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Nijm L, Matossian C, Rhee MK, Stephens JD, Rosselson ME, Majmudar PA, Gollamudi SR, Patel RH, Bauskar A, Montieth A, Vantipalli S, Gibson A, Metzinger JL, Goldstein MH, Gurses Ozden R. Early Real-World Patient and Staff Experience with an Intracanalicular Dexamethasone Insert. Clin Ophthalmol 2024; 18:1391-1401. [PMID: 38784434 PMCID: PMC11114144 DOI: 10.2147/opth.s448973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose To evaluate both the early experience of real-world patients treated with dexamethasone ophthalmic insert (0.4 mg; DEXTENZA®), hereafter referred to as DEX, after cataract surgery as well as staff/practice integration of DEX relative to eyedrops. Patients and Methods This was a cross-sectional survey study of 23 cataract practices in the United States. Respondents were patients and practice staff who had experience with DEX following cataract surgery. Both patients and practice staff completed an online survey. Descriptive statistics summarized the survey responses to portray the experience of the respondents. Results Surveys were completed by 62 patients and 19 practice staff. Almost all patients (93%) were satisfied or extremely satisfied with DEX. Patients highly preferred DEX (93%) to topical steroid drops (7%) based on past experiences with topical steroid drops. Most practice staff (95%) were satisfied or highly satisfied with DEX, reporting a 45% reduction in time spent educating patients on postoperative drop use and a 46% decrease in time spent addressing calls from pharmacies regarding postoperative medications. Conclusion Incorporating the DEX insert into clinical practice in cataract surgery practices can improve patient adherence, while potentially providing significant savings to practices in terms of time spent educating patients and responding to patient and pharmacy call-backs.
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Affiliation(s)
- Lisa Nijm
- Warrenville EyeCare and LASIK, Warrenville, IL, USA
- University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
| | | | | | | | | | | | | | - Ravi H Patel
- Eye Associates of Central Texas, Round Rock, TX, USA
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2
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Novack GD, Robin AL. Ocular Pharmacology. J Clin Pharmacol 2024. [PMID: 38708561 DOI: 10.1002/jcph.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
Treatment of ocular diseases presents unique challenges and opportunities for the clinician and for the clinical pharmacologist. Ophthalmic pharmaceuticals, typically given as liquids, require consideration of solubility, physiological pH, and osmolarity, as well as sterility and stability, which in turn requires optimal pharmaceutics. Ocular tissue levels are challenging to obtain in humans, and the clinical pharmacokinetics is typically blood levels, which are primarily related to safety, rather than efficacy. The eye is a closed compartment with multiple physiological barriers with esterases and transporters, but relatively little cytochrome oxidases. Delivery routes include topical, intravitreal, and systemic. Patient dosing involves not only adherence issues common to all chronic diseases, but also performance requirements on eye drop instillation. Therapeutically, ocular diseases and their pharmacological treatments include both those analogous to systemic diseases (e.g., inflammation, infection, and neuronal degeneration) and those unique to the eye (e.g., cataract and myopia).
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Affiliation(s)
- Gary D Novack
- PharmaLogic Development, Inc., San Rafael, CA, USA
- Department of Ophthalmology and Vision Science, School of Medicine, University of California, Davis, CA, USA
| | - Alan L Robin
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
- Department of Ophthalmology, School of Medicine Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of International Health, Johns Hopkins University, Baltimore, MD, USA
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Wirta D, Li XY, Shen W, Lu C, Novack GD. Double-Masked, Vehicle-Controlled, Randomized, Phase II Study of the Ocular Hypotensive Activity and Safety of VVN539 Ophthalmic Solution. OPHTHALMOLOGY SCIENCE 2024; 4:100426. [PMID: 38192683 PMCID: PMC10772809 DOI: 10.1016/j.xops.2023.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 01/10/2024]
Abstract
Purpose To assess safety and ocular hypotensive efficacy of VVN539 ophthalmic solution in a first-in-human study. Design Multicenter, double-masked, randomized, vehicle-controlled, dose-response, parallel-comparison study. Participants Sixty-eight subjects with ocular hypertension (OHT) or open-angle glaucoma enrolled at 5 private practices. Methods After washout of ocular hypotensive medications as required, the subjects were randomized to receive either VVN539 ophthalmic solution 0.02%, 0.04%, or vehicle once-daily (QD) in the morning (5 days), once-daily in the evening (6 days) and then twice-daily (6 days). Main Outcome Measures Comparison of VVNM539 to its vehicle in mean intraocular pressure (IOP) at each diurnal time point (8:00am, 10:00am, and 4:00pm) at visit 4 (day 7), visit 5 (day 14), and visit 6 (day 21). Results Mean IOP decreased throughout dosing in the active groups to between 18 and 20 mmHg in both active groups, to between 22 to 23 mmHg in the vehicle group. VVN539 0.04% was statistically superior to vehicle at all 9 diurnal time points (QD AM, QD PM, and twice daily, P ≤ 0.0109). VVN539 0.02% was statistically superior to vehicle at only 6 of 9 diurnal time points (selected QD times and twice daily). The most common ocular treatment-emergent adverse event was conjunctival hyperemia (11 [47.8%], 10 [4.5%], and 1 [4.3%]), followed by ocular hyperemia (3 [13.0%], 5 [22.7%] and 0), respectively. There were no clinically significant changes of note in visual acuity, biomicroscopy, dilated ophthalmoscopy, blood chemistry, hematology, or cardiovascular measures. Conclusions In conclusion, the results of this initial phase II study indicate that VVN539 ophthalmic solution showed clinically and statistically significant ocular hypertensive activity and was relatively well tolerated for the treatment of subjects with primary open-angle glaucoma or OHT. Additional studies will be required for a more complete evaluation of the utility of VVN539 ophthalmic solution. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- David Wirta
