Treated Glaucoma Patients Research Articles

A Systematic Review of End-of-Life Visual Impairment in Open-Angle Glaucoma: An Epidemiological Autopsy.

Glaucoma patients are still at risk of becoming blind. It is of clinical significance to determine the risk of blindness and its causes to prevent its occurrence. This systematic review estimates the number of treated glaucoma patients with end-of-life visual impairment (VI) and blindness and the factors that are associated with this. A systematic literature search in relevant databases was conducted in August 2014 on end-of-life VI. A total of 2574 articles were identified, of which 5 on end-of-life VI. Several data items were extracted from the reports and presented in tables. All studies had a retrospective design. A considerable number of glaucoma patients were found to be blind at the end of their life; with up to 24% unilateral and 10% bilateral blindness. The following factors were associated with blindness: (1) baseline severity of visual field loss: advanced stage of glaucoma or substantial visual field loss at the initial visit; (2) factors influencing progression: fluctuation of intraocular pressure (IOP) during treatment, presence of pseudoexfoliation, poor patient compliance, higher IOP; (3) longer time period: longer duration of disease and older age at death because of a longer life expectancy; and (4) coexistence of other ocular pathology. Further prevention of blindness in glaucoma patients is needed. To reach this goal, it is important to address the risk factors for blindness identified in this review, especially those that can be modified, such as advanced disease at diagnosis, high and fluctuating IOP, and poor compliance.

Social Law Entitlements and Compensations for Visually Impaired Patients in Germany, Focussed on Glaucoma

Although prevention of progression is the most important issue in the treatment of glaucoma patients, information on visual aids and social law entitlements is also helpful. In this article, the main aspects of compensation for visual impairment are outlined so that you can competently support your patients, without much effort, with helpful tips and appropriate instructions.

Clinical evaluation of the effect of diquafosol ophthalmic solution in glaucoma patients with dry eye syndrome

To investigate the effects of diquafosol on intraocular pressure (IOP) and dry eye symptoms in glaucoma patients with dry eye syndrome (DES). This study evaluated a total of 138 glaucoma patients with DES who were treated with diquafosol ophthalmic solution (DIQUAS(®)). Before treatment and 1, 4, 12, 36, and 52weeks after treatment, IOP, ocular surface disease index (OSDI), tear film break-up time (BUT), Schirmer I test scores, fluorescein staining, conjunctival impression cytology, and adverse drug reactions were evaluated. Throughout the treatment period, the mean IOP for all the patients remained stable after treatment with diquafosol (15.4±2.8mmHg at baseline and 16.0±2.8mmHg at 52weeks). The mean OSDI score improved significantly at 4, 12, and 52weeks after diquafosol treatment. The BUT and Schirmer I test scores were significantly increased after diquafosol treatment. The Oxford scheme score was significantly decreased at 1, 4, 12, 36, and 52weeks after diquafosol treatment. A significant improvement in goblet cell density was observed after 4weeks of treatment with diquafosol. Adverse drug reactions were reported in 22 (15.9%) patients. There were no serious adverse drug reactions. Diquafosol was effective in improving objective and subjective symptoms and maintained a stable IOP in glaucoma patients with DES. Therefore, the addition of diquafosol treatment in glaucoma patients with DES or ocular surface side effects using anti-glaucoma medication may be beneficial.

Strategies to estimate the characteristics of 24-hour IOP curves of treated glaucoma patients during office hours.

