Use Of Prostaglandin Analogues Research Articles

Association between the use of prostaglandin analogues and ocular surface disease: a systematic review.

Patients with glaucoma often experience chronic ocular surface diseases, potentially underestimated in frequency and severity. To provide updated estimates of ocular surface diseases linked to prostaglandin analogue antiglaucoma eye medication, a systematic review was conducted. Twenty-seven publications were selected from databases like PubMed, Scopus, and Web of Science, following a search strategy targeting glaucoma and prostaglandins while excluding certain medications '(Glaucoma AND prostaglandins OR 'prostaglandin analogues')('eye drops' OR 'artificial tears' OR 'ocular surface' OR 'dry eye' OR 'dry eye syndrome' OR 'ocular surface disease' OR 'tear film') NOT ('beta blockers' OR 'alpha adrenergic agonists' OR 'carbonic anhydrase inhibitors' OR 'rho-quinase')'. The review revealed a correlation between prostaglandin analogue use and ocular surface damage, assessing parameters such as tear break-up time, Schirmer test value, ocular surface staining, hyperaemia score, and meibomian gland characteristics. Some studies explored switching patients to alternative glaucoma medications, noting varied effects on ocular surface parameters. Comparisons suggested better tolerance and outcomes with preservative-free options over prostaglandins. Additionally, the impact of treatment duration and diquafosol on ocular health, including meibomian gland loss, was examined across different formulations. Although a link between prostaglandin analogues (with or without preservatives) and ocular surface damage was established, inconsistencies in methodologies and assessment across studies were noted. This comprehensive review, spanning a decade of glaucoma research, underscores the need for re-evaluation of treatment strategies in ophthalmology. It stresses the significance of informed decision-making for enhanced glaucoma care, taking into account the observed effects of various medications on eye health.

Recurrence following ptosis repair surgery: a multivariate analysis of risk factors

ABSTRACT Purpose To identify and evaluate the risk factors for ptosis repair failure. Methods Retrospective, case-controlled study evaluating adult patients with ptosis who underwent ptosis surgery by external levator advancement/resection (ELR) or Müller muscle conjunctival resection (MMCR) with at least 3 months postoperative follow-up. Regression analyses were performed of ptosis repair outcomes comparing preoperative and perioperative risk factors for failure. Results A total of 240 patients (404 eyelids) met the inclusion criteria for the study. Surgical outcomes were measured categorically by success rate and measured quantitively over time using Kaplan–Meier survival analysis. Success was categorically achieved in 101/112 (90%) eyelids after MMCR and 231/292 (79%) eyelids after ELR (p = .0088). Success as measured over 5 years of follow-up was significantly better in eyelids following MMCR compared to ELR (p = .0469). In terms of surgical failure, the following variables were found to be predictive in order of decreasing risk: chronic topical prostaglandin use, chronic topical corticosteroid use, surgical approach, lower preoperative margin reflex distance 1, prior intraocular surgery, age, lower preoperative levator function, concomitant blepharoplasty, presence of a glaucoma filtering bleb, and female gender. Conclusions Ptosis repair surgery is a complex and challenging procedure. This study provides the largest comparative analysis of ELR versus MMCR to date with findings suggesting MMCR to be more a successful surgery than ELR. Topical prostaglandin analogue use appears to be the highest known risk factor for MMCR and ELR ptosis repair failure.

Evaluation of Macular Thickness in Glaucoma Patients Using Prostaglandin Analog Eye Drops Undergoing Trabeculectomy with Mitomycin C: Prospective, Comparative, Randomized, Masked Examiner Study

