What is the direct cost of treatment of acute primary angle closure glaucoma? The Singapore model

AIM: To estimate the cost of management of acute primary angle closure glaucoma in Singapore. METHODS: In this cost analysis using retrospective data, the authors performed a MEDLINE search of published papers on acute primary angle closure glaucoma (APACG) in Singapore. Using information from published data, clinical management pathways were constructed and clinical outcomes identified. For each management path, costs of medical treatment, hospitalization, clinic charges, investigations, laser treatment and surgery were identified and accounted over a 5-year treatment period, using year 2002 rates. RESULTS: Given that, in Singapore, APACG affects 12.2 per 100,000 per year (95% confidence interval [CI], 10.5-13.9) in those aged 30 and older, each annual cohort would need to pay 261,741.78 US dollars (95%CI: US$225 310.90-298 265.10) or 287,560.26 US dollars (95%CI: 247,274.04-330,624.84 US dollars), if inclusive of cataract surgery, over 5 years after the episode of APACG. In this period, individuals would have to commit between 879.45 US dollars and 2576.39 US dollars, depending on the complexity of disease and accompanying cataract surgery. CONCLUSION: Acute primary angle closure glaucoma produces a substantial financial burden on society as well as on the individuals.     

Is there an association between pre-existing sleep apnoea and the development of glaucoma?

AIM: To determine if sleep apnoea is associated with an increased risk of developing glaucoma. METHODS: This was a nested case-control study. Patients seen at the Veterans Affairs Medical Center (BVAMC) in Birmingham, Alabama, with newly diagnosed glaucoma (cases) between 1997 through 2001 were selected (n = 667) and age matched with non-glaucomatous controls (n = 6667). Patient information was extracted from the BVAMC data files containing demographic, clinical, and medication information. An index date was assigned to the glaucoma subjects corresponding to the time of diagnosis. Patients who had a glaucoma diagnosis before the observation period of the study were excluded. 10 controls were randomly selected for each case and matched on age (plus or minus 1 year) and an encounter on or before the index date of the matched case. Ihe main outcome measures were crude and adjusted relative risks for the association between the previous diagnosis of sleep apnoea and the development glaucoma. Adjustment was performed for the associations of diabetes, lipid metabolism disorders, hypertension, cardiovascular disease, cerebrovascular disease, arterial disease, and migraines. RESULTS: Individuals who developed glaucoma were more likely to have a previous sleep apnoea diagnosis relative to control subjects. However, this finding was of borderline significance at an alpha of 0.05 (p value = 0.06, odds ratio = 2.20, 95% confidence intervals 0.967 to 5.004). Following adjustment for other potential risk factors, no significant difference was seen (p value = 0.18, odds ratio = 1.80, 95% confidence interval 0.76 to 4.23). CONCLUSIONS: This nested case-control study does not support a large impact of sleep apnoea on the eventual development of glaucoma relative to other putative risk factors.     

Sociodemographic factors and utilization of eye care services: is there an association with patients presenting to a tertiary referral hospital in acute angle‐closure?

Background: The aim of this study is to examine the relationship between sociodemographic factors and utilization of eye care services in patients presenting in acute angle‐closure (AAC). Design: A hospital‐based retrospective, case‐control study. Participants: Fifty‐five patients consecutively presenting to the emergency department of the Royal Victorian Eye and Ear Hospital with AAC (cases), and 43 patients consecutively referred to the outpatient department for prophylactic laser peripheral iridotomy (controls) over a 3‐year period. Methods: Standardized telephone questionnaires. Main Outcome Measures: Comparisons were made for sociodemographic factors, utilization of eye care services and provision of information on glaucoma and premonitory symptoms of AAC. Results: No significant differences across a range of socioeconomic and demographic factors were found. Fewer cases reported having attended an eye care professional ever (P = 0.02), or in the 12 months preceding their acute hospital attendance (P = 0.002), and had less awareness of angle closure glaucoma (P = 0.001). Logistic regression modelling demonstrated premonitory symptoms of AAC (odds ratio 3.96, [95% confidence interval 1.52–10.32], P < 0.001) and a period of greater than 12 months since the last eye examination (odds ratio 3.89, [95% confidence interval 1.64–9.21]) were significantly associated with the risk of AAC. Conclusions: No significant differences in socioeconomic or demographic parameters between cases and controls were identified. Control subjects had a history of more frequent and recent access to eye care services than cases. The finding that more than one‐third of patients presenting with AAC had consulted an eye care provider in the preceding year suggests that a significant proportion of individuals at risk of AAC remain undetected.     