BackgroundIt is known that office-hour measurements might not adequately estimate IOP mean, peaks and fluctuations in healthy subjects. The purpose of the present study is to verify whether office-hour measurements in patients in different body positions can estimate the characteristics of 24-hour intraocular pressure (IOP) in treated POAG patients.MethodsThe 24-hour IOP curves of 70 eyes of 70 caucasian patients with treated glaucoma were analyzed. Measurements were taken at 9 AM; 12, 3, 6, and 9 PM; and 12, 3, and 6 AM, both in the supine (TonoPen XL) and sitting (Goldmann tonometer) positions. The ability of five strategies to estimate IOP mean, peak and fluctuation was evaluated. Each method was analyzed both with regression of the estimate error on the real value and with “hit or miss” analysis.ResultsThe least biased estimate of the Peak IOP was obtained using measurements from both supine and sitting positions, also yielding the highest rate of correct predictions (which was significantly different from 3 of the remaining 4 strategies proposed, p < 0.05). Strategies obtained from the combination of supine, sitting and peak measurements resulted to be least biased for the Mean IOP and the IOP Fluctuation estimate, but all strategies were not found significantly different in terms of correct prediction rate (the only significant difference being between the two strategies based on sitting or supine measurements only, with the former being the one with the highest correct prediction rate).ConclusionsThe results of this study remark the concept that IOP is a dynamic parameter and that intensive measurement is helpful in determining its characteristics. All office-hour strategies showed a very poor performance of in correctly predicting the considered parameters within the thresholds used in this paper, all scoring a correct prediction rate below 52 %.

Visual Field Change and 24-Hour IOP-Related Profile with a Contact Lens Sensor in Treated Glaucoma Patients

To test the hypothesis that a 24-hour recording of intraocular pressure (IOP)-related measurements derived from a contact lens sensor (CLS) correlates to the rate of visual field progression in treated glaucomatous eyes. Prospective, cross-sectional study. Forty treated glaucomatous patients with 8 or more 24-2 visual field tests. Twenty-four-hour recording with a CLS that provides IOP-related measurements. Rates of visual field mean deviation (MD) change before and at the time of CLS recording and CLS parameters, namely number of large peaks, mean peak ratio, wake-to-sleep slope, amplitude and area under the cosine curve, and variability from the mean. When comparing the rate of MD change before and at the time of CLS recording of all patients, the average slope was -0.05 dB/year faster in the beginning compared with the end (P = 0.087), suggesting a deceleration of progression by the time of CLS recording. The number of long peaks and the mean peak ratio when patients were awake were the best predictors of faster progression. The combination of CLS parameters provided better measures of goodness of fit than Goldmann IOP parameters (mean, peak, and fluctuation) in the same period. Intraocular pressure-related parameters obtained with 24-hour recording with a CLS were associated with the rate of visual field progression in treated glaucomatous eyes. This technology may be useful in detecting eyes at higher risk of glaucoma progression while receiving treatment.

Examining Delay Intervals in the Diagnosis and Treatment of Primary Open Angle Glaucoma in an Egyptian Population and Its Impact on Lifestyle.

Purpose. To examine causes as well as extent of delay in diagnosis and treatment of primary open angle glaucoma patients in a sample of Egyptians. Patients and Methods. 440 patients with primary open angle glaucoma were interviewed to evaluate delay in their diagnosis and treatment. The extent and cause of delay were investigated. The total delay interval, if any, was correlated with socioeconomic and other factors. Results. The median total delay was one year, with 50% of patients having a total delay of 1 year or less, of which 25% exhibited zero total delay. 25% of patients had a delay ranging from 1 to 3 years, and 25% had a total delay ranging from 3 to 27 years. Diagnostic delay accounted for 43.03% of cases. Longer delays were met in patients with certain socioeconomic factors. Patients with a positive family history of glaucoma displayed shorter delay periods. Conclusion. Significant delay in the diagnosis and treatment of glaucoma was found. Poor socioeconomic status seems to hinder timely diagnosis and treatment of POAG. Certain socioeconomic factors seem to correlate with the extent of delay. More effort is thus needed to subsidize the cost of investigations and treatment for glaucoma patients.

Multicenter clinical trial of high-intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery.

