Prescribed Eye Drops Research Articles

The Achievement of IOP Target Among a Sample of Iraqi Patients with Glaucoma: A Retrospective Study.

Glaucoma is a chronic progressive eye disorder. It is the primary cause of blindness. To prevent glaucomatous damage and blindness, the intra-ocular pressure (IOP) must be lowered to certain levels, this level is known as "IOP" target. Many studies conducted in developed countries have found that the majority of glaucoma patients failed to reach their target IOP. This study aimed to assess the achievement of IOP target among Iraqi patients with glaucoma and to determine the factors affecting it. A single-center retrospective cohort study was conducted by inspecting the records of all patients with confirmed cases of glaucoma who were admitted to the Ibn-Al-Haitham Hospital outpatient unit from January 2020 to December 2022. To be included in the study, the patient must be newly diagnosed with glaucoma. In addition, full information on the patient's demographics, medical therapy used, and IOP at baseline and after 1 month of treatment must be available in the patient's case sheet. After considering the study inclusion criteria, the records of 760 patients were excluded, and only 100 patients were eligible. The included patients were mostly males, with an average age of 57.86 years. A 70% of the patients had elevated IOP in both eyes. Most patients (38%) were treated with two anti-glaucoma drugs. Only 35% of the patients achieved their targeted IOP. Regarding the factors influencing the achievement of the IOP target, all demographic data (age and gender) had a non-significant effect, while the number of prescribed drugs affected the ability of the patient to reach the IOP target. Most of Iraqi glaucomatous patients do not achieve their IOP target. The number of prescribed eye drops can significantly affect the ability of glaucoma patients to reach their targeted IOP.

Study of dry eye syndrome: Focus on causative factors, treatment modalities, quality of life, and preservatives used in eye drops.

Dry eye syndrome (DES) is a global issue occurring due to tear deficiency or excessive tear evaporation. It is associated with a variety of symptoms causing ocular discomfort. The purpose of the study was to evaluate causative factors, treatment modalities, quality of life, and preservatives used in eye drops. This prospective, follow-up study was conducted in the ophthalmology outpatient department of a tertiary care teaching hospital. Patients older than 18 years of age of either sex diagnosed with DES and willing to give written informed consent were included. The patients were subjected to the Ocular surface disease index Questionnaire (OSDI Questionnaire) twice; at the time of the first visit and at 15 days follow-up. A male preponderance was observed with a 1.86:1 male-to-female ratio. The mean age of the study population was 29.15 ± 10.07 years. The most common presenting complaints were symptoms related to dryness of the eyes followed by refractive error. Exposure to TV/computer screen for more than 6 hours is the most common causative factor. There was a statistically significant improvement in overall quality of life (QoL) in patients of DES on treatment. However, no significant difference was seen in the improvement of quality of life in comparison with different preservatives used in prescribed eye drops for the treatment of DES. DES can adversely affect the quality of life of patients. Prompt treatment of this condition can significantly improve the patient's QoL. Physicians should be encouraged to perform quality of life evaluations for patients with DES to guide them in treatment with more individual-specific treatment options.

Noncompliance with prescribed eye drops is still a widespread problem in patients undergoing cataract surgery

Noncompliance with prescribed eye drops is still a widespread problem in patients undergoing cataract surgery

Factors of noncompliance with prescribed eye drops in patients undergoing cataract surgery.

In the face of enormous evidence supporting the significance of using prescribed eye drops before and after cataract surgery, noncompliance is still a common issue. Improvements in cataract surgical procedures with no dedication to support patients throughout their pre-operative management and post-operative recovery deliver low-quality healthcare and may lead to substantial harm to the patient and the public. Therefore, it is vital for clinicians to carefully address the factors of noncompliance with prescribed eye drops and then educate their patients regarding this. This article provides full details of the factors affecting noncompliance with prescribed eye drops in patients undergoing cataract surgery.

The Prevalence of Dry Eye Disease and Related Factors Among Adult Patients Attending Primary Healthcare Centers in Riyadh, Saudi Arabia.