- Clinical Research, Eye Research Foundation, Newport Beach, California, USA
| | - Xiao-Yan Li
- Research & Development, VivaVision Biotech, Inc
| | - Wang Shen
- Research & Development, VivaVision Biotech, Inc
| | - Caroline Lu
- Research & Development, VivaVision Biotech, Inc
| | - Gary D. Novack
- Research & Development, PharmaLogic Development, Inc., San Rafael, California
- Department of Ophthalmology & Vision Science, University of California School of Medicine, Davis, Sacramento, California
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Espinoza G, Justiniano MJ, Rodriguez-Una I, Godin F, Arango A, Villamizar S. Twelve-month outcomes of Kahook dual blade goniotomy combined with cataract surgery in Latino patients. Int Ophthalmol 2024; 44:44. [PMID: 38337081 DOI: 10.1007/s10792-024-03024-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To evaluate 12 month surgical outcome of Kahook Dual Blade (KDB) goniotomy in combination with cataract surgery in Latino patients with open angle glaucoma (OAG) and ocular hypertension (OHT). METHODS This retrospective study included 45 eyes of 40 patients who underwent KDB goniotomy combined with cataract extraction from January 2016 to September 2020 at two centers in South America. Primary outcome was surgical success defined as ≥ 20% intraocular pressure (IOP) reduction or ≥ 1 medication reduction from preoperative without additional IOP-lowering procedures and an IOP ≥ 5 mmHg or ≤ 21 mmHg. Additionally, we used 2 cutoffs values for success of IOP ≤ 18 and ≤ 15 mmHg. Secondary outcomes included: IOP, medication use, best corrected visual acuity, complications and failure-associated factors. RESULTS Success rates at 12 months with cutoff limits of 21, 18 and 15 mmHg were 84.3%, 75.6% and 58.7%, respectively. At 12 months, mean preoperative IOP significantly decreased from 19.23 ± 0.65 mmHg on 2.3 ± 1.0 medications to 14.33 ± 0.66 mmHg on 0.6 ± 0.9 medications (p < 0.001) , with 62% of eyes free of hypotensive medication. Eyes that developed postoperative IOP spikes showed a higher risk for failure using the cutoff limit of IOP ≤ 18 mmHg with a hazard ratio of 3.6 (95% confidence interval [CI], 1.80-7.13; p < 0.001). There were no serious ocular adverse events. CONCLUSIONS KDB combined with cataract extraction showed safety and efficacy for decreasing IOP in OAG and OHT Latino patients. Additionally, dependence on medications was reduced significantly after surgery.
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Affiliation(s)
- Gustavo Espinoza
- Centro Oftalmológico Virgilio Galvis, Bucaramanga, Santander, Colombia.
- Fundación Oftalmológica de Santander FOSCAL, Ave. El No 23-60, TMS, Cañaveral, Tv. El Bosque Floridablanca, Bucaramanga, Santander, Colombia.
| | | | | | - Fernando Godin
- Grupo de investigación Salud Visual y ocular Unbosque, Universidad del Bosque, Bogotá D.C., Colombia
| | - Andres Arango
- Centro Oftalmológico Virgilio Galvis, Bucaramanga, Santander, Colombia
| | - Sylvia Villamizar
- Centro Oftalmológico Virgilio Galvis, Bucaramanga, Santander, Colombia
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Lee TE, Cho Y, Yoo HH. The effects of self-video feedback on the eyedrop instillation techniques of glaucoma patients: a prospective randomized controlled trial. Int Ophthalmol 2024; 44:7. [PMID: 38316676 PMCID: PMC10844463 DOI: 10.1007/s10792-024-02941-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/16/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND To evaluate the effectiveness of instillation technique education using self-video feedback in glaucoma patients. METHODS Sixty-two patients who self-instilled glaucoma eyedrops were randomly assigned to the self-video feedback and control groups according to the block randomization. Each group of the patient was asked to instill eyedrops, and videos were recorded. For the control group, only an educational video was provided. In the self-video feedback group, the patients provided educational video and feedback using a recorded video of their own instillation. After 1 month of education, the patient's instillation techniques were video-recorded again. We divided the steps of instilling eyedrops into ten steps and evaluated whether each step was properly performed using the recorded images from each patient. The main outcome was the proportion of patients who properly instilled their eyedrops in each step. RESULTS Before education, there was no significant difference in the proportion of patients who were properly instilled between the two groups. In the group that received video feedback, the proportion of patients who instilled the eyedrops correctly after education in some items was significantly higher than that of the control group, and in particular, the educational effect of 'avoids touching dropper to eyelid or eyelash' was superior. CONCLUSIONS In patients with glaucoma, education on the method of instillation was effective in improving the techniques of instillation. In the items that required accurate actions, the video feedback that allowed the patient to observe themselves had a better improvement effect compared to the traditional education method. TRIAL REGISTRATION NUMBER KCT0008090 (09/01/2023, retrospectively registered).