To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation procedure in patients with open-angle glaucoma naïve of previous filtering surgery. Prospective non-comparative interventional clinical study conducted in five French University Hospitals. Thirty eyes of 30 patients with open-angle glaucoma, intra-ocular pressure (IOP)>21mmHg and with no previous filtering glaucoma surgeries were sonicated with a probe comprising six piezoelectric transducers. The six transducers were activated with a 6-s exposure time. Complete ophthalmic examinations were performed before the procedure and at 1day, 1week, 1, 2, 3, 6 and 12months after the procedure. Primary outcomes were qualified surgical success (defined as IOP reduction from baseline ≥20% and IOP>5mmHg with possible re-intervention and without hypotensive medication adjunction) and complete surgical success (defined as IOP reduction from baseline ≥20%, IOP>5mmHg and IOP<21mmHg with possible re-intervention and without hypotensive medication adjunction) at the last follow-up visit and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visit compared with baseline, medication use, complications and re-interventions. Intra-ocular pressure was significantly reduced (p<0.05) from a mean pre-operative value of 28.2±7.2mmHg (n=3.6 hypotensive medications) to 19.6±7.9mmHg at 12months (n=3.1 hypotensive medications and n=1.1 procedures) (mean IOP reduction of 30%). Qualified success was achieved in 63% of eyes (19/30) (mean IOP reduction of 37% in these eyes) and complete success in 46.7% of eyes (14/30) (mean IOP reduction of 37% in these eyes) at the last follow-up. No major intra- or post-operative complications occurred. The UC(3) procedure seems to be an effective and well-tolerated method to reduce IOP in patients with open-angle glaucoma without previous filtering surgery.

Long-term outcomes in patients initially responsive to selective laser trabeculoplasty.

To determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tolerated medical therapy (MTMT). The Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the charts of glaucoma patients who underwent SLT after receiving MTMT. Eyes that did not achieve their target pressure within 3mo following SLT were excluded from the study. Changes in mean IOP and number of glaucoma medications used were analyzed at 1, 3, and 5y following SLT. Seventy-five eyes of 67 patients were included in the study. Fifteen eyes that received SLT failed to achieve their target pressure within 3mo and were excluded from the study. The average follow-up time was 37.4mo (±14.4). Mean IOP was significantly reduced 1y after treatment (P=0.005). It was also reduced 3, 5y after treatment without reaching statistical significance (P=0.20 and P=0.072, respectively). There was a significant decrease in mean number of medications used 1, 3, 5y after treatment (P<0.001, P<0.001, and P=0.039, respectively). In the span of 5y, 2 eyes (2.7%) underwent repeat SLT, 7 eyes (9.3%) underwent glaucoma surgery and an additional 3 eyes (4.0%) underwent both. SLT significantly reduced the number of glaucoma medications used 5y following treatment in glaucoma patients receiving MTMT. SLT may delay operating-room surgery.

Multicenter Clinical Trial of High‐Intensity Focused Ultrasound Treatment in Glaucoma Patients without Previous Filtering Surgery

PurposeTo evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation procedure in patients with open‐angle glaucoma naïve of previous filtering surgery.MethodsProspective non‐comparative interventional clinical study conducted in five French University Hospitals. Thirty eyes of 30 patients with open‐angle glaucoma, intraocular pressure (IOP) &gt;21 mmHg and with no previous filtering glaucoma surgeries were sonicated with a probe comprising six piezoelectric transducers. The six transducers were activated with a 6‐s exposure time. Complete ophthalmic examinations were performed before the procedure and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after the procedure. Primary outcomes were surgical success (defined as IOP reduction from baseline ≥20% and IOP &gt;5 mmHg with possible retreatment and without hypotensive medication adjunction) at the last follow‐up visit and vision‐threatening complications. Secondary outcomes were mean IOP at each follow‐up visit compared to baseline, medication use, complications and retreatments.ResultsIOP was significantly reduced (p &lt; 0.05) from a mean preoperative value of 28.2 ± 7.2 mmHg (n = 3.6 hypotensive medications) to 19.6 ± 7.9 mmHg at 12 months (n = 3.1 hypotensive medications and n = 1.1 procedures) (mean IOP reduction of 30%). Success was achieved in 63% of eyes (19/30) at 12 months (mean IOP reduction of 37% in these eyes). No major intra‐ or postoperative complications occurred.ConclusionsThe ultrasonic circular cyclocoagulation procedure seems to be an effective and well‐tolerated method to reduce IOP in patients with open‐angle glaucoma without previous filtering surgery.