Objective In this study, we aimed todetermine the prevalence of dry eye disease (DED) and its related factors among adult patients in Riyadh, Saudi Arabia. Methodology We conducted a cross-sectional studybased on a pre-designed, validated questionnaire (the McMonnies questionnaire)at primary healthcare centers in Riyadh in January-May 2019. Participants were classified into two groups: those with and without a diagnosis of DED. Factors related to the diagnosis were derived using univariate analysis. A backward stepwise logistic regression model was used to further explore predictors of DED and included all variables that were significant in the univariate analysis. Results A total of 276 patients participated in this study. About half (53.3%) were males, and 47.8%were aged 25-45 years. While more than two-thirds of the participants (70.3%) had some symptoms indicative of DED, only 42% were diagnosed with DED. A higher prevalence of DED was found in females. About half (47.5%) had been prescribed eye drops or other treatments for dry eyes. Univariate analysis showed a significant correlation between the incidence of DED and living in southern Riyadh (p=0.017). Additionally, all age groups were significantly associated with DED, and a higher prevalence was reported in those older than 45 years. Backward stepwise logistic regression revealed that using dry eye drops was among the most significant predictors of DED [odds ratio (OR): 339, 95% confidence interval (CI): 73.2-1577.3, p<0.001]. Conclusion Based on our findings, DED was more common among women and with advancing age. DED was associated with the presence of dry eye symptoms, arthritis, usage of dry eye drops, and living in southern Riyadh. There is a need to design and implement health awareness programs to prevent such medical issues among the population.

Ocular chemical burns following accidental instillation of tinea pedis treatment solution: A report of two cases

Many commonly used household chemicals and medical eye drops look alike, resulting in a worldwide increase in incidences of accidents caused by confusion between similar-looking agents. In this case report, we present two patients who visited the emergency department following inadvertent instillation of tinea pedis treatment solution instead of eye drops. Both patients developed corneal chemical burns following the accidental application. Notably, the visual acuity and symptoms eventually recovered for both patients after hospitalization. However, complete recovery occurred only after several weeks. Both patients were relatively old and had been prescribed eye drops after previous ophthalmic surgery. Since the eye is a sensory organ that receives visual information, ocular injuries significantly affect the quality of life and social functioning of the patient. Incidences of accidental misidentification of eye drops are steadily increasing in South Korea; unfortunately, regulatory policies are unavailable to avoid such hazards. Therefore, physicians should be mindful of the potential risks associated with misidentification of everyday household products and must spend time educating patients when prescribing eye drops. Policy regulations are warranted for products with containers that resemble eye drop bottles. Such items need to be clearly labeled with additional warnings to prevent misidentification and accidental ocular instillation.

Meloxicam-associated immune thrombocytopenia

A 71 year old man presented with a 24 hour history of a pruritic rash on his bilateral lower extremities, petechiae and purpura. 3 days prior he saw an Ophthalmologist for eye dryness and pain. He was prescribed eye drops and Meloxicam. After taking Meloxicam, he developed petechiae and purpura in both lower extremities (Figure 1) prompting him to seek medical care. Admission complete blood count revealed a platelet count of 3,000 (reference range, 142,000-424,000 per microliter). He was started on empiric intravenous immunoglobulin (IVIG) therapy and methylprednisolone for suspected immune thrombocytopenic purpura (ITP). Evaluation for hidden secondary causes of ITP was unremarkable: comprehensive metabolic panel, antinuclear antibody, cytoplasmic antineutrophil cytoplasmic antibodies, perinuclear anti neutrophil cytoplasmic antibodies, Hepatitis panel, HIV 1 &amp; 2, Helicobacter pylori, urinary toxicology test, Vitamin B12 level, rheumatoid factor, double stranded DNA, Epstein Barr virus (EBV) PCR, Varicella Zoster virus (VZV) PCR, Cytomegalovirus PCR, CD5, CD19, CD20, CD23 and antiphospholipid antibodies. Computed tomography with contrast of the abdomen/pelvis, chest and brain were all unremarkable. Hematology consultant recommended a five day course of IVIG 400 mg/kg and methylprednisolone 125 mg IV before discharge. Upon discharge, the platelet count had risen to 15,000. He was prescribed prednisone and instructed to follow-up with hematology.