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Affiliation(s)
- Tae-Eun Lee
- Department of Ophthalmology, Jeonbuk National University Medical School, 20, Geonjiro Deokjin gu, Jeonju-si, Jeollabuk do, 54907, Korea.
| | - Youngri Cho
- Department of Ophthalmology, Jeonbuk National University Medical School, 20, Geonjiro Deokjin gu, Jeonju-si, Jeollabuk do, 54907, Korea
| | - Hyo Hyun Yoo
- Department of Medical Education, Jeonbuk National University Medical School, 20, Geonjiro Deokjin gu, Jeonju-si, Jeollabuk do, 54907, Korea
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Berdahl JP, Sarkisian SR, Ang RE, Doan LV, Kothe AC, Usner DW, Katz LJ, Navratil T. Efficacy and Safety of the Travoprost Intraocular Implant in Reducing Topical IOP-Lowering Medication Burden in Patients with Open-Angle Glaucoma or Ocular Hypertension. Drugs 2024; 84:83-97. [PMID: 38060092 PMCID: PMC10789685 DOI: 10.1007/s40265-023-01973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE A randomized, double-masked, multicenter, phase 2 trial to evaluate the long-term safety and efficacy of travoprost intraocular implant, an extended-release drug delivery system designed to provide uninterrupted sustained intraocular pressure (IOP)-lowering therapy, thereby reducing patient treatment burden and improving adherence with IOP-lowering medication. METHODS Patients with open-angle glaucoma or ocular hypertension were administered a fast-eluting implant (FE implant, n = 51) and received twice-daily (BID) placebo eye drops, a slow-eluting (SE implant, n = 54) and received BID placebo eye drops, or underwent a sham surgical procedure and received BID timolol 0.5% (n = 49). IOP was measured at baseline, day 1-2, day 10, week 4, week 6, month 3, and every 3 months thereafter through 36 months. Efficacy was evaluated by mean change from 8:00 AM unmedicated baseline IOP through month 36, and the percentage of patients receiving the same or fewer topical IOP-lowering medications as at screening (pre-study). Safety was evaluated by adverse events and ophthalmic parameters. RESULTS Clinically and statistically relevant IOP-lowering treatment effects were observed through month 36 after a single administration of the travoprost implant compared with BID timolol with mean IOP reductions ranging from 7.6 to 8.8 mmHg for the FE implant group, from 7.3 to 8.0 mmHg for the SE implant group, and from 7.3 to 7.9 for the timolol group at the 8:00 AM timepoint (P < 0.0001 for all treatment groups at all visits). At months 12, 24, and 36, a greater percentage of FE and SE implant patients versus timolol patients were well controlled on the same or fewer topical IOP-lowering medications compared with screening with 63 and 69% for the FE and SE implants groups, respectively, versus 45% for the timolol group at month 36. The safety profile of the implant was favorable; there were no dislodgements, no explantations, no adverse events of conjunctival hyperemia or periorbital fat atrophy, no discontinuations due to study eye adverse events, nor any serious adverse events in the study eye. Comparable changes from baseline in corneal endothelial cell counts were observed in the three treatment groups over the 36 months. CONCLUSION The travoprost intraocular implant demonstrated robust IOP-lowering and substantially reduced topical IOP-lowering medication burden for up to 36 months following a single administration, while maintaining a favorable safety profile. The travoprost intraocular implant promises to be a meaningful addition to the interventional glaucoma armamentarium by addressing the key shortcomings of topical IOP-lowering medications, including low adherence and topical side effects while controlling IOP for up to 36 months. TRIAL REGISTRY ClinicalTrials.gov identifier NCT02754596 registered 28 April 2016.
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Affiliation(s)
| | | | - Robert E Ang
- Asian Eye Institute, Rockwell Center, 1200, Makati City, Philippines
| | - Long V Doan
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Angela C Kothe
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Dale W Usner
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - L Jay Katz
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, 19107, USA
- Department of Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Tomas Navratil
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA.
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Takao E, Ichitani A, Tanito M. Estimation of Topical Glaucoma Medication Over-Prescription and Its Associated Factors. J Clin Med 2023; 13:184. [PMID: 38202191 PMCID: PMC10779581 DOI: 10.3390/jcm13010184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
This study aims to report the disparity between the ideal and actual quantities of eyedrops prescribed to individual glaucoma patients. This retrospective observational study included 676 patients receiving treatment with antiglaucoma topical medication(s) in at least one eye. These patients had follow-up appointments scheduled at mean intervals of 3.4 ± 1.4 months and were actively using antiglaucoma medication. The mean age was 70.4 ± 11.9 years, with 372 (55%) being male. The over-prescription volume was 1.4 ± 1.7 bottles per month for each medication when prescribed for both eyes. Multiple regression analysis revealed that older age (p = 0.03), hyperopic refractive error (p < 0.0001), and the use of multiple medications (p = 0.03) were associated with a larger over-prescription volume, while the use of unit-dose medication only (p < 0.0001) was associated with a smaller over-prescription volume. Factors such as sex, Mini-Cog cognitive function score, best-corrected visual acuity, intraocular pressure, glaucoma type, and a history of cataract surgery were not significantly associated. This study revealed a significant over-prescription of eyedrops for glaucoma patients, with actual prescriptions often exceeding the theoretically ideal amount by 2.4 times, influenced by factors like age and the format of prescriptions, where unit-dose eyedrops show promise in reducing excess.