Multicenter clinical trial of high‐intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery

PurposeTo evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation procedure in patients with open‐angle glaucoma naïve of previous filtering surgery.MethodsProspective non‐comparative interventional clinical study conducted in five French University Hospitals. Thirty eyes of 30 patients with open‐angle glaucoma, intraocular pressure (IOP) &gt; 21 mmHg and with no previous filtering glaucoma surgeries were sonicated with a probe comprising six piezoelectric transducers. The six transducers were activated with a 6‐s exposure time. Complete ophthalmic examinations were performed before the procedure and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after the procedure. Primary outcomes were surgical success (defined as IOP reduction from baseline ≥ 20% and IOP &gt; 5 mmHg with possible retreatment and without hypotensive medication adjunction) at the last follow‐up visit and vision‐threatening complications. Secondary outcomes were mean IOP at each follow‐up visit compared to baseline, medication use, complications and retreatments.ResultsIOP was significantly reduced (p &lt; 0.05) from a mean preoperative value of 28.2 ± 7.2 mmHg (n = 3.6 hypotensive medications) to 19.6 ± 7.9 mmHg at 12 months (n = 3.1 hypotensive medications and n = 1.1 procedures) (mean IOP reduction of 30%). Success was achieved in 63% of eyes (19/30) at 12 months (mean IOP reduction of 37% in these eyes). No major intra‐ or postoperative complications occurred.ConclusionsThe ultrasonic circular cyclocoagulation procedure seems to be an effective and well‐tolerated method to reduce IOP in patients with open‐angle glaucoma without previous filtering surgery.

Specifying active components of educational interventions to promote adherence to treatment in glaucoma patients: application of a taxonomy of behavior change techniques.

PurposeIn response to recent calls for clearer specification of behavior change interventions, the purpose of this study was to apply a system of taxonomy for behavior change techniques (BCTs) to two educational interventions to improve adherence to glaucoma eye drops. Clarification of constituent BCTs will promote easy and reliable application of the interventions in clinical settings and research.MethodsA published taxonomy of BCTs was used to code two interventions (group and individual) to increase adherence to eye drops. Intervention materials were coded by assigning a BCT label to each text unit. We noted the frequency with which each BCT occurred, compared the interventions in terms of the BCTs that were delivered, and identified whether the taxonomy was sufficient to describe the intervention components.ResultsThe individual intervention consisted of 94 text units. Fifty-seven were identified as targeting behavior change and coded using 18 BCTs, many coded more than once. In the group intervention, 165 units of text were identified, and 125 were coded using 22 BCTs. The most frequently coded BCT was “provide information about behavior–health link” in the group intervention and “prompt barrier identification” in the individual intervention. The interventions included similar BCTs. All text units targeting behavior change were codable into BCTs.ConclusionThe similarity of the two interventions may have implications for the cost-effectiveness of the interventions. The taxonomy was found sufficient to describe both interventions. This level of specification can be used to ensure that precisely the same intervention that has been pilot tested is reproducible in the clinical setting and in any further research.

Pharmacoeconomic aspects of glaucoma therapy with prostaglandin analogues in patients with signs of ocular surface disease

Treatment of glaucoma is prevalent in modern healthcare. The standard of care at this time in the majority of glaucoma patients is to be treated with prostaglandin analogues. The aim of the present study was to compare the cost-effectiveness and the effect on the daily quality of life of preservative-free tafluprost to benzalkonium chloride (BAK) preserved latanoprost ophthalmic solutions which are present on the Russian market. In the patients with signs of ocular surface disease. Material and methods. The cost calculation was carried out on the basis of the weighted average retail price in Moscow from March 2015. The research was carried out over a 1 yeartime period. At the assessment, we assumed that clinical efficacy of the compared drugs did not differ; but at the same time the absence of the negative impact of treatment on patients’ quality of life (QoL), assessed by COMTol questionnaire, was observed in 30 % of patients treated with BAK-preserved latanoprost and in 52 % of patients treated with preservative-free tafluprost. Results and discussion. The costs of glaucoma treatment with preservative-free tafluprost and with branded BAK-preserved latanoprost are now comparable. The cost per 1 patient without the negative impact of treatment on patients’ QoL for tafluprost (Taflotan®) was 42.6 % lower than that for branded latanoprost (Xalatan®), 72.7 % higher than that for the generic latanoprost Glaumax®, and 24.3 % higher than that for the generic latanoprost Latanomol™. The analysis of the results’ sensitivity to changes in the cost of drugs in real limits demonstrated their high reliability. When taking a decision on the reimbursement for prostaglandin analogues, one should be aware that generic latanoprost ophthalmic solutions may differ significantly from the branded drug both in physical and chemical properties as well as in clinical efficacy and safety. Conclusion. Preservative-free tafluprost and branded BAK-preserved latanoprost are characterized by comparable clinical efficacy whereas preservative-free tafluprost has better tolerability. At a comparable cost of treatment, preservative-free tafluprost has a higher cost-effectiveness. This allows recommending its inclusion in regional and federal programs for the treatment of glaucoma in patients with ocular surface disease signs.