Introduction: The aim of the study was to evaluate the macular thickness of glaucomatous patients undergoing trabeculectomy (TREC) with mitomycin C (MMC) with or without the use of prostaglandin analog (PA) eye drops. Methods: In this prospective, comparative clinical trial, patients with glaucoma and indications for TREC with MMC using PA and without previous macular changes were randomized into 2 groups: the study group (SG) and the control group (CG). In the CG, PA was suspended between 30 and 60 days after the preoperative exams. The subjects were evaluated, including optical coherence tomography (OCT) with the Cirrus 4000 macular protocol preoperatively and in the postoperative period on 3 occasions: 1–3 days (“PO1”), 6–9 days (“PO7”), and 27–30 days (“PO30”) after surgery. The results were compared between groups. Results: Thirty-five eyes of 35 patients were included (17 in the CG and 18 in the SG). There was no statistically significant difference in age (p = 0.2), the preoperative visual field mean deviation (p = 0.08), or the preoperative intraocular pressure (SG: 24.8 ± 7.8 mm Hg vs. CG: 22.8 ± 6.0 mm Hg, p = 0.4). The preoperative macular OCT parameters were equivalent between the groups (p > 0.05). When comparing the variation of parameters between the groups between preop and PO30 there was equivalence in all of the comparisons evaluated. The presence (or absence) of the lens did not affect the results. Conclusion: PA eye drops did not affect macular thickness after TREC with MMC in glaucomatous patients.

Utility of prostaglandin analogues and phosphodiesterase inhibitors as promising last resorts for the treatment of vitiligo: A systematic review, from mechanisms of action to mono-, combination and comparative therapies.

The treatment of vitiligo is a persistent challenge in dermatology. New treatments are being offered and studied in this field for those resistant to or intolerant of classical therapies. In this systematic review, we study the use of prostaglandin analogues (PGAs) and phosphodiesterase inhibitors (PDEIs) in the treatment of vitiligo, as they are known for their pigmentation inducing effects through activating melanocytes. We searched four main online databases with the keywords "Vitiligo", "Prostaglandin analogue" and "Phosphodiesterase inhibitor". A total of 42 articles were included, with 1027 cases, studying drugs like bimatoprost, latanoprost, travoprost, dinoprostone, apremilast, crisaborole, etc. Among the included studies, the treatment regimens are commonly once or twice daily for 12-48 weeks, with a mean of 20.61 weeks, and the routes of administration are mainly topical gels or ophthalmic solutions and oral tablets. Side effects are mild and tolerable, namely erythema, itching or burning sensations at application site for topicals, or gastrointestinal problems with apremilast. Repigmentation results are significant in both adult and pediatric patients and progressive or stable vitiligo. PGAs and PDEIs outperform many classical therapies, for example, narrowband ultraviolet B phototherapy (NB-UVB), tacrolimus, mometasone or methylprednisolone mini-pulse. PGAs or PDEIs are usually used in combination therapies to either cause synergism or increase drug delivery, and almost always enhance repigmentation, for example, with NB-UVB, fractional CO2 laser, microneedling, and mometasone. Monotherapy or add-on PGAs and PDEIs can be considered effective treatments for vitiligo and promising last resorts for those resistant to other therapies.

Comparative Evaluation of the Efficacy and Safety of Brimonidine Generics in Glaucoma Therapy

Glaucoma is a chronic neurodegenerative disease that eventually leads to irreversible blindness. The main risk factor for the development and progression of glaucoma is elevated IOP. In cases where the use of prostaglandin analogues is limited, brimonidine is the most rational choice as initial therapy. It is the only molecule that both reduces aqueous humor production and enhances uveoscleral outflow. The use of several hypotensive drugs for a long time can lead to pronounced changes in the tissues of the anterior segment of the eye. In this case, there are complaints characteristic of the dry eye syndrome. The aggravation of this condition can affect the adherence of patients to treatment and worsen the course of the disease. Therefore, it is important to prescribe hypotensive drugs that have a sufficient hypotensive effect with a good safety profile. Purpose. To evaluate the efficacy and safety of Brimonidine SZ in combination therapy for glaucoma after changing the hypotensive regimen. Patients and methods. The study was conducted in a group of 50 patients (50 eyes) with initial or advanced drug-compensated primary open-angle glaucoma (mean age 64.8 years), among them there were 27 (54 %) women and 23 (46 %) men. In patients included in the study, brimonidine 0.15 % or 0.2 % was replaced with Brimonidine SZ as part of combination hypotensive therapy. To analyze the results obtained, data on corneal-compensated IOP, the degree of corneal staining with fluorescein, assessments of conjunctival hyperemia, indicators of the OSDI questionnaire and the level of adherence to treatment at the initial visit, as well as 1 and 3 months after changing the hypotensive regimen, were compared. Results. There were no statistically significant differences in the level of IOP at different times after changing the hypotensive regimen. Objective indicators of the state of the tissues of the anterior surface of the eye did not change. According to the results of the evaluation of the main signs of dry eye syndrome (OSDI) and the degree of adherence of patients to treatment, no significant changes were found either. Conclusion. Brimonidine SZ has a similar hypotensive efficacy with brimonidine 0.15 % and 0.2 % as part of combination hypotensive therapy. The safety profile of Brimonidine SZ is comparable to analogues, which allows us to consider this drug as a possible alternative when choosing hypotensive therapy.