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Affiliation(s)
| | | | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan
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8
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Kim JR, Kim SY, Kang H, Kim DI, Yoo HJ, Han SM, Lu P, Moon GD, Hyun DC. Contact Lens with pH Sensitivity for On-Demand Drug Release in Wearing Situation. ACS APPLIED BIO MATERIALS 2023; 6:5372-5384. [PMID: 37967413 DOI: 10.1021/acsabm.3c00637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Drug-releasing contact lenses are emerging therapeutic systems for treating ocular diseases. However, their applicability is limited by the burst release of drugs during lens wear and premature drug leakage during packaging, rendering the precise control of release duration or dose difficult. Here, we introduce a pH-sensitive contact lens exhibiting on-demand drug release only during lens wear and negligible premature drug leakage during packaging and transportation, which is accomplished by incorporating drug-loaded mesoporous silica nanoparticles (MSNs) coated with a pH-sensitive polymer into the contact lens. The compositionally optimized pH-sensitive polymer has a lower critical solution temperature (LCST) at >45 °C at pH 7.4, whereas its LCST decreases to <35 °C under acidic conditions (pH ∼ 6.5). Consequently, the MSN-incorporated contact lens sustainably releases the loaded drugs only in the acidic state at 35 °C, which corresponds to lens-wear conditions, through the MSN pores that open because of the shrinkage of polymer chains. Conversely, negligible drug leakage is observed from the contact lens under low-temperature or neutral-pH conditions corresponding to packaging and transportation. Furthermore, compared with the plain contact lens, the pH-sensitive contact lens exhibits good biocompatibility and unchanged bulk characteristics, such as optical (transmittance in the visible-light region), mechanical (elastic modulus and tensile strength), and physical (surface roughness, oxygen permeability, and water content) properties. These findings suggest that the pH-sensitive contact lens can be potentially applied in ocular disease treatment.
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Affiliation(s)
- Jong Ryeol Kim
- Department of Polymer Science and Engineering, Polymeric Nano-Materials Laboratory, Kyungpook National University, Daegu 41566, South Korea
| | - So Young Kim
- Department of Polymer Science and Engineering, Polymeric Nano-Materials Laboratory, Kyungpook National University, Daegu 41566, South Korea
| | - Hosu Kang
- Department of Polymer Science and Engineering, Polymeric Nano-Materials Laboratory, Kyungpook National University, Daegu 41566, South Korea
| | - Da In Kim
- Department of Polymer Science and Engineering, Polymeric Nano-Materials Laboratory, Kyungpook National University, Daegu 41566, South Korea
| | - Hye Jin Yoo
- Department of Polymer Science and Engineering, Polymeric Nano-Materials Laboratory, Kyungpook National University, Daegu 41566, South Korea
| | - Sung Mi Han
- Optical Convergence Technology Center, Daegu Catholic University, Gyeongsan-si, Gyeongbuk 38430, Korea
| | - Ping Lu
- Department of Chemistry and Biochemistry, Rowan University, 201 Mullica Hill Road, Glassboro, New Jersey 08028, United States
| | - Geon Dae Moon
- Dongnam Regional Division, Korea Institute of Industrial Technology, Busan 46938, Korea
| | - Dong Choon Hyun
- Department of Polymer Science and Engineering, Polymeric Nano-Materials Laboratory, Kyungpook National University, Daegu 41566, South Korea
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9
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Bedrood S, Berdahl J, Sheybani A, Singh IP. Alternatives to Topical Glaucoma Medication for Glaucoma Management. Clin Ophthalmol 2023; 17:3899-3913. [PMID: 38111854 PMCID: PMC10726774 DOI: 10.2147/opth.s439457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
Topical glaucoma medications have favorable safety and efficacy, but their use is limited by factors such as side effects, nonadherence, costs, ocular surface disease, intraocular pressure fluctuations, diminished quality of life, and the inherent difficulty of penetrating the corneal surface. Although traditionally these limitations have been accepted as an inevitable part of glaucoma treatment, a rapidly-evolving arena of minimally invasive surgical and laser interventions has initiated the beginnings of a reevaluation of the glaucoma treatment paradigm. This reevaluation encompasses an overall shift away from the reactive, topical-medication-first default and a shift toward earlier intervention with laser or surgical therapies such as selective laser trabeculoplasty, sustained-release drug delivery, and micro-invasive glaucoma surgery. Aside from favorable safety, these interventions may have clinically important attributes such as consistent IOP control, cost-effectiveness, independence from patient adherence, prevention of disease progression, and improved quality of life.
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Affiliation(s)
| | | | - Arsham Sheybani
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Radcliffe NM, Shah M, Samuelson TW. Challenging the "Topical Medications-First" Approach to Glaucoma: A Treatment Paradigm in Evolution. Ophthalmol Ther 2023; 12:2823-2839. [PMID: 37855977 PMCID: PMC10640619 DOI: 10.1007/s40123-023-00831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
Topical glaucoma medications are effective and safe, but they have numerous well-documented limitations that diminish their long-term utility and sustainability. These limitations can include high rates of nonadherence (with associated glaucoma progression), concerning side effects, inconsistent circadian intraocular pressure (IOP) control, complex dosing regimens, difficulty with self-administration, costs, and decreased quality of life. Despite these limitations, topical medications traditionally have been first-line in the glaucoma treatment algorithm, as no other minimally invasive treatment alternatives existed. In recent years, however, novel interventional therapies-including sustained-release drug-delivery platforms, selective laser trabeculoplasty, and micro-invasive glaucoma surgery procedures-have made it possible to intervene earlier without relying on topical medications. As a result, the topical medication-first treatment approach is being reevaluated in an overall shift toward earlier more proactive interventions.
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Affiliation(s)
- Nathan M Radcliffe
- New York Eye Surgery Center, 1101 Pelham Parkway North, Bronx, NY, 10469, USA.