Oxidative stress and mitochondrial failure in the pathogenesis of glaucoma neurodegeneration.

This review focuses on oxidative stress and mitochondrial failure for understanding mechanisms of optic nerve damage in primary open-angle glaucoma. The chapter shows scientific evidence for the role of mitochondrial disbalance and reactive oxygen species in glaucoma neurodegeneration. Mitochondria regulate important cellular functions including reactive oxygen species generation and apoptosis. Mitochondrial alterations result from a wide variety of damaging sources. Reactive oxygen species formed by the mitochondria can act as signaling molecules, inducing lipid peroxidation and/or excitotoxicity with the result of cell lesion and death. Antioxidants may help to counteract oxidative stress and to promote neuroprotection. We provide information that may lead to a new way for diagnosing and treating glaucoma patients.

Short-Term Enhancement of Visual Field Sensitivity in Glaucomatous Eyes Following Surgical Intraocular Pressure Reduction

To examine the hypothesis that surgical intraocular pressure (IOP) reduction leads to enhancement of visual field (VF) sensitivity in glaucomatous eyes. Prospective case-control study. Patients with uncontrolled IOP requiring trabeculectomy or aqueous drainage device were enrolled. Controls consisted of medically treated glaucoma patients with stable IOP and no change in medical therapy during follow-up. Two baseline preoperative VFs and 3 follow-up VF examinations at 1, 2, and 3 months postoperatively were used for analysis. The same number of VF examinations measured within an 18-month interval was used for control eyes. VF locations with significant change were defined as exceeding 95% test-retest confidence limits based upon the mean sensitivity using the 2 baseline VF exams. The number of significantly changing locations per eye and changes in mean and pattern standard deviation (PSD) from the mean baseline fields were compared between groups using a Poisson generalized estimating equation model. Thirty eyes of 30 surgically treated glaucoma patients and 41 eyes of 28 stable controls were enrolled. Postoperative IOP was decreased at follow-up 3 compared with baseline (P < .001) in the surgical eyes, but was similar in control eyes (P = .92). At follow-up 3, the number of test locations improving in central (P = .014) and peripheral (P = .019) VF locations was significantly greater in the surgical eyes. The number of eyes with improved PSD at follow-up 3 was significantly greater in the surgical eyes compared with controls (P = .02). Short-term enhancement of central and peripheral VF sensitivity occurs after surgical reduction of IOP in glaucomatous eyes and may represent a potential biomarker for retinal ganglion cell response to therapeutic interventions in glaucoma.

Laser cyclophotocoagulation enhances the regulative capacity of retinal vessels in glaucoma.