Is there an association between functional vision and learning to read?

Background: Controversy exists about the role of visual parameters and vision in learning to read. This study aims to determine whether ocular parameters or performance on a dynamic test of visual function differs for children of differing reading ability. Methods: Two hundred and eighty‐four children (mean age 9.9 ±1.8 years) received a vision screening emphasising binocular anomalies associated with discomfort at near (distance and near visual acuity, distance vision challenged with binocular +1 D lenses, near heterophoria, near point of convergence, stereopsis and accommodative facility). Non‐verbal mentation age and reading accuracy were assessed. One hundred and six children performed a computerised task of motion coherence detection. Children were classified as normal readers (n = 195), children with dyslexia (n = 49) or learning disabled children (n = 40) based on their mentation age and their reading age. Results: There were no statistically significant differences or correlations between visual parameters and reading performance. Over thirty per cent of the children had accommodative facilities below or equal to six cycles per minute. Children with learning disabilities performed worst on the motion coherence task but this was statistically significant only when compared to the performance of dyslexics. Discussion: The lack of association between ophthalmic parameters and poor reading ability supports the view of the Committee on Children with Disabilities. However, 39 per cent of the children might be expected to experience difficulty ‘reading to learn’, as suggested by the American Academy of Optometry, as they showed anomalies associated with visual discomfort with prolonged reading. The motion coherence test did not differentiate dyslexics from normal readers and was worst in children with learning disability. Accommodative facility testing remained the most useful predictor of potential visual discomfort.     

Is there is an association between the presence of Staphylococcus species and occurrence of vernal keratoconjunctivitis?

Purpose

The aim of this study was to identify the association of normal bacterial flora with vernal keratoconjunctivitis (VKC) occurrence in VKC and non-VKC groups.

Methods

Conjunctival specimens were collected from 18 VKC patients and 22 healthy controls, cultured and identified following standard methods. The association between the presence of bacteria and occurrence of VKC was analyzed using Chi square statistic.

Results

Comparable bacterial growth was observed in VKC (77.8%) as well as control group (77.2%) (p = 0.970). Analysis of individual bacterial revealed that Staphylococcus aureus was detected more frequently in VKC (27.78% vs. 4.55% in control, p = 0.041) and Staphylococcus epidermidis was found much more commonly in the control eyes (45.45% in control vs. 5.56% in VKC, p = 0.005).

Conclusions

An aggravating role of S. aureus colonization in the occurrence of VKC, and a possible role of S. epidermidis against the occurrence of VKC were concluded.     

Entropion uveae: early sphincter atrophy, signposting primary angle closure glaucoma?