| | - Manjool Shah
- New York University (NYU) Langone Health, New York, NY, USA
| | - Thomas W Samuelson
- Minnesota Eye Consultants, University of Minnesota, Minneapolis, MN, USA
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11
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Lebrón Gutiérrez K, Thomas S, Martin JL, Dahlmann-Noor A. Usability of an Eye Drop Delivery Aid for Single-Dose Instillation: Results from a Market Research Study. Clin Ophthalmol 2023; 17:3675-3684. [PMID: 38054183 PMCID: PMC10695020 DOI: 10.2147/opth.s435467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
Background One of the challenges of treating chronic ocular diseases like vernal keratoconjunctivitis (VKC), glaucoma, and ocular surface disease is patient adherence to topical medication. To support correct eye drop instillation, a variety of delivery aids have been developed for both single-dose and conventional multi-dose containers. Methods To evaluate Dropaid™ Single-dose, an eye drop delivery aid designed for single-dose containers, a usability study was conducted on 30 parents and caregivers of patients with VKC. After assessing the ability to squeeze a single eye drop from the single-dose container onto the eye of a pediatric medical dummy, the delivery aid was evaluated using an 11-point Likert scale on a variety of characteristics: from "very difficult" (-5) to "very easy" (+5). Results The majority of participants rated the task of opening the single-dose units (SDUs), preparing, and positioning the Dropaid™ Single-dose device as "very easy". When providing a single eye drop from the container, 87% of participants rated the Dropaid™ Single-dose device as either "very easy" or "easy", with a median rating score of +5.0 (interquartile range [IQR], 4.0-5.0). For general ease of use, 84% considered the delivery aid as either "very easy" or "easy", with a median score of +4.0 (IQR, 3.0-5.0). Most participants (93%) rated Dropaid™ Single-dose as either "very comfortable" or "comfortable" to hold, with a median score of +5.0 (IQR, 4.0-5.0). Conclusion The Dropaid™ Single-dose delivery aid demonstrated rapid learning and ease of use across all stages of application, including opening the container, eye drop administration, and handling comfort. Although designed for use with single-dose containers to help eye drop instillation in patients with VKC, Dropaid™ Single-dose may provide a wider utility across a range of other ocular diseases such as glaucoma and dry eye.
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12
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Baghban R, Talebnejad MR, Meshksar A, Heydari M, Khalili MR. Recent advancements in nanomaterial-laden contact lenses for diagnosis and treatment of glaucoma, review and update. J Nanobiotechnology 2023; 21:402. [PMID: 37919748 PMCID: PMC10621182 DOI: 10.1186/s12951-023-02166-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Despite the existence of numerous eye drops in the market, most of them are not sufficiently effective because of quick clearance and the barriers within the eye. To increase the delivery of the drugs to the eye, various new formulations have been explored in recent decades. These formulations aim to enhance drug retention and penetration, while enabling sustained drug release over extended periods. One such innovative approach is the utilization of contact lenses, which were originally designed for cosmetic purposes and vision correction. Contact lenses have appeared as a promising formulation for ocular drug delivery, as they can increase the bioavailability of drugs in the eye and diminish unwanted side effects. They are specifically appropriate for treating chronic eye conditions, making them an area of interest for researchers in the field of ophthalmology. This review outlines the promising potential of nanomaterial-laden contact lenses for diagnosis and treatment of glaucoma. It classifies therapeutic approaches based on nanomaterial type, summarizes diagnostic advances, discusses improvement of contact lenses properties, covers marketing perspectives, and acknowledges the challenges of these innovative contact lenses for glaucoma management.
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Affiliation(s)
- Roghayyeh Baghban
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Talebnejad
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Aidin Meshksar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Heydari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Tanito M, Mochiji M, Tsutsui A, Harano A, Ichioka S, Takayanagi Y, Kataoka Y, Takagi Y, Shii D. Factors Associated with Topical Medication Instillation Failure in Glaucoma: VRAMS-QPiG Study. Adv Ther 2023; 40:4907-4918. [PMID: 37707675 PMCID: PMC10567858 DOI: 10.1007/s12325-023-02646-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION To report eyedrop instillation techniques and factors associated with instillation failure among glaucoma subjects in the Video-Recorded Assessment of Medication Skill and Questionnaire-based evaluation of Perception in Glaucoma Study. METHODS In this cross-sectional observational study, subjects were 60 patients with glaucoma (mean ± standard deviation age, 68.4 ± 11.3 years; 30 men) who required ocular hypotensive medication(s). Subjects completed ophthalmologic examinations and the Mini-Cog cognitive function test; their typical eyedrop instillation technique was video-recorded. Subjects rated their technique as successes/failures by questionnaire and two examiners rated the successes/failures based on video assessment. Discrepancy between self-reported and video-assessed success/failure rates of instillation was the main outcome measures. Multivariate logistic regression identified factors in instillation failure. RESULTS Of 48/56 (86%) self-reported successes, 27/48 (56%) failed based on video assessment; as a result, 32/56 (57%) were inconsistent between subjective and objective assessments. Overall, 30/56 (54%) failed based on video assessment. In the subject-based data model, older age [odds ratio (OR) 0.93/year, P = 0.025] and lower cognitive function score (OR 2.7/score, P = 0.025) were factors in failed instillations. In the eye-based data model, less myopic objective refractive error (OR 0.77/diopter, P = 0.016) and lower visual field foveal threshold (OR 1.1/decibel, P = 0.041) were factors in failures. CONCLUSION In addition to older age, decreased cognitive function, hyperopia, and decreased foveal sensitivity are risks for failed eyedrop instillation. Treating physicians can screen patients who require guidance by checking the risk factors of instillation failure rather than by relying on patient reports.