Purpose: To determine the effects of laser surgical IOP reduction by means of transscleral cyclophotocoagulation (CPC) on retinal blood flow parameters in glaucoma patients using Dynamic Vessel Analysis (DVA). Materials and Methodology: 26 patients (average age: 70 years) with a long history of primary open angle glaucoma underwent CPC. The effect on the reactive capacity of retinal vessels was assessed before and 6-8 weeks after CPC by means of the Dynamic Vessel Analyzer (DVA) using flicker light provocation. Results: In our group of POAG patients, IOP was significantly reduced about approximately 20% by CPC while systemic blood pressure and heart rate were not changed. The most obvious differences between the pre- and postoperative DVA measurements could be observed in the maximal dilation of the retinal arteries which increased from 0.75 % (+/- 0.6) to 3.17 % (+/- 0.5) with an average increase of 2.4 % (p<0.01). In addition, the ability of the arteries for constriction improved significantly (p<0.05) while the dynamic responses of the veins and the initial baseline values (MU) of the vessel diameters did not change. Conclusions: Our results of DVA measurements after an IOP-lowering laser surgical intervention (CPC) reveal a significant recovery of the regulative capacity of retinal arteries in glaucoma patients that has up to now neither been properly documented nor appreciated. Future studies with long-term follow-up must determine the clinical importance of these findings for the treatment of glaucoma patients.

Projected Cost Comparison of Trabectome, iStent, and Endoscopic Cyclophotocoagulation Versus Glaucoma Medication in the Ontario Health Insurance Plan

To compare the direct cost of treating glaucoma patients with Trabectome, iStent, and endoscopic cyclophotocoagulation (ECP) versus topical medications in Ontario, Canada. Costs are projected over a 6-year period, and presented on a per-patient level from the perspective of the Ontario Health Insurance Plan (OHIP). The per-bottle cost of each medication was obtained from the 2011 Ontario Drug Benefit (ODB) formulary. A wastage adjustment fee was added to the cost, as was a pharmacy markup, and an ODB dispensing fee. Previously published medication prescription rates were used to determine the frequency with which each medication is prescribed. We estimated the overall cost by taking a weighted average of the cost of each class of glaucoma medications.The cost of each glaucoma device was determined by contacting local distributors. We then added the cost of disposables used during surgery (viscoelastic and keratome) to the cost of each procedure. Start-up costs for each device and surgeons' fees were excluded from the overall cost. At 6 years, treatment with the Trabectome offered a cumulative cost savings of $279.23, $1572.55, and $2424.71 per patient versus monodrug, bidrug, and tridrug therapy, respectively. A cumulative cost difference of -$20.77, $1272.55, and $2124.71 per patient were found when comparing iStent versus monodrug, bidrug, and tridrug therapy, respectively. Treatment with ECP yielded a cost savings of $779.23, $2072.55, and $2924.71 per patient versus monodrug, bidrug, and tridrug therapy, respectively. Over a projected period of 6 years, the Trabectome, iStent, and ECP may all offer a modest cost savings to OHIP versus the cost of glaucoma medication. Further analysis of direct and indirect costs to patients as well as quality of life assessments will help further delineate the role of these treatments in the glaucoma treatment paradigm.

Adherence to medical treatment in primary open-angle glaucoma in Egypt

Purpose The aim of the study was to find the state of adherence to medical treatment and the factors affecting it among Egyptian primary open-angle glaucoma patients. Patients and methods A total of 110 adult patients, previously diagnosed with primary open-angle glaucoma, were administered a questionnaire that included most of the potential causes of nonadherence (defined as missing one or more doses of a previously prescribed topical intraocular pressure (IOP)-reducing eye drop during the last 4 weeks) to glaucoma medication reported in the literature (based on age, sex, education level, illness duration, association of other chronic diseases, medication side effects, instillation difficulties, fear of blindness, concept of missing one dose only, hope of prognosis, number of used drugs, and financial cost) during their usual follow-up visit to the outpatient clinic of the Nile Health Insurance Hospital from November 2009 to May 2010. Results Forty-two (38.8%) patients were found to be nonadherent and 68 (61.8%) patients were adherent (no missed doses in the last 4 weeks). Hope of controlling the disease had a statistically significant positive effect on adherence to treatment, whereas the presence of other chronic illnesses had a positive statistically significant effect on nonadherence. The effect of other factors, such as age, sex, education level, illness duration, medication side effects, instillation difficulties, fear of blindness, concept about missing one dose only, number of used drugs, and financial cost, although affecting the adherence level, were statistically insignificant. Conclusion Despite the recent development of drugs with relatively simpler treatments and fewer side effects, nonadherence to topical hypotensive treatment continues to be a considerable obstacle in the treatment of glaucoma patients. The mood of the patient and awareness about his illness are very important factors that determine the adherence level. Fear of blindness and the hope of a good prognosis are powerful motivating factors.

