年龄、居住地、有无青光眼家族史、青光眼类型、有无手术史及医生处方是否征询患者意见、是否向患者告知用药方法等因素对用药依从性的影响差异无统计学意义.患者的文化程度(P =0.021)、用药前眼压(P =0.005)、是否定期复查(P=0.000)、是否对治疗有信心(P=0.008)、是否担心药物的副反应(P =0.002)、药品的种类(P=0.000)、所有眼药水每日累计点药的频次(P =0.000)、用药是否需要他人帮助(P =0.002)等因素对用药依从性的影响差异有统计学意义.结论 临床眼科医师应充分考虑到青光眼患者长期局部用药治疗过程中影响依从性的多种因素,给予个性化的用药指导方案,以提高患者的用药依从性和治疗效果.     

降眼压药物对青光眼患者眼表影响的研究进展

青光眼是一种累及视网膜神经节细胞的慢性视神经病变,以视乳头萎缩、视野缺损及视力下降为共同特征的疾病。由于青光眼是一种慢性疾病,长期滴用局部降眼压药物往往会合并眼表疾病,从而降低药物依从性,最终影响治疗效果。目前局部降眼压药物主要有前列腺素类衍生物、β-肾上腺素能受体阻滞剂、α-肾上腺素能受体激动剂、局部碳酸酐酶抑制剂、拟胆碱能类药物。本文就以上5种降眼压药物对青光眼患者眼表影响和相关机制做一综述,并为青光眼患者的眼表保护提供预防性措施。     

苏为坦滴眼液的替代降眼压作用

目的:在其他降眼压药物眼压控制不佳、或无法耐受其他降眼压药物的原发性开角型青光眼或高眼压症患者中评价苏为坦TM0.04g/L的治疗效果。方法:使用单种或多种降眼压药物后眼压控制不佳,或无法耐受其他降眼压药物的原发性开角型青光眼或高眼压症患者40例61眼,给予苏为坦滴眼液替代治疗。每晚点药1次,每次1滴。将连续点药后1,4,12wk的眼压与基线眼压进行比较研究,同时观察血压、心率等全身及局部副作用及其患者的依从性。结果:使用苏为坦滴眼液后眼压明显下降。连续点药1,4,12wk眼压下降分别为6.78±3.45mmHg,5.92±4.29mmHg,5.88±4.12mmHg,P<0.05;降压有效率分别为97%,93%,92%。用药后1,4,12wk降压效果比较,无统计学差异。用药前后,视力、视野、视乳头杯盘比、血压均无明显改变。不良反应发生率为22%,均为轻度,最主要的不良反应为结膜充血,但不妨碍继续用药。患者依从性好。结论:苏为坦TM0.04g/L滴眼液对治疗其他降眼压药物眼压控制不佳、或无法耐受其他降眼压药物的原发性开角型青光眼或高眼压症患者是有效和安全的。     

新型抗青光眼药物——固定联合制剂

近年新型抗青光眼药物——固定联合制剂陆续在我国上市。固定联合制剂是由两种或两种以上不同降眼压机制的青光眼药物联合组成,降压效果强于单制剂或不劣于它们协同使用。固定联合制剂仍然存在与单制剂类似的副作用,但少于单制剂。固定联合制剂为临床上使用两种以上药物降眼压患者提供更有力的降压效果,提高治疗方案的便利性,减少多瓶用药防腐剂对眼表的损害,改善病人的依从性和药物治疗的持久性。     

