Noncompliance with glaucoma medication in Korean patients: a multicenter qualitative study

Purpose

To investigate the common side effects of topical antiglaucoma medication, factors affecting compliance, and the utilization of herbal medicine for glaucoma treatment in South Korea.

Patients and methods

A cross-sectional multicenter hospital-based study. In-depth interviews using a structured questionnaire were conducted with 581 individuals diagnosed with glaucoma. Additional eligibility requirements were: all participants were diagnosed with glaucoma in one or both eyes and prescribed eye drops at least one month before the start of the study, and were in a suitable condition for an interview. The frequency of response for each category in the interview questionnaire was analyzed.

Results

Conjunctival injection, a stinging sensation, and blurred vision were the most frequently reported side effects, among which blurred vision was the most unbearable. Patient knowledge of glaucoma was the only factor associated with the patient’s self-evaluation of compliance. Forgetfulness was the most common reason for nonadherence. Only 2.9 % of patients were taking herbal medicine.

Conclusions

Physicians should address a patient’s complaint of blurred vision resulting from medication. Complete initial explanation of the consequences of nonadherence and of the potential vision loss from glaucoma are critical elements in improving patient adherence in Asian populations.     

Glaucoma among Omani diabetic patients: a cross-sectional descriptive study: (Oman diabetic eye study 2002)

PURPOSE/METHODS: A cross-sectional study was carried out to review the ocular status of 2,063 diabetic patients in Oman. A part of this study is presented to highlight the magnitude and determinants of glaucoma. The study also recommends policies for comprehensive care of glaucoma among diabetic patients. The ocular pressure, disc changes, and field changes were noted by ophthalmologists. The diabetes profile was noted by physicians. RESULTS: The rate of glaucoma among diabetic patients was 8.87% (95% CI 8.12 to 9.62). Male diabetic patients had significantly higher rates of glaucoma than female diabetic patients. The rate was significantly higher in higher age groups. The mean ocular pressure in glaucomatous eyes was 28.6 mm Hg. The rate was not significantly different in patients with type I and type II diabetes (RR 1.03 [95% CI 0.61 to 1.79]). The risk of visual disability was higher among diabetic patients with glaucoma than diabetic patients without glaucoma (RR 1.56 [95% CI 1.14 to 2.13]). CONCLUSIONS: Ocular pressure measurement could be a simple and reliable first-level screening tool. Diabetic patients with glaucoma should be given special care to reduce visual disability. All patients with diabetes should be thoroughly checked periodically to rule out glaucoma.     

Influencing factors of fear of falling among glaucoma patients in west China: a cross-sectional study

AIM: To investigate the current situation and influencing factors of fear of falling in glaucoma patients in western China. METHODS: In this cross-sectional study, glaucoma patients treated in the Ophthalmology Department of West China Hospital of Sichuan University were conducted to investigate the demographic data, visual acuity, visual field, activities of daily living, risk of falling, fear of falling and psychological states. Generalized linear model was used for multivariate analysis with fear of falling as dependent variable and other factors as independent variables. RESULTS: The mean score of the Chinese version modified Fall Efficacy Scale (MFES) was 7.52±2.09 points. Univariate analysis and multivariate analysis showed that the history of falls within one year, visual acuity, visual field, risk of falling, activities of daily living and psychological states had statistically difference on fear of falling (P<0.05). CONCLUSION: Glaucoma patients in west China have relatively high risk of fear of falling. History of falling within 1y, severe visual function impairment, high risk of falling, incapable of independence of daily living, and abnormal psychological state are risk factors of fear of falling among glaucoma patients.     

局部抗青光眼药物的回顾性研究

目的：通过回顾性分析佛山市第二人民医院(地方三甲医院)2009/2016年门诊处方中局部降眼压药物,分析过去8a该院青光眼药物使用频度和变化趋势。

方法：回顾性分析2009-01-01/2016-12-31于我院门诊就诊的所有青光眼患者局部抗青光眼药物使用情况。分年度比较各类药物处方频次百分比,单药与联合用药的构成比及用药频度。

结果：β-肾上腺素能受体阻滞剂的处方频次构成比由2009年的81.51%下降为2016年的69.37%; 拟胆碱能类药物由2009年的12.04%下降为2016年的3.78%; 前列腺素类衍生物由2009年的8.40%上升为2016年的31.40%; α2-肾上腺素能受体激动剂由2009年的0上升为2016年的29.44%; 局部碳酸酐酶抑制剂变化不大。单用一种药物的比例由2009年的65.83%,降为2016年的46.22%,两种药物联合使用的比例由2009年的32.49%增加为2016年的38.77%; 三种药物联合使用的比例在2009年时为1.68%,到2016年时为12.96%; 四种药物联合使用的比例在2009年时为0,到2016年时增为1.97%; 而五种药物联合使用属个别情况。

结论：局部青光眼药物使用频度发生了显著的变化。β-肾上腺素能受体阻滞剂和拟胆碱能类药物的使用频度逐年下降,前列腺素类衍生物和α2-肾上腺素能受体激动剂的使用频度逐年上升。单用一种药物的比例在逐年降低,联合用药的比例则在逐年增加。     

Multifocal VEP and OCT findings in patients with primary open angle glaucoma: A cross-sectional study