Prevalence of Ocular Surface Disease in Patients with Glaucoma using Topical Antiglaucoma Medications

Purpose: To establish the prevalence of ocular surface disease (OSD) in glaucoma patients using topical intraocular pressure-lowering (IOP) therapy and to compare the frequency and severity of symptoms with the control group of normal subjects.Methods: This prospective, multicenter, observational study included patients with glaucoma in four different Departments of Ophthalmology. A matched group of normal subjects served as controls. For each patient we have collected detailed family history, clinical records and calculated ocular surface disease index (OSDI) scores (0-100), based on the information obtained from OSDI questionnaires.Results: In total, we have evaluated 160 patients. Of those, 110 were glaucoma patients and 50 were normal subjects. Among 110 glaucoma treated patients 83 (75%) had OSDI scores indicating mild to severe OSD. Among 50 patients without glaucoma 15 (30%) had OSDI score indicating mostly mild to moderate OSD. The severity of symptoms correlates with the number of IOP medications used and the duration of treatment.Conclusion: This study confirms the high prevalence of OSD in patients treated for glaucoma with topical IOP medications. The adverse effect of these agents can influence the compliance and successful treatment of glaucoma patients.

Conjunctivochalasis as a Contributing Factor for the Development of Ocular Surface Disease in Medically Treated Glaucoma Patients

To evaluate the impact of conjunctivochalasis (CCh) and its severity on the ocular surface parameters of glaucoma subjects treated with topical antiglaucomatous medication. One hundred patients with the clinical diagnosis of glaucoma were recruited for this study. CCh was graded based on the extent of inferior lid margin involvement as follows: 1=single (temporal) location, 2=two locations (nasal and temporal), and 3=whole lid. For all the subjects, the break-up time (BUT), lissamine green (LG) staining, and Schirmer test (under topical anesthesia) was performed for both eyes. Ocular Surface Disease Index (OSDI) questionnaire scores were also noted for each subject. Student t test, Mann-Whitney U test, and Kruskal-Wallis test was used for statistical evaluations. Sixty-three subjects had evidence of CCh; 32 had grade 1, 24 had grade 2, 7 had grade 3 CCh, and 37 glaucoma patients had no evidence of CCh. There were significant differences in the BUT scores (7.2±2.7 vs. 10.1±2.4 s, P<0.001), Schirmer values (7.7±3.9 vs. 13.3.±4.0 mm, P<0.001), LG staining score (1.6±1.0 vs. 0.3±0.5, P<0.001), and the OSDI scores (19.4±17.2 vs. 6.7±5.2, P<0.001) between patients who had CCh and those without CCh. The BUT scores and Schirmer test values of patients with grades 2 and 3 CCh were significantly lower than those of grade 1 CCh and those without CCh (P<0.001). The LG grading and OSDI scores were significantly higher in grade 2 and 3 patients as compared with those with grade 1 CCh and those without CCh (P<0.001). The functional characteristics of the ocular surface appear to be adversely influenced by the presence and the extent of CCh in glaucoma patients.

Glaucoma therapy and ocular surface disease

To provide an update on clinical and experimental literature for ocular surface effects of glaucoma therapy and to provide practical guidelines for ophthalmologists treating glaucoma patients with ocular surface disease (OSD). Preservatives, notably benzalkonium chloride (BAK), continue to contribute to OSD and demonstrate a variety of toxic ocular effects both in-vitro, and in animal/human studies. Recent literature frequently compares BAK with Polyquad, SofZia, and preservative-free therapies. Some clinical benefit has been demonstrated with newer BAK-free alternatives. BAK-free and preservative-free therapies are becoming available but are not always a feasible alternative. It is important to recognize different clinical manifestations of allergy and chronic inflammation and to discuss options for patients experiencing OSD.