青光眼患者药物治疗依从性的临床调查研究

目的 研究青光眼患者长期药物治疗的依从性及其影响因素.方法 横断面研究.采用问卷调查与访谈相结合的方式,对门诊长期连续治疗的100例青光眼患者进行调查,了解其药物治疗的依从性及其影响因素.采用SPSS 15.0统计学软件,对影响患者药物治疗依从性的多种因素在X2检验的基础上进行二分类logistic回归分析.结果 100例青光眼患者中,男性54例,女性46例;年龄9～80岁;用药时间从6个月至20年不等.100例中,用药依从者61例(61.0%),不依从者39例(39.0%),总体用药依从性为61.0%.调查分析结果表明,患者性别(X2=0.718)、年龄(X2=0.537)、居住地(X2=0.338)、青光眼类型(X2=3.797)、有无手术史(X2=0.338)及医生处方是否征询患者意见(X2=0.297)、是否向患者交待用药方法(X2=0.157)等因素对药物治疗依从性无明显影响,差异无统计学意义(均P>0.05).二分类logistic回归分析结果表明,患者用药前眼压(P=0.013)、用药种类(P=0.005)、药液是否滴在眼睑皮肤上(P=0.005)、滴眼液时是否需要帮助(P=0.012)、是否定期复查(P=0.011)、自身对青光眼治疗的信心(P=0.004)等因素对药物治疗依从性有显著影响,差异有统计学意义(均P<0.05).患者自述中的药物副作用、滴眼液方案复杂易忘、就医不便(包括候诊时间长)等因素排在影响药物治疗依从性的前3位.结论 临床眼科医师应充分考虑到影响患者药物治疗依从性的多种因素,向患者交代使用抗青光眼药物应注意的问题,给予具体用药指导,以提高青光眼患者的药物治疗依从性,从而增进疗效.     

青光眼治疗新策略

局部使用降眼压药物是目前治疗青光眼的主要方法,复合制剂指把2种或2种以上的药物放在一个滴眼瓶里,它增强了降眼压作用,减少了副反应,能提高患者的依从性.目前,已在临床上使用的复合制剂主要有胆碱能激动剂与肾上腺素能激动剂复合制剂、β-受体阻滞剂与胆碱能激动剂复合制剂、局部碳酸酐酶抑制剂β-受体阻滞剂复合制剂、前列腺素类药物与β-受体阻滞剂复合制剂和α2受体激动剂与β-受体阻滞剂复合制剂.大多数复合制剂都含有β-受体阻滞剂,随着前列腺素类药物逐渐取代β-受体阻滞剂成为一线用药,含前列腺素类药物的复合制剂可能成为未来的发展趋势和青光眼治疗的新策略.尽管如此,复合制剂也存在自身的缺点,并非适用于所有的患者.因此,临床医生应该根据个体化用药原则,为患者制定出合理的用药方案.     

Conjunctival and corneal sensitivity in patients under topical antiglaucoma treatment

The purpose of the study is to measure corneal and conjunctival sensitivity in patients under glaucoma topical treatment as compared to a control group. It is a case–control study. Corneal and conjunctival esthesiometry were carried out through a Cochet–Bonnet esthesiometer. We took healthy individuals as controls, who did not use any type of ophthalmic topical medications and without history of ocular surface pathology or irritation. The study group was subdivided per number of applications (1, 2, and 3 or more applications). From a total 182 eyes from 91 patients, of which 26 (28.57 %) were controls and 65 (71.43 %) were in the study group, a mean corneal sensitivity of 58.98 ± 2.25 mm was found in the control group and 52.97 ± 6.41 mm in patients using topical medication. Mean conjunctival sensitivity was 18.80 ± 5.40 mm in the control group and 11.76 ± 5.45 mm in the study group. There was no statistically significant difference among groups when separated by 1, 2, and 3 or more applications. Eyes under use of timolol-containing medications showed lower sensitivity values as compared to other topical antiglaucoma medications. Corneal and conjunctival sensitivities are diminished in patients with chronic use of topical hypotensive medications and these results can explain the lack of correlation between signs and symptoms that is typically found in patients treated for glaucoma or ocular hypertension.     