Selective Laser Trabeculoplasty as a Substitute for Medications in Patients with Mild-to-moderate Glaucoma in the Brazilian Public Health System.

Selective laser trabeculoplasty can be used as a substitute for medications in patients with mild-to-moderate glaucoma, reducing the cost of eye drop distribution in the Brazilian public health system. To observe the effectiveness of selective laser trabeculoplasty (SLT) as a substitute for eye drops in patients with open angle glaucoma in the Brazilian Public Health System. SLT was performed bilaterally after medication washout. This is a prospective interventional study comparing intraocular pressure (IOP) when using eye drops at baseline (post-washout), and at 12-month follow-up after SLT. Medication was added if the target IOP was not achieved, following the Brazilian Public Health System eye drops protocol, based on medication costs. Absolute (without eye drops) and qualified (with eye drops) success were measured with IOP ≤ 21, IOP ≤ 18, IOP ≤ 15 and IOP ≤ 12 mm Hg. Besides IOP evolution, the ability to reduce IOP (in %), and eye drops reduction were evaluated. Ninety-two eyes of 46 patients were included, 70 eyes with mild glaucoma and 22 with moderate glaucoma; the mean number of eye drops was 2.26±1.06 (82.6% were using a prostaglandin analogue), and post-washout IOP of 21.10±5.24 mm Hg. There was relative success at IOP ≤18 mm Hg, where the mild group had greater success than the moderate group (88.1% vs. 71.4%, P =0.824). The average IOP reductions were 23.04% and 25.74% at 6 and 12 months, respectively. The average number of eye drops was 1.02, with 1.1% using a prostaglandin analogue. Furthermore, 68.19% of the patients had a decrease in the quantity of eye drops used. SLT is effective in reducing IOP and replacing eye drops in patients in the Brazilian Public Health System. Moreover, there was a significant reduction in the use of prostaglandin analogues.

Risk of Pseudophakic Cystoid Macular Edema in Fellow-Eye Cataract Surgeries: A Multicenter Database Study

To quantify the risk of pseudophakic cystoid macular edema (pCME) in fellow-eye cataract surgery and to determine risk factors, including prior first-eye pCME. Retrospective, clinical database study. Patients undergoing bilateral nonsimultaneous cataract surgeries in 8 UK National Health Service clinical centers between July 2003 and March2015. We excluded patients with a history of diabetic macular edema (DME) or CME and perioperative topical nonsteroidal anti-inflammatory drug use in either eye. We calculated the overall risk of pCME and used Poisson model with robust estimation of standard error to identify potential risk factors for pCME in the fellow eye. The risk of postoperative clinical pCME in the fellow eye. A total of 54 209 patients were included. The mean age was 74.6 ± 10.4 years, and 38.8% were male. The fellow eye developed pCME in 544 patients (1%). The risk of fellow-eye pCME among patients without first-eye pCME was 0.9%. However, the risk of fellow-eye pCME among those with first-eye pCME was 10.7%. In the fully adjusted model, we found that the risk factors for the development of fellow-eye pCME were first-eye pCME (RR, 8.55, 95% confidence interval [CI], 6.19-11.8), epiretinal membrane (ERM) (RR, 4.1, CI, 2.63-6.19), history of retinal vein occlusion (RR, 2.94, CI, 1.75-4.93), diabetes without history of DME (RR, 2.08, CI, 1.73-2.5), advanced cataract (RR, 1.75, CI, 1.16-2.65), prostaglandin analogue use preoperatively (RR, 1.49, CI, 1.13-1.97), and male sex (RR, 1.19, CI, 1.0-1.41). History of pCME in the first-operated eye is the strongest independent risk factor for the development of pCME in the fellow eye. Our findings may guide clinicians in counseling patients on the risk of pCME before performing cataract surgery in the fellow eye and help in identifying high-risk patients who may benefit from prophylactic therapy. Proprietary or commercial disclosure may be found after the references.