Case Reports: Endovascular Treatment of Cerebral Venous Sinus Thrombosis

Background: The causes of cerebral venous sinus thrombosis (CVST) are diverse, and headache is the only symptom in mild cases. However, in severe cases, perfusion disorders may concomitantly cause intracerebral hemorrhage, resulting in serious complications. Herein, we report two severe CVST cases in which good outcomes were obtained following endovascular treatment. Patients and Methods: Case 1. A 42-year-old man consulted an ophthalmologist with a chief complaint of decreased vision. The patient had a considerably high intraocular pressure and papilledema. However, due to unknown etiology, he was only prescribed eye drops. He subsequently developed headaches and experienced an alteration in his. An urgent surgery was performed with using the pull-back technique using a suction catheter, following which, the patient’s neurological symptoms improved. Case 2. A 50-year-old man was transferred to our hospital with a chief complaint of generalized clonic convulsions. The patient was diagnosed with venous sinus thrombosis. Attempts were made to crush the thrombus with a percutaneous transluminal angioplasty balloon and aspirate the thrombus with an aspiration catheter. However, thrombus removal and recanalization could not be achieved. Subsequently, a thrombectomy was performed using the FilterWire technique with a distal embolic protection device. Anterograde blood flow was restored, and the convulsive seizures disappeared. Conclusion: Venous perfusion injury should be avoided in severe cases of CVST, and endovascular treatment using various devices is a therapeutic option in such cases.

Philadelphia glaucoma detection and treatment project: ocular outcomes and adherence to follow-up at a single health centre

To determine ocular outcomes and factors associated with adherence to ophthalmic follow-up in a medically underserved population at a single health centre in Philadelphia. Retrospective chart review. Patients from a community glaucoma screening program. Chart review was conducted for participants who received a complete eye examination at the Philadelphia District Health Center 5 between January 1, 2012 and May 31, 2014 within the Philadelphia Glaucoma Detection and Treatment Project. Multivariate logistic regression was used to determine factors related to ophthalmic follow-up adherence. A total of 249 participants completed an eye examination (mean age = 57.7 ± 6.9 years). Most were African American (n = 220; 88.4%); female (n = 129; 51.8%). Forty-seven participants (18.9%) received glaucoma-related diagnoses, 20 (8.0%) were prescribed ocular medication, and 26 (10.4%) underwent laser therapy. Ninety (36.1%) attended their recommended follow-up eye examination at the health centre. Glaucoma-related diagnosis (p ≤ 0.001), recommendation of a 4- to 6-week follow-up period (p < 0.001), prescribed eye drops (p < 0.001), or received laser therapy (p = 0.047) were factors most predictive of ophthalmic follow-up adherence. The collaborative effort of eye care providers and health centres offers an important opportunity to detect, treat, and manage glaucoma and other ocular pathology in medically underserved communities. Having a glaucoma-related diagnosis, initiating treatment, and scheduling regular follow-up visits are the most important factors influencing adherence to follow-up eye appointments.

A Novel Approach to Helping People with Glaucoma Use Their Drops Routinely.