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Affiliation(s)
- Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan.
| | - Mihoko Mochiji
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Aika Tsutsui
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Akiko Harano
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Sho Ichioka
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Yuji Takayanagi
- Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane, Japan
| | - Yumiko Kataoka
- Japan Medical Affairs Group, Santen Pharmaceutical Co., Ltd., 4-20 Ofukacho, Kita-ku, Osaka, Japan
| | - Yasutaka Takagi
- Japan Medical Affairs Group, Santen Pharmaceutical Co., Ltd., 4-20 Ofukacho, Kita-ku, Osaka, Japan
| | - Daisuke Shii
- Japan Medical Affairs Group, Santen Pharmaceutical Co., Ltd., 4-20 Ofukacho, Kita-ku, Osaka, Japan
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Grissom N, Gardiner SK, Rees JP, Sanchez FG, Mansberger SL, Cunningham ET, Burgoyne CF, Rice K, Belter C, Kinast RM. Patients with Low Vision Struggle with Placing Eye Drops and Benefit from an Eye Drop Aid. Ophthalmol Glaucoma 2023; 6:501-508. [PMID: 37084868 DOI: 10.1016/j.ogla.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE To evaluate eye drop self-administration in a low-vision patient population and test whether a nose-pivoted drop delivery device (NPDD, GentleDrop) can improve eye drop delivery in these patients. DESIGN Repeated-measures case series. PARTICIPANTS Thirty subjects (58 eyes) with low vision, defined as best-corrected visual acuity worse than 20/60 or visual field worse than 20° in the better-seeing eye. METHODS We video-recorded subjects while self-administering eye drops using their own traditional delivery at baseline, after a standardized teaching, and with an NPDD. Two masked graders independently reviewed each drop delivery. Primary success was defined as the drop reaching the eye without the bottle touching the eye or eyelids. Subjects rated ease-of-use (1-10 scale, 10 = easiest) after each drop delivery and completed a satisfaction survey, which included asking whether subjects could place drops independently (1-5 scale, 5 = most independent). MAIN OUTCOME MEASURES Logistic-transformed generalized estimating equation regression to compare technique satisfaction, ease-of-use, independence, no contact, and success. RESULTS Primary success was observed in 30 (52%) of 58 eyes at baseline and increased to 44 eyes (76%) with an NPDD (P = 0.013). Bottle tip contact occurred in 23 (40%) of 58 eyes at baseline and 8 eyes (14%) with an NPDD (P = 0.004). Mean ease-of-use scores were 6.7 ± 3.1 at baseline and 8.3 ± 1.8 (P < 0.001) with an NPDD. Likewise, the NPDD improved success, bottle tip contact, and ease-of-use compared with post-teaching traditional delivery (P < 0.01). Twenty-two (73%) of 30 subjects preferred the NPDD to traditional delivery. Twenty-nine (97%) thought the NPDD was comfortable to use, and all would recommend the device. A subgroup analysis was performed on 16 subjects that self-reported difficulty instilling drops at baseline. The NPDD showed similar results, and it increased confidence in placing drops independently (4.6 ± 0.9) compared with baseline (2.7 ± 1.6, P < 0.001). Fifteen (94%) subjects in this subgroup preferred the NPDD. CONCLUSIONS Low-vision subjects struggled to self-administer eye drops. An NPDD can improve bottle tip contact, ease-of-use, satisfaction, and independence. Eye care providers could consider screening low-vision patients about difficulty with eye drop self-administration and recommending eye drop aids. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Jack P Rees
- Legacy Devers Eye Institute, Portland, Oregon
| | - Facundo G Sanchez
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Steven L Mansberger
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; The Francis I. The Proctor Foundation, UCSF School of Medicine, San Francisco, California
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Karen Rice
- Legacy Devers Eye Institute, Portland, Oregon
| | | | - Robert M Kinast
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon.
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15
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Sanyal S, Ravula V. Mitigation of pesticide-mediated ocular toxicity via nanotechnology-based contact lenses: a review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-28904-z. [PMID: 37542697 DOI: 10.1007/s11356-023-28904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/17/2023] [Indexed: 08/07/2023]
Abstract
The xenobiotic stress exerted by pesticides leads to the deterioration of human and animal health including ocular health. Acute or prolonged exposure to these agricultural toxicants has been implicated in a number of pathological conditions of the eye such as irritation, epiphora or hyper-lacrimation, abrasions on the ocular surface, and decreased visual acuity. The issue is compounded by the fact that tissues of the eye absorb pesticides faster than other organs of the body and are more susceptible to damage as well. However, there is a lacuna in our knowledge regarding the ways by which pesticide exposure-mediated ocular insult might be counteracted. Topical instillation of drugs known to combat the pesticide induced toxicity has been explored to mitigate the detrimental impact of pesticide exposure. However, topical eye drop solutions exhibit very low bioavailability and limited drug residence duration in the tear film decreasing their efficacy. Contact lenses have been explored in this respect to increase bioavailability of ocular drugs, while nanoparticles have lately been utilized to increase drug bioavailability and increase drug residence duration in different tissues. The current review focuses on drug delivery and futuristic aspects of corneal protection from ocular toxicity using contact lenses.
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Affiliation(s)
- Shalini Sanyal
- Laboratory of Self Assembled Biomaterials and Translational Science, Institute for Stem Cell Science and Regenerative Medicine (DBT-inStem), GKVK Post, Bellary Road, Bengaluru, 560065, Karnataka, India.