重视长期局部应用抗青光眼药物对眼表组织的损伤

长期应用抗青光眼药物能引起结膜慢性炎症、浅层点状角膜炎及干眼症等眼表疾病。病理研究发现该类患者结膜杯状细胞数量减少、眼表上皮鳞状化生及角膜上皮细胞凋亡。已有证据表明滴眼液中的防腐剂苯扎氯胺有毒性作用,是眼表组织损伤的重要原因。药物性眼表损伤患者临床表现无特异性,症状轻微,病变发生滞后,常与眼表疾病共存或混淆,可严重影响患者的生活质量和青光眼的治疗。因此,要十分重视长期局部应用抗青光眼药物对眼表组织的损伤问题,选用降眼压效果好、作用时间长的抗青光眼药物,必要时使用联合固定配方制剂,减少药物使用的种类和次数。对需要使用多种药物才能达到靶眼压或出现眼表组织损伤的患者,应及时采取手术或激光等其他治疗措施。注意对眼表组织损伤的预防及共存眼表疾病的治疗。研制无防腐剂或含有新型防腐剂的抗青光眼药物,改进或研制长效药物和药物赋形剂是今后新型抗青光眼药物剂型发展的方向。     

Prevalence of signs and symptoms of ocular surface disease in individuals treated and not treated with glaucoma medication

Background: To determine the prevalence of signs and symptoms of ocular surface disease in two hospital‐based cohorts; glaucoma patients and non‐glaucoma patients. Design: A cross‐sectional, comparative case series. Participants: Glaucoma patients (n = 300) prescribed topical glaucoma medications for ≥6 months were compared with control patients (n = 100) who were not applying prescribed topical medications. Methods: A validated self‐report questionnaire was used to elicit the extent of ocular symptoms. Signs of ocular surface and eyelid disease were assessed along with medication history. Main Outcome Measures: Signs and symptoms of ocular surface pathology were determined including the tear film break‐up time, fluorescein staining of the cornea and conjunctiva, meibomian gland dysfunction and Schirmer's test. Results: A significant increase in the prevalence of ocular surface disease signs was observed in the glaucoma population, 70.3%, compared with controls, 33% (P < 0.001). The overall prevalence of clinically significant ocular surface disease symptoms was not significantly different between cohorts, 30.7% versus 24.0%, respectively (P = 0.252). Logistic regression analysis showed that the number of anti‐glaucoma medications and duration of therapy were key predictors of significant ocular surface disease signs in the glaucoma group. There was no significant correlation between signs and symptoms of ocular surface disease in either group after adjusting for age and gender. Conclusions: Signs and symptoms of ocular surface disease are relatively common in older patients, but signs of ocular surface disease are significantly higher in individuals who instil topical glaucoma therapy.     

Evaluation of an eye drop guide to aid self-administration by patients experienced with topical use of glaucoma medication

BACKGROUND: Methods to improve patient compliance with prescribed topical use of glaucoma medication are sorely needed. A guide for the topical administration of ocular medication was suggested as such a tool. We investigated whether eye drop self-administration would be improved with use of the guide. METHODS: An eye drop guide, a funnel-shaped device designed to fit within the contour of the orbital margins, was offered to 114 patients for use at home with their glaucoma medication. A questionnaire asking about the ease of eye drop self-administration was administered before and after 1 week's use of the device. RESULTS: Of the 111 patients who accepted the guide, 93 returned a usable completed questionnaire. Seventy-four percent said that they found it easier to administer their eye drops without the guide and preferred to do so (chi2 = 21.77, p < 0.01). Patients using more doses per day found it more difficult to administer their drops using the guide (r = -0.233, p < 0.05), and those who had been using drops longer preferred not to continue using the guide (r = -0.222, p < 0.05). Patients who found the written instructions clearer found it easier to administer their drops using the guide (r = 0.329, p < 0.05). INTERPRETATION: Although intended to ease the administration of eye drops, the guide proved to be counterproductive. Further work is necessary to investigate other methods of improving patient compliance with prescribed topical use of ocular medications.     