Pharmacy data reveal that 70% of patients were missing one or more days worth of drops out of five. Adopting approaches to behavior change and management skills used for people with diabetes may provide insight to improve self-management of glaucoma. Every person who is diagnosed with a chronic health condition such as glaucoma has unique life circumstances that may present barriers to behavior change. An accurate diagnosis and a treatment plan are useless if patients do not use their prescribed eye drops. Active listening and effective communication can result in persons who are more engaged in their self-care behaviors. Collaborative communication using person-centered and strengths-based messages could help eye care providers identify challenges and concerns for people with glaucoma who are experiencing inconsistencies with their eye drops. In an atmosphere where patients can discuss their challenges with treatment recommendations without judgment or fear, they are more likely to trust their provider and therefore share their situation openly and honestly. This is accomplished by choosing language that communicates mutually-agreed-upon self-management goals and addresses and strengthens individual and clinical outcomes. The eye care professional is then seen by the patient as a resource who can empathize when setbacks occur and reinforce the patient's self-management goals. Open-ended questions and tell-ask-tell approaches for identifying barriers to care are keys to more effective communication and trusting relationships. This includes recognizing that glaucoma is associated with increased rates of anxiety or depression that may be an overlooked barrier to self-management. By adopting language recommendations from diabetes care and education, eye care practitioners may be better equipped to help people with glaucoma improve their self-care.

Latanoprost could exacerbate the progression of presbyopia

PurposeProstaglandin analogues (PG) reduce intra-ocular pressure by enhancing uveoscleral flow at the ciliary body, which controls accommodation via the ciliary muscle. We investigated the effect of PG on accommodation and presbyopia progression in glaucoma patients.MethodsWe conducted a clinic-based, retrospective, cross-sectional study. Inclusion criteria were bilateral phakic patients aged 40–69 years with best corrected visual acuity better than 20/30. Exclusion criteria were any disease affecting vision other than glaucoma and history of ocular surgery. Subjects with no prescription or vision-affecting disease served as controls (n = 260). The glaucoma patients were prescribed eye drops containing 0.005% latanoprost for more than six months (n = 23). We measured the binocular near add power at a distance of 30 cm in both groups and compared the results using Kaplan-Meier analysis.ResultsThe mean age (± SD) of the control subjects was 51.5 ± 5.2 years and 39% were male. Similarly, the glaucoma patients had a mean age of 51.0 ± 7.2 years and 39% were male. There were no significant differences in age, gender, intra-ocular pressure, spherical equivalent, astigmatism, or anisometropia between groups. Survival analysis indicated that the glaucoma patients in this study reached the endpoint (near add power of +3.00 D) significantly earlier than control patients (P = 0.0001; generalized Wilcoxon test).ConclusionsExacerbation of presbyopia progression in glaucoma patients is a potential side effect of latanoprost eyedrops.

Current trends among pediatric ophthalmologists to decrease myopia progression-an international perspective.

To explore what the current worldwide preferred practice patterns of pediatric ophthalmologists are to decrease myopia progression among their patients. A questionnaire was sent to all members of supranational and national pediatric ophthalmology and strabismus societies. The questionnaire was fully completed by most respondents 90.10% (847 of 940 responses). Fifty-seven percent (457) routinely treat to decrease myopia progression. The most common parameter to initiate treatment was a myopic increase of 1 diopter/year or more (74.8%, 246). Seventy percent (345) prescribed eye drops. Atropine 0.01% was the most popular (63.4%, 277) followed by atropine 1% (10.9%, 48) and atropine 0.5% (8.9%, 39). Eighty-six percent (394) of the respondents advised to spend more time outdoors, to reduce the amount of time viewing screens (60.2%, 277), and cutback the use of smart phones (63.9%, 294). Most pediatric ophthalmologists treat to decrease myopia. They employ a wide variety of means to decrease myopia progression. Atropine 0.01% is the most popular and safe modality used similarly to recent reports. However, there is no consensus when treatment should be initiated. Further prospective studies are needed to elucidate the best timing to start treatment and the applicability of recent studies in the Asian population to other ethnic groups. This will improve the ability to update pediatric ophthalmologist with evidenced-based treatment options to counter the myopia epidemic.

Knowledge of medications among patients with glaucoma in Taiwan.