PURPOSE: An easily recognized clinical marker for early changes of primary angle closure glaucoma (PACG) or eyes predisposed to angle closure is important so that timely laser iridotomy can prevent morbidity. Pupillary ruff changes, specifically appearance of entropion uveae (EU), are frequent in eyes with PACG. METHODS: Pupillary ruff was examined under magnification and EU, if present, was graded and correlated with gonioscopic grading and presence of peripheral anterior synechiae (PAS) in consecutive patients with primary open angle glaucoma (POAG), non-glaucomatous controls, and PACG of the subacute, acute, chronic symptomatic, and creeping angle closure glaucoma subgroups. RESULTS: No POAG eye had an abnormal pupillary ruff. A total of 86.7% of subacute PACG eyes and all eyes with acute and chronic PACG showed some grade of EU. Iridocorneal synechiae were more significantly correlated with EU than goniosynechiae (p<0.001). Meridian of iridocorneal but not iridotrabecular synechiae could be correlated with the meridian of EU. In age-matched patients EU was only present in eyes with steep iris configuration, with significant correlation with narrow angles and goniosynechiae. In the detection of PACG the presence of EU Grade I was 94.9% sensitive and 98.2% specific for PACG eyes compared to the gonioscopic picture of angle closure in occludable angles. Its positive predictive value was 91.4%. CONCLUSIONS: EU shows significant correlation with narrow angles, steep iris configuration, and PAS. Kinking of radial iris arteries during angle closure probably causes temporary ischemia, especially of end arteries supplying area of the pupil and sphincter pupillae. EU emerges as an easily observed, objective marker for PACG.     

Is there an universal artificial tear?

Dry eye is a multifactorial disease of the tears and ocular surface that results visual disturbance and tear film instability The main therapy is with artificial tears.     

Association between serotonin-norepinephrine reuptake inhibitors and acute angle closure: What is known?

Serotonin-norepinephrine reuptake inhibitors are widely used antidepressants with a relatively safe profile. One of the complications associated with this group of drugs is acute angle closure. The mechanisms linking serotonin-norepinephrine reuptake inhibitors and acute angle closure are complex and may be interlinked with the effects of the drug on the inhibition of serotonin and noradrenaline reuptake, as well as pseudo-anticholinergic effects, dopaminergic effects, and idiosyncratic reactions with the drug molecule in the eye. Individual characteristics, such as polymorphisms of the gene encoding the 2D6 subunit of cytochrome P450, may affect the metabolism of the serotonin-norepinephrine reuptake inhibitor, whereas the combination with other drugs may lead to an increased risk of iridocorneal angle closure and may further exacerbate other mechanisms. Improved knowledge of the mechanisms linking serotonin-norepinephrine reuptake inhibitors and acute angle closure and of the risk factors predisposing to patients to acute angle closure will reduce the number of patients affected by this dangerous complication.     

Is primary open-angle glaucoma an ocular manifestation of systemic disease?

Graefe's Archive for Clinical and Experimental Ophthalmology - Primary open-angle glaucoma is currently characterized by a pattern of progressive retinal ganglion cell loss that stems from a...     

Is poor life expectancy a predictive factor in the progression of primary open angle glaucoma?

AIM: To investigate the disease progression and final visual outcome of glaucoma patients with poor life expectancy, compared to matched patients with a longer life expectancy. METHOD: Visual fields at diagnosis and at the last ophthalmic appointment before death were analysed for glaucoma patients referred between 1991 and 1995, and deceased before the end of 2001. These patients were matched to the patients living beyond 2001. Functional vision was also assessed, and classified as better than the NHS partial sighted criteria. RESULTS: A total of 61 deceased patients were identified, resulting in 40 matched pairs. In all, 6.5% of the patients with poor life expectancy progressed from functional vision to beyond partial sighted criteria, and none of the matched patients progressed to this extent. At final assessment an association between poor life expectancy and progression beyond functional vision was found existing (P = 0.02), with a lesser association at diagnosis (P = 0.06). Visual field scores of the matched pairs who had test results available for both initial and final assessment (n = 23 pairs) showed no statistically significant difference between the two groups at diagnosis (P = 0.52); However, a significant difference at final the assessment did exist (P = 0.042). No difference between the initial (off medication) intraocular pressures (IOPs) was found (P = 0.82). At the final assessment a significant difference existed (P = 0.025), with the surviving group having a higher final mean pressure (15.9 mmHg, SD 2.8, vs 18.3 mmHg, SD 4.9). CONCLUSION: Patients with poor life expectancy progressed more than the matched surviving patients, when measured from an initially similar position, despite better IOP control.