Gaseous mediators (H2S, NO and CO) a new approach in gastrointestinal protection

Gastrointestinal damage is generated by a wide range of harmful agents, and is the result of the activation of inflammatory, oxidant and cytotoxic mechanisms, that together overwhelm the “mucosa defense” of the gastrointestinal (GI) tract. It is currently known that the mechanisms by which gastric damage is generated are slightly different from those that generate intestinal damage. The treatments available on the market such as citoprotectors, the use of selective Ciclooxigenase 2 (COX-2) inhibitors, the co-prescription of acid suppressive agents and the use of prostaglandin analogues are mainly focused on the mechanisms of gastric damage, and their use has begun to be limited due to its adverse effects at intestinal and cardiovascular level. Due to its multifactorial origin, the prevention and treatment of GI damage requires effective therapies that can protect both gastric and intestinal level modulating more than one mechanism. Recently, has been reported the contribution of gaseous mediators nitric oxide (NO), hydrogen sulfide (H2S) and carbon monoxide (CO) in many physiological processes in the gastrointestinal tract, including the maintenance of GI mucosal barrier integrity. Experimental evidence has shown promising results regarding the gastric safety of these gasotransmitters, especially those coupled to NSAIDs. This review will try to give a general overview of the mechanisms of gastric and intestinal damage, their main differences, the existing therapies for their treatment and the information available on gas transmitters with a brief description of roles of each of these gaseous molecules.

Предпочтения практикующих российских врачей-офтальмологов при определении стратегии лечения пациентов с первичной открытоугольной глаукомой (результаты многоцентрового научно-аналитического исследования)

The aim of the study was to establish the preferences of domestic ophthalmologists in the selection of prescribing schemes and approaches in the treatment of patients with different stages of primary open-angle glaucoma (POAG). The results of a questionnaire survey of 472 ophthalmologists conducted during the period from August to November 2022 were analyzed. The main part of the questionnaire contained questions concerning the preferences of specialists in selecting the tactics of treatment of patients with glaucoma, for example, treatment schemes for patients with different stages of POAG, including priorities of particular prescriptions (groups of drugs and other approaches), details of current clinical practice — patients' compliance with the prescribed treatment and its cost, expediency of using combined antiglaucoma drugs in the form of their fixed combinations (FC), as well as preservative-free drugs. It was established that 328 (69.5%) ophthalmologists prefer to use the possibility of combined mechanism of action of antiglaucoma hypotensive drugs, 92 (19.5%) - the possibility of targeted influence on uveoscleral outflow. In patients with the initial stage of glaucoma the prescription of monotherapy with the use of prostaglandin analogs (PGAs) is used, in persons with the advanced stage of glaucoma the priority in the prescription of combined forms of drugs is determined, and at the highly advanced stage of the disease surgical treatment is performed. Polypragmasy in prescriptions of antiglaucoma topical drugs impedes effective treatment, and in this regard, ¾ of respondents were in favor of a more active use of FC drugs, considering their use more justified to achieve the goal of treatment than the use of separate prescription schemes. The use of preservative-free forms of drugs allows to keep the ocular surface of glaucoma patients intact for a long time, to predict the results of the expected (and imminent) surgical treatment and to increase the compliance to treatment. The results of the study indicate a confident adherence of ophthalmologists to the guidelines of current clinical recommendations when choosing drug regimens and treatment regimens in patients with different stages of glaucoma.