| | - Venkatesh Ravula
- Laboratory of Self Assembled Biomaterials and Translational Science, Institute for Stem Cell Science and Regenerative Medicine (DBT-inStem), GKVK Post, Bellary Road, Bengaluru, 560065, Karnataka, India
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16
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Sun R, Ma S, Chen X, Deng Y, Gou J, Yin T, He H, Wang Y, Tang X, Zhang Y. Inflammation-responsive molecular-gated contact lens for the treatment of corneal neovascularization. J Control Release 2023; 360:818-830. [PMID: 37481212 DOI: 10.1016/j.jconrel.2023.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
Corneal neovascularization (CNV) badly damages the corneal transparency, resulting in visual disturbance and blindness. The frequent administration of glucocorticoid eye drops in clinical increases the possibility of side effects and reduces patient compliance. Considering CNV is often accompanied by an increase in ROS production, a ROS-responsive monomer 2-(methylthio)ethyl methacrylate was introduced into the matrix as a "gating switch". The prepared dexamethasone contact lenses (MCLs@Dex) showed a significant H2O2-responsive release for 168 h. To avoid corneal hypoxia and neovascularization caused by long-term wearing, high‑oxygen-permeability fluorosiloxane materials were incorporated. The oxygen permeability of MCLs@Dex was 4 times that of commercially available hydrogel contact lenses and had ultra-low protein adsorption, which meets the requirements of long-term wearing. In vivo pharmacokinetic studies showed that MCLs@Dex increased the mean residence time by 19.7 times and bioavailability by 2.29 times compared with eye drops, validating the ROS response and sustained release properties. More importantly, MCLs@Dex had satisfactory effects on reducing inflammation and decreasing the related cytokines and oxidative stress levels, and demonstrated significant inhibition of neovascularization, with a suppression rate of 76.53% on the 14th day. This responsive drug delivery system provides a promising new method for the safe and effective treatment of ocular surface diseases.
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Affiliation(s)
- Rong Sun
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China
| | - Shuting Ma
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China
| | - Xi Chen
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China
| | - Yaxin Deng
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China
| | - Jingxin Gou
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China
| | - Tian Yin
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China
| | - Haibing He
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China
| | - Yanjiao Wang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China
| | - Xing Tang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China
| | - Yu Zhang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, PR China.
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17
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Droste AP, Newman-Casey PA. Emerging glaucoma treatments: are we seeing an improvement in adherence? EXPERT REVIEW OF OPHTHALMOLOGY 2023; 18:101-111. [PMID: 37520660 PMCID: PMC10373909 DOI: 10.1080/17469899.2023.2199981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/03/2023] [Indexed: 08/01/2023]
Abstract
Introduction Non-adherence to glaucoma medication and poor follow-up is a global health concern. Areas covered Glaucoma remains one of the largest causes of irreversible blindness worldwide. Traditional treatment guidelines suggest topical eye drop medication as first line therapy followed by addition of supplementary medications before proceeding to more invasive glaucoma surgeries. Unfortunately, poor glaucoma self-management remains high, leading to disease progression and blindness. Recent advancements in the field of pharmacotherapies, surgeries, and behavioral approaches have taken aim at increasing support for glaucoma self-management. We review the current and emerging approaches towards glaucoma management, with the exception of bleb-based surgical approaches, to investigate if they have had an impact on adherence. Literature searches were conducted via MEDLINE (PubMed), Embase (Elsevier), Cochrane Library (Wiley), and Preprints from January 1st, 2018, to January 26th, 2023. Expert opinion The ability to offer patients a multitude of choices enables patients to tailor their glaucoma treatment to their values and lifestyle. Offering personalized patient education and coaching to support chronic glaucoma self-management would better enable patient engagement in whichever treatment path is chosen. Currently, literature regarding the impact of these new advancements on treatment engagement is lacking; this field is ripe for additional intervention and assessment.
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Affiliation(s)
- Andrew P Droste
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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18
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Hovanesian J, Singh IP, Bauskar A, Vantipalli S, Ozden RG, Goldstein MH. Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy. Curr Opin Ophthalmol 2023; 34:S1-S13. [PMID: 36951648 DOI: 10.1097/icu.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
PURPOSE OF REVIEW To discuss common reasons for nonadherence and review existing and emerging options to reduce nonadherence with ocular medical therapy and optimize therapeutic outcomes. RECENT FINDINGS Nonadherence can arise from patient-related issues (e.g. physical, cognitive) and healthcare-related issues (e.g. cost, access to care). Multiple strategies have been developed and evaluated to overcome these barriers to adherence. Identifying nonadherence and its cause(s) facilitates the development of strategies to overcome it. SUMMARY Many common causes of nonadherence can be mitigated through a variety of strategies presented.
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Affiliation(s)
| | - I Paul Singh
- The Eye Centers of Racine and Kenosha, Racine, Wisconsin
| | - Aditi Bauskar
- Ocular Therapeutix, Inc., Bedford, Massachusetts USA
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19
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Abdi B, Mofidfar M, Hassanpour F, Kirbas Cilingir E, Kalajahi SK, Milani PH, Ghanbarzadeh M, Fadel D, Barnett M, Ta CN, Leblanc RM, Chauhan A, Abbasi F. Therapeutic contact lenses for the treatment of corneal and ocular surface diseases: advances in extended and targeted drug delivery. Int J Pharm 2023; 638:122740. [PMID: 36804524 DOI: 10.1016/j.ijpharm.2023.122740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/21/2023]
Abstract
The eye is one of the most important organs in the human body providing critical information on the environment. Many corneal diseases can lead to vision loss affecting the lives of people around the world. Ophthalmic drug delivery has always been a major challenge in the medical sciences. Since traditional methods are less efficient (∼ 5%) at delivering drugs to ocular tissues, contact lenses have generated growing interest in ocular drug delivery due to their potential to enhance drug bioavailability in ocular tissues. The main techniques used to achieve sustained release are discussed in this review, including soaking in drug solutions, incorporating drug into multilayered contact lenses, use of vitamin E barriers, molecular imprinting, nanoparticles, micelles and liposomes. The most clinically relevant results on different eye pathologies are presented. In addition, this review summarizes the benefits of contact lenses over eye drops, strategies for incorporating drugs into lenses to achieve sustained release, results of in vitro and in vivo studies, and the recent advances in the commercialization of therapeutic contact lenses for allergic conjunctivitis.