To investigate the knowledge and learning ability of glaucoma patients regarding their anti-glaucoma topical medications. Patients on regular follow-up at the Glaucoma Clinic at Hsin-Chu General Hospital were recruited. After detailed ocular examinations, the participants were asked to recall and identify their glaucoma eye drops. The same test was repeated 3 months later. The results of both tests, the learning ability of patients regarding their glaucoma drugs, and the relationship between learning ability and demographic variables were evaluated. Two hundred eighty-seven glaucoma patients participated in this study. Of the study population, 25.8% and 57.1% could recall their topical mediation at the first and second tests, whereas 72.1% and 88.5% could identify their prescribed eye drops at the first and second tests, respectively. Approximately 34% of the participants showed improved knowledge at the repeat test, whereas 40% of the participants showed no improvement. Participants with a better learning ability were more likely to be younger, with a higher level of education, and with less visual field impairment. The knowledge of glaucoma patients regarding their prescribed medication was deficient in Taiwan. Physician effort could improve knowledge on the prescribed drugs. Patient-centered education should be considered, targeting elderly individuals, illiterate individuals, and those with loss of visual function to increase compliance with glaucoma medication.

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

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. 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. 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. 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.

Influence of Parental Health Literacy and Dosing Responsibility on Pediatric Glaucoma Medication Adherence

To assess glaucoma medication adherence in children, hypothesizing that poor parental health literacy and eye drop instillation by the child are associated with worse adherence. This prospective, observational study enrolled pediatric patients with glaucoma who were prescribed eye drops. Parent(s) reported who was responsible for eye drop instillation (parent vs child), took the Rapid Estimate of Adult Literacy in Medicine, and were instructed on the use and purpose of the Medication Event Monitoring System. Calculations included average adherence (proportion of prescribed doses taken), dosing errors (number of overdosing or underdosing events in 24 hours), and proportion of doses taken on schedule (doses taken within2 hours of prescribed dosing interval). Results are reported as mean (SD) or median. The study included 46 of the 50 enrolled children who used the Medication Event Monitoring System for 30 days or more. Adherence ranged from 43% to 107% (93%[12%]) and was not associated with age (slope, 0.09 [0.52]; P=.86) but decreased with the parent's lower health literacy (slope, 0.62 [0.24]; P=.01).The mean number of dosing errors for medications prescribed daily vs twice daily was similar (3.3 vs 2.9; P=.66). The proportion of doses taken on schedule (within2hours of prescribed dosing interval) ranged from 3% to 97% (median, 34%; mean, 41%[24%]) and was better when the parent vs the child instilled eye drops (46% [26%] vs 23% [19%]; P< .001). Time-dependent glaucoma medication adherence was better when the parent was responsible for eye drop instillation. Overall decreased adherence was associated with decreased parental health literacy. Children of parents with poor health literacy are vulnerable to poor medication adherence; efforts to address poor health literacy may improve outcomes.

Index of Suspicion * Case 1: Recurrent Oral Ulcers in an Adolescent * Case 2: Visual Impairment in an Autistic Child * Case 3: Fever and Hepatosplenomegaly in an Infant

A 16-year-old African American girl presents with extremely painful recurrent oral ulcers over the past 2 months. She reports similar painful ulcers of the genital area that have whitish discharge and intermittent low-grade fevers. A recent complaint of blurry vision prompted a visit to an ophthalmologist, who prescribed eye drops for “inflammation.” She denies sexual activity, drug use, nausea, vomiting, diarrhea, headaches, rash, joint pains, cough, or frequent infections. Her past medical history is unremarkable, but an older brother has human immunodeficiency virus (HIV) infection. Physical examination reveals a well-developed adolescent girl in no acute distress. Her vital signs are within age-appropriate limits. She has several well-demarcated aphthous ulcers in her buccal mucosa and oval ulcers with whitish discharge over her labia majora. The remainder of the physical examination yields no findings of note. Laboratory testing reveals normal findings on a complete metabolic panel, urinalysis, and serum immunoglobulin and complement assessment. Her Hgb is 11.5 g/dL (115 g/L) and her ESR is elevated at 55 mm/hr. Serologic testing reveals negative titers for herpes simplex virus (HSV) types 1 and 2; HIV; cytomegalovirus; Toxoplasma ; and hepatitis A, B, and C. HSV cultures from ulcers as well as gonococcus and Chlamydia DNA and rapid plasma reagin tests are negative. Antinuclear and antidouble-stranded DNA antibodies are negative. However, a test for antiphospholipid antibodies is mildly positive to B2 glycoprotein. Biopsy results are consistent with vulvitis. A discussion with the patient's ophthalmologist confirms the clinical diagnosis and well-known complication. A 15-year-old Hispanic boy who has a previous diagnosis of autism presents to the ophthalmology clinic with a 2-month history of vision problems. His parents report that he does not walk around freely because he cannot see, he holds on to walls, and he runs into the furniture. He is no longer able to …