Investigating the Use of Pilocarpine, Timolol, and Prostaglandin Analogues in English Publications

Investigating the Use of Pilocarpine, Timolol, and Prostaglandin Analogues in English Publications

Topical prostaglandin analogue use and cystoid macular oedema following uneventful cataract surgery: a randomised control trial

Background/aimsThe association between the development of cystoid macular oedema (CMO) following uneventful cataract surgery and prostaglandin analogue (PGA) therapy has not been fully determined. The study aim was to investigate...

Lower Eyelid Horizontal Tightening in Prostaglandin Associated Periorbitopathy.

To determine the effect of chronic topical use of prostaglandin analogs for glaucoma on lower eyelid tension. A prospective case-control study was performed. Lower eyelid tension was measured in a group of glaucoma patients (73 eyelids) using prostaglandin analogs and a paired control group (87 eyelids). Seven glaucoma patients with unilateral use of prostaglandin analogs had the lower eyelid tension of the exposed side compared with the contralateral eyelid. Eyelid tension was digitally measured in photographs in neutral position and after manual downward traction in the center of the eyelid (modified distraction test). Duration of drug exposition, age, use of other topical medication and other prostaglandin-associated periorbitopathy signs as long eyelashes, eyelid hyperemia, eyelid pigmentation, and deepening of upper eyelid sulcus were recorded for analysis. Mean lower eyelid tension in prostaglandin group was significantly higher than in control group: distraction 5.26 mm (SD 1.52) versus 6.80 mm (SD 1.29) (p < 0.001). On the unilateral prostaglandin use intragroup comparison, mean lower eyelid distraction in prostaglandin side was 4.24 mm (SD 1.80) and in control side was 6.79 mm (SD 1.63) (p < 0.012). Beta blocker and carbonic anhydrase inhibitor concomitant use was associated with lower eyelid tension measures in prostaglandin users. Presence of long eyelashes was associated with higher eyelid tension. All other measured variables did not demonstrate interaction with eyelid tension. Chronic topical use of prostaglandin analogs for glaucoma is associated with lower eyelid tightening.

Evaluating the Relationship of Intraocular Pressure and Anterior Chamber Volume With Use of Prostaglandin Analogues.

In this prospective study, naive prostaglandin use in primary open-angle glaucoma was associated with scleral biomechanical alteration and intraocular pressure (IOP) measuring errors. The purpose of this study is to determine the effects of naïve use of prostaglandin analogues (PGA) on IOP and anterior chamber volume (ACV), as well as investigate how PGAs might affect corneal and scleral stiffness and their impact on ocular rigidity. This study was a prospective study of 21 recently diagnosed open-angle glaucoma patients (33 eyes) initiating medical therapy with a topical prostaglandin eye drop. Corneal morphologic and biomechanical parameters as well as IOP were measured at 3 visits over a 4-month period with the following equipment: Pentacam, Corvis ST, Ocular Response Analyzer, Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry. The study demonstrated a significant decrease in mean IOP with initiation of PGA in all 4 tonometers (P<0.0001). The greatest change in IOP occurred in the first 4 weeks of treatment (P<0.0001). The mean ACV showed a significant decrease at visit 2 (P<0.02) and visit 3 (P<0.04) compared with baseline visit 1. However, there was a paradoxical increase in ACV in 37% of eyes at visit 2, despite a significant mean reduction in IOP by GAT and dynamic contour tonometry.The IOP/ACV ratio at visit 1 significantly predicted the reduction in respective measures of IOP, as well as scleral stiffness measured by stiffness parameter-highest concavity. In clinical practice, GAT may not be the most appropriate tonometer for measuring IOP in PGA treated eyes due the measurement errors from ocular biomechanical alteration. The IOP/ACV ratio could potentially serve as a new diagnostic parameter to determine the likelihood of PGA treatment success.

Understanding the Dual Dilemma of Dry Eye and Glaucoma: An International Review.