Central corneal thickness and measured IOP response to topical ocular hypotensive medication in the Ocular Hypertension Treatment Study

PURPOSE: To determine whether central corneal thickness (CCT) correlates with measured intraocular pressure (IOP) response to topical ocular hypotensive medication in the Ocular Hypertension Treatment Study (OHTS). DESIGN: Prospective randomized clinical trial. METHODS: Intraocular pressure measurements were performed by Goldmann applanation tonometry. Central corneal thickness was measured by ultrasonic pachymetry. The following indicators of IOP response to topical ocular hypotensive medication were examined: (1) IOP after an initial four- to six-week one-eyed therapeutic trial of a nonselective beta-blocker (N = 549) or a prostaglandin analog (N = 201); (2) the mean IOP response during 12 to 60 months of follow-up among medication participants (N = 689); (3) the percentage of follow-up visits at which both eyes met the treatment goal; (4). the total number of different medications prescribed to reach treatment goal; and (5) the total number of different medications prescribed multiplied by the number of months each medication was prescribed. RESULTS: Central corneal thickness was inversely related to the IOP response after the initial one-eyed therapeutic trial and during 12 to 60 months of follow-up (P < .05). Mean CCT was not correlated with the number of different medications prescribed during follow-up, the total medication-months, or the percentage of visits at which IOP target was met. CONCLUSIONS: Individuals with thicker corneas had smaller measured IOP responses to ocular hypotensive medication than those with normal or thin corneas. We believe that CCT measurements may be useful in patient management and in interpreting clinical trials of ocular hypotensive medication.     

Patient satisfaction with topical ocular hypotensives

Background: The aim of this study is to assess patient satisfaction, convenience of use, ease of administration, side effects and treatment burden of topical ocular hypotensives. Design: Prospective, observational cohort. Participants: Two thousand five hundred and forty‐one patients with glaucoma or ocular hypertension. Methods: The Treatment Impact Patient Satisfaction Scale (TIPSS) was administered by mail to all patients with glaucoma or ocular hypertension registered with Glaucoma New Zealand during a 3‐month study period. The questionnaire assessed patient demographics; topical ocular hypotensive use including number of medications, frequency of administration, ease of use, class of medication, and presence/severity of side effects; impact on quality of life; and patient satisfaction. Univariate and multivariate analyses were performed to identify determinants of patient satisfaction. Main Outcome Measures: Patient satisfaction. Results: Almost 80% of respondents were either ‘very satisfied’ or ‘satisfied’ with topical ocular hypotensives. Factors that were predictive of patient satisfaction included satisfaction with frequency of eye drop use {odds ratio (OR) 2.4 (95% confidence interval [CI] 1.8–3.1); P < 0.001}, subjective convenience (OR 2.6 [95% CI 2.0–3.4]; P < 0.001) and ease of administration (OR 2.5 [95% CI 2.0–3.3]; P < 0.001). Male gender was associated with lower satisfaction (OR 0.6 [95% CI 0.5–0.9]; P = 0.01). Factors that were not predictive of patient satisfaction included age, duration of eye drop use, class of medication and the presence of side effects. Conclusions: Patients with glaucoma and ocular hypotension are satisfied with topical ocular hypotensives. Efforts to improve patient satisfaction should focus on convenience and ease of administration.     

Reducing intraocular pressure: is surgery better than drugs?

Reducing IOP is presently the evidence based, most accepted and most practised therapeutical approach for glaucoma patients. Currently topical ocular hypotensive medications, with its different classes, as well as filtering surgery (trabeculectomy and non-penetrating glaucoma surgery) are in the forefront of therapeutic modalities for IOP reduction. This article looks at the potential advantages and disadvantages of topical medications versus filtering surgery. It does not directly address the question of initial treatment of glaucoma, or what is the better treatment of glaucoma, as other review articles had, but rather looks in a more specific on the pros and the cons of each in relation to IOP reduction. In other words this article deals with the situation once the decision has been made to reduce IOP.