ABSTRACT: Bakground To evaluate objectively the anatomical and functional changes of optic nerve in eyes with primary open angle glaucoma (POAG) by the joint use of optical coherence tomography (OCT) and multifocal visual evoked potentials (mfVEP). METHODS: 29 eyes with open angle glaucoma and visual field defects, as well as 20 eyes of 10 age-matched control normal subjects were tested. All participants underwent a complete ophthalmological examination. Moreover, Humphrey visual field test, OCT examination and recording of mfVEP were performed. Amplitude and implicit time of mfVEP, as well as RNFL thickness were measured. Differences in density components of mfVEP and in RNFL thickness among POAG eyes and control eyes were examined using Student's t-test. RESULTS: In glaucomatous eyes the mean Retinal Response Density (RRD) was lower than normal in ring 1, 2 and 3 of mfVEP (p < 0.0001). Specifically the mean amplitude of mfVEP in POAG eyes was estimated at 34.2 +/- 17.6 nV/deg2, 6.9 +/- 4.8 nV/deg2 and 2.6 +/- 1.6 nV/deg2 in rings 1, 2 and 3 respectively. In contrast the mean implicit time was similar to control eyes. In addition, the mean RNFL thickness in POAG eyes was estimated at 76.8 +/- 26.6 mum in the superior area, 52.1 +/- 16.3 mum in the temporal area, 75.9 +/- 32.5 mum in the inferior area and 58.6 +/- 19.4 mum in the nasal area. There was a statistically significant difference in RNFL thickness in all peripapillary areas (p < 0.0001) between POAG eyes and controls, with superior and inferior area to present the highest decrease. CONCLUSIONS: Our study shows that, although Standard Automatic Perimetry is the gold standard to evaluate glaucomatous neuropathy, the joint use of mfVEP and OCT could be useful in better monitoring glaucoma progression.     

Combined treatment in patients with unstabilized glaucoma

The efficacy of cortexine used to treat patients with unstabilized primary open-angle glaucoma (OAG) was studied after penetrating through trophic sclerectomy with cyclodialysis. Thirty-nine patients (58 eyes) with developed OAG were examined. All the patients underwent penetrating trophic sclerectomy with cyclodialysis, followed by a course of subconjunctival injections of cortexine 10 mg. The positive effect persisted for 1.5 years and a stabilizing glaucomic process was observed in 78% of the patients.     

Primary angle closure glaucoma: a descriptive study in Scottish Caucasians

Purpose: The aim of this study is to describe the ocular and demographic features of Caucasian patients newly presenting with primary angle closure glaucoma and the proportion of workload it represents at a tertiary university hospital glaucoma service. Methods: A retrospective case notes review was conducted for all Caucasian patients newly diagnosed with narrow angles, primary angle closure, acute primary angle closure and primary angle closure glaucoma that were seen over a period of 2 years. Demographic and ocular variables were compared and statistical analysis was carried out with the paired t‐test and chi‐squared test. Number of primary open angle closure glaucoma and acute angle closure cases were compared with total number of new referrals to the department, new patients diagnosed with glaucoma and population numbers for the North East of Scotland. Results: One hundred and four patients were analysed. Twenty‐four (23.1%) had narrow angles, 30 (28.8%) had primary angle closure and 50 (48.1%) had primary angle closure glaucoma. Twelve (11.5%) presented with acute primary angle closure. There was no significant difference for gender, age, hypermetropia or visual acuity between groups. Primary angle closure glaucoma constituted 22.9% (50/128) of newly diagnosed glaucoma cases. Based on the 2001 Scotland census, the crude annual incidence of newly diagnosed primary angle closure glaucoma was estimated at 14.8 per 100 000 and 3.6 per 100 000 for acute primary angle closure in the over‐45‐year‐old population. Conclusion: Our study confirms that primary angle closure glaucoma is uncommon in Caucasians, but not as rare as originally perceived as it makes up a fair proportion (22.9%) of glaucoma workload.     

Changing paradigms in the medical treatment of glaucoma

Glaucoma is defined by a typical optic neuropathy accompanied by characteristic visual field loss and eventual blindness. The major risk factor for glaucoma is elevated intraocular pressure (IOP). Lowering IOP is currently the only proven method for reducing the risk of glaucomatous visual field loss and remains the primary goal of therapy. With the recent introduction of many new medications that lower IOP, the definition of what constitutes maximum tolerated medical therapy has been changing. The treatment can now be tailored better to each individual patient. The regimen needs to be affordable, easy to understand, and least interfering with the patient's quality of life. beta-blockers still are the mainstay of initial therapy, but more and more prostaglandin analogs and also alpha-2 agonists are being used initially. Systemic carbonic anhydrase inhibitors and cholinergics are being used less frequently.     

Goldmann tonometry and pachymetry measures in patients with and without topical medical treatment at a glaucoma clinic

Purpose: To investigate, by audit, the intraocular pressure (IOP) and central corneal thickness (CCT) of patients attending a routine glaucoma clinic, in order to assess the potential effect of CCT on IOP measures. Methods: Data on current IOP (Goldmann), CCT (ultrasound) and glaucoma medications use were collected from 140 patients who presented for a follow‐up visit over a 3‐month period. Baseline IOP was retrieved from patient records. Results: The IOP was lower at follow‐up, an expected effect of the use of IOP‐lowering medications. However, the CCT was lower in medicated patients indicating, but not proving, that it changed in response to the lowering of IOP. Overall, the measured IOP was higher in patients with greater CCT values (p < 0.001) but this IOP–CCT relationship was most noticeable in patients with normal tension glaucoma and not obvious in those diagnosed with ocular hypertension. Overall, the slope of the IOP–CCT relationship was slightly steeper for those patients prescribed glaucoma medications. Conclusions: In the routine assessment of glaucoma patients, corneal thickness can be shown to have an impact on applanation tonometry data. However, this effect may not be uniformly evident in patients with different types of glaucoma and may be different for patients under topical medical treatment.