Glaucoma-related ocular surface disease (G-OSD) is a significant, yet often underdiagnosed, ocular co-morbidity affecting 40% to 59% of glaucoma patients worldwide. Although the use of topical glaucoma medications represents a proven strategy to control the untoward effects of high intraocular pressure, this treatment can profoundly disrupt the homeostasis of the tear film. The cumulative effect of medications, preservatives, and excipients alter underlying cellular structures which results in tear film abnormalities and instability of the ocular surface. Furthermore, these chronic inflammatory changes have been shown to impact efficacy of glaucoma treatment, patient compliance with therapy and overall quality of life. The pathogenesis of G-OSD is multifactorial and involves a vicious self-perpetuating cycle of inflammatory cytokines and proteins. The diagnosis of such disease is based on similar tests used in assessing traditional dry eye, taking into consideration findings specific to this patient population. The hallmark of treatment for these patients is to minimize the ocular surface inflammatory response by choosing glaucoma therapies that spare the ocular surface such as preservative free formulations and initiating dry eye treatment early in the course of care. In summary, glaucoma affects millions of patients around the world and chronic use of topical glaucoma medications may negatively impact the patient's ocular surface, symptoms, and vision. Understanding the pathogenesis of G-OSD, recognizing its risk factors and incorporating diagnostic and therapeutic strategies that restore and maintain ocular surface homeostasis will result in improved care for our patients.

High Correlation between Glaucoma Treatment with Topical Prostaglandin Analogs and BDNF Immunoreactivity in Human Retina

ABSTRACT Purpose To examine the expression of brain-derived neurotrophic factor (BDNF) and its high-affinity receptor, tropomyosin-related kinase receptor-B (TrkB), in normal and glaucomatous human retinas. Methods Human retinas were collected from 8 donors who had been clinically diagnosed and treated for glaucoma, and from 9 control donors. Immunohistochemical analysis for BDNF and TrkB was performed. The percent of each retina expressing BDNF and TrkB was quantified for the total retinal thickness, and separately for the retinal ganglion cell (RGC) complex + retinal nerve fiber layer (RNFL). The expression of each protein was correlated with clinical outcomes obtained from the subject’s ocular histories. Results There was no significant difference in BDNF or TrkB expression when comparing glaucomatous and control retinas. Correlation analysis revealed a significant relationship between BDNF expression and the use of prostaglandin analogs. TrkB expression was highly correlated with the last-measured intraocular pressure (IOP), the use of carbonic anhydrase inhibitors, the use of beta blockers, and the total number of drugs used for the treatment of glaucoma. Conclusion Topical drugs used to treat glaucoma were associated with an increase in retinal BDNF and TrkB expression in human retina, independent of IOP, which may represent molecular evidence of neuroprotective pathway activation.

Effectiveness of combined use of rectal misoprostol and oxytocin for prevention of postpartum hemorrhage after cesarean section

Post-Partum Hemorrhage (PPH) is defined as the loss of blood which is greater than 500ml after vaginal delivery or greater than 1000 ml after a cesarean section delivery. About 28% of the total maternal deaths were due to PPH particularly in developing countries. Oxytocin has been considered as the ‘gold standard’ drug in the treatment and prevention of PPH. Prophylactic use of prostaglandin analogue i.e., misoprostol in addition to oxytocin during cesarean section is expected to reduce the incidence of PPH. This study aims at comparing the efficacy of combined use of rectal misoprostol and oxytocin infusion with oxytocin in the prevention of PPH. A comparative observational study was conducted on 200 subjects which were divided into two equal groups by Simple Random Selection. One group was treated with Inj. Oxytocin 20U I.V infusion alone while the other group was treated with Tab. Misoprostol 600mcg, rectal route and Inj. Oxytocin 20U I.V infusion. Majority of the subjects were observed under the age group of 21-25years, under primigravidae. A significant decrease in the volume of mean blood loss (740.00 ± 164.00 ml: p = 0.045) and the mean drop of hemoglobin level(Hb) (0.88±0.74gm/dl; p = 0.0001) were observed in group treated with Tab. Misoprostol 600mcg and Inj. Oxytocin and was found to be statistically significant. Preoperative administration of misoprostol per rectal route and oxytocin infusion after the cesarean section have shown, a better control of bleeding and maintenance of hemoglobin level when compared to oxytocin infusion alone. Thus, instead of oxytocin monotherapy combined use of misoprostol and oxytocin would be more effective in prevention of PPH.