Readability of prescription labels and medication recall in a population of tertiary referral glaucoma patients

To evaluate readability of eye drop labels and accurate recall of prescription instructions in a glaucoma population. A hospital-based, cross-sectional study. A trained, interviewer examined patient ability to read standard and larger font medication labels. A questionnaire was administered to ascertain accurate recall of prescribed eye drops. Clinical information was obtained through independent chart review. Glaucoma severity was classified according to a glaucoma staging system. The setting for the study was the glaucoma outpatient clinic, Royal Victorian Eye and Ear Hospital (Melbourne, Australia), a major tertiary referral centre. A total of 200 glaucoma patients (96.2% response), aged 45-90 years, on eye drops took part in the study. Non-English-speaking patients were excluded. The main outcome measure was the ability to read prescribed medication labels and accurately recall treatment regime was compared with glaucoma severity and the number of eye drops. Of the glaucoma patients, 12% were unable to read standard pharmacy labels. Only 5.5% were unable to read the larger font labels. Of the patients, 32% were not able to accurately recall the type of drops or prescribed frequency of instillation. An inability to read standard labels was associated with a threefold reduction in the likelihood of accurate medication recall (95% confidence intervals, 1.40-7.66, P < 0.05). Patients with three or more types of eye drops were five times less likely to recall their medications (95% confidence interval, 0.07-0.57, P < 0.05). Inability to read or recall prescribed eye drops was associated with glaucoma severity and the number of prescribed eye drops. These factors may impact significantly on patients' adherence to glaucoma medications.

The Effect of a Glaucoma Medication Reminder Cap on Patient Compliance and Intraocular Pressure

A multi-site, open-labeled clinical trial was conducted to evaluate the ease of use and acceptance of a newly developed medication cap with a memory aid (C Cap Compliance Cap, Allergan, Inc.) and its effect on patient compliance and intraocular pressure. One-hundred-twenty-two patients with glaucoma or ocular hypertension received their prescribed eye drops in bottles with the compliance cap. Overall, 83% of the patients found the compliance cap very easy to use. By the end of the study, significantly more patients (67%) claimed 100% compliance than prior to using the compliance cap (41%). An overall drop in intraocular pressure of 0.8 mm Hg was seen. However, in a subset of patients who reported an increase in compliance, mean intraocular pressure decreased from baseline by 1.7 mm Hg. The results of this study suggest that the compliance cap helps patients with glaucoma or ocular hypertension remember to take their medication as prescribed.

Cyanoacrylate Nail Glue Mistaken for Eye Drops

To the Editor.— During the past 3 years, I cared for eight patients who put cyanoacrylate glue in their eyes accidentally. Of these patients, three admitted to mistaking nail glue for prescribed eye drops. The injuries were usually corneal abrasions, loss of lashes, eyelid skin excoriation, or conjunctival inflammation. Many bottles used for nail glue appear identical to those used for ophthalmic solutions (Figure). The use of artificial nails has attained increased popularity in the last few years. Many do-it-yourself kits contain these plastic bottles. Poorly sighted individuals, careless persons, and children run the greatest risk of mistaking these dispensers for eye medications. These bottles often are stored in medicine cabinets alongside medications. Judging from the published literature, it is apparent that label warnings are inadequate in preventing eye injury. 1,2 The people who use eye drops most often, such as glaucoma patients and contact lens wearers, are those most