Effects of Long Term Use of Prostaglandin Analogues with and Without Preservative on Normal Conjunctival Flora of Glaucoma Patients

In recent times, it has been suggested that bacteria may acquire resistant genes or gene mutation might take place in bacteria, imparting resistance to antiseptics.

Topical Prostaglandin Analog Use Is Associated with Increased Failure Rate of Ptosis Repair

Topical Prostaglandin Analog Use Is Associated with Increased Failure Rate of Ptosis Repair

Use of Topical Intraocular Pressure-lowering Medications in the US Population: Results From the NHANES Study 1999 to 2014.

We found no evidence of an increase in the number of Americans using topical intraocular pressure (IOP) medication or a number of drops used per patient from 1999 to 2014, although there were significant changes in the class of medications used. The purpose of this study was to determine changes in topical IOP-lowering medication use in the United States from 1999 to 2014. A series of 8 nationally representative, weighted cross-sectional surveys of United States residents were performed every 2 years from 1999 to 2014. On 2-year cycles, professional interviewers performed in-home interviews of a representative sample of the nation as part of the National Health and Nutrition Examination Survey study. Participants were asked, "In the past month, have you used or taken medication for which a prescription is needed?" Adults over age 40 who responded to this question were included in the analysis. The primary outcome was number of US adults using topical IOP-lowering medication. Secondary outcomes included the number and types of medications used. There was no change in the number of adults using topical IOP-lowering medications over the time period studied (P=0.74) with 1.4% (95% confidence interval: 0.9%-1.8%) of US residents on IOP-lowering medications in 1999 to 2000 and 1.4% of US residents (95% confidence interval: 1.1%-1.8%) on topical medications in 2013 to 2014. There was no change in the number of medications per patient over the period of the study (P=0.14). There was a significant increase in the use of prostaglandin analogs and combination medications and a decrease in the use of β-blockers (all P<0.01). In contrast to the increase in glaucoma medication use seen in several other developed nations, use in the United States remained stable from 1999 to 2014. This may be due to differential use of other procedures. Future studies of IOP-lowering medications incorporating the effect of new agents and minimally invasive surgeries are warranted.

The Degree of Posttraumatic Enophthalmos Detectable by Lay Observers.

This study was to determine the degree of posttraumatic enophthalmos that is detectable by lay observers. In this case-control study, 60 photographs (frontal and oblique angles) of patients from an oculoplastics registry at the authors' institution were reviewed by lay observers. Patients were included if they had between 1 and 5 mm of unilateral enophthalmos, at least 6 months following trauma. They were divided into five groups of 10 and each group was separated by increments of 1 mm. Controls were selected from the same database and had 0 mm difference between each eye. Patients were excluded if they had any medical condition that might cause enophthalmos (including use of prostaglandin analogues). Participants were also excluded if they had any medical or surgical condition affecting the contralateral side. Lay observers were randomly selected from a pool of volunteers in nonmedical programs at our affiliated university. The primary outcome measure was the asymmetry cut-off (in millimeters) in which more than 50% of the cases (chance) were identified correctly. The generalized mixed model predicts that 66% of lay observers would correctly identify a difference between both eyes at a rate greater than would be predicted by chance, if at least a 5 mm difference existed between them (95% confidence interval [CI] 55.5-75%). This study shows that lay observers only reliably detect unilateral enophthalmos when there is at least a 5 mm difference between the eyes. This study used two-dimensional (2D) photographs and, therefore, results with three-dimensional (3D) observation may be different. In this study of 2D photographs, unilateral posttraumatic enophthalmos is only reliably detected by lay observers when a 5 mm difference exists between the eyes.