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Affiliation(s)
- Behnam Abdi
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran
| | - Mohammad Mofidfar
- Department of Chemistry, Stanford University, Stanford, CA, USA; School of Medicine, Stanford University, Stanford, CA, USA
| | - Fatemeh Hassanpour
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran
| | | | - Sepideh K Kalajahi
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran
| | - Paria H Milani
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran
| | - Mahsa Ghanbarzadeh
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran
| | - Daddi Fadel
- Center for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Melissa Barnett
- University of California, Davis Eye Center, Sacramento, CA, USA
| | - Christopher N Ta
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Roger M Leblanc
- Department of Chemistry, University of Miami, Coral Gables, FL, USA.
| | - Anuj Chauhan
- Chemical and Biological Engineering Department, Colorado School of Mines, CO, USA.
| | - Farhang Abbasi
- Institute of Polymeric Materials (IPM), Sahand University of Technology, New Town of Sahand, Tabriz, Iran; Faculty of Polymer Engineering, Sahand University of Technology, New Town of Sahand, Tabriz, Iran.
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20
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Novack GD. One More Time: Generic Solutions are the Same as Branded. Ophthalmol Glaucoma 2023; 6:225-227. [PMID: 36739262 DOI: 10.1016/j.ogla.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023]
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21
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Zhao QF, Hirneiss C. Does Diabetes Influence Adherence in Glaucoma Patients? Klin Monbl Augenheilkd 2023; 240:136-141. [PMID: 36351553 DOI: 10.1055/a-1975-2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With chronic diseases, patient adherence plays a crucial role in delaying disease progression and in determining the success of therapy. Problems arise not only from low medication adherence, but also non-adherence to recommended follow-up examinations. Obtaining an accurate estimate of adherence is difficult, especially in glaucoma patients, due to the fact that most antihypertensive drugs are administered in the form of eye drops. There is great variability in the published adherence values for glaucoma patients. Most studies report an average medication adherence of approximately 70%, with around 50% of patients having good adherence (at least 80% of medication administered as planned). Furthermore, 6.8 - 31.4% of the eye drops do not end up in the patient's eye, which means there is even less active ingredient to achieve a therapeutic effect. Glaucoma patients also show low persistence and adherence to follow-up appointments. Since diabetes increases the risk for POAG and secondary glaucoma and given that diabetics have particularly low adherence, the question arose whether a diabetes diagnosis is associated with reduced adherence in glaucoma patients. Previous studies found no significant association between diabetes and reduced adherence in glaucoma patients, although a significant impact of elevated HbA1c on adherence in glaucoma patients was found in one study. However, this connection still needs to be examined more closely in studies with larger samples.
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Affiliation(s)
- Qifan Felix Zhao
- Glaukomsprechstunde, Augenklinik und Poliklinik des Klinikums der Universität München, München, Deutschland
| | - Christoph Hirneiss
- Glaukomsprechstunde, Augenklinik und Poliklinik des Klinikums der Universität München, München, Deutschland
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22
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Gonzalez VH, Wirta DL, Uram M, Schupp A, Widmann M, Novack GD. Two Randomized, Double-masked, Placebo-controlled Studies of the Local Anesthetic Effect of Articaine Ophthalmic Solution. Clin Ophthalmol 2023; 17:1357-1365. [PMID: 37192994 PMCID: PMC10183183 DOI: 10.2147/opth.s409241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
Background We wanted to develop a new topical ocular anesthetic with good bioavailability in anterior segment tissues. Given concerns about contamination and sterility in multi-dose products, we selected a unit-dose, nonpreserved presentation of AG-920 (articaine ophthalmic solution) in blow-fill-seal containers (similar to currently marketed pharmacological therapies for dry eye disease). Methods Consistent with US Food and Drug Administration guidance, two pivotal, Phase 3, randomized, placebo-controlled, double-masked, parallel design studies conducted at two US private practices in 240 healthy subjects. A single dose of AG-920 or identical looking placebo into one (study) eye (2 drops 30 s apart). Subjects underwent a conjunctival pinch procedure and assessment of the pain associated with the pinch. The main outcome measure was the proportion of subjects with rating of "No pain at 5 minutes". Results AG-920 provided a rapid onset of local anesthesia (less than one minute) with clinically and statistically significantly greater effect in AG-920 (68% and 83%) than placebo (3% and 18% for Study 1 and Study 2, respectively, P<0.0001). The most frequent adverse event was instillation site pain (27% vs 3%) followed by conjunctival hyperemia (probably related to the pinch, 9% vs 10%) in the AG-920 and placebo groups, respectively. Conclusion AG-920 was found to be have a rapid onset and useful duration of local anesthesia with no major safety issues, and may be useful for the eye-care professional. Registered with clinicaltrials.gov as NCT04513652 and NCT04829344.
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Affiliation(s)
| | | | | | | | | | - Gary D Novack
- PharmaLogic Development, Inc., San Rafael, CA, USA
- Department of Ophthalmology & Vision Science, University of California, Davis, School of Medicine, Sacramento, CA, USA
- Correspondence: Gary D Novack, PharmaLogic Development, Inc., 17 Bridgegate Drive, San Rafael, CA, 94903, USA, Tel +1 415 472-2181, Email
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23
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Kan YM, Kho BP, Kong L, Chong QX, Tiong MNJ, Wong LMJ. Eye drop instillation technique among patients with glaucoma and evaluation of pharmacists' roles in improving their technique: an exploratory study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:520-525. [PMID: 35942810 DOI: 10.1093/ijpp/riac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/22/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study aimed to explore the eye drop instillation technique of patients with glaucoma and whether a pharmacist-led counselling session can improve their technique. Patients' perceptions of pharmacists' role in providing the counselling were also explored. METHODS This cross-sectional study was conducted between December 2020 and March 2021 at Sarawak General Hospital, Malaysia. Convenience sampling was used to recruit patients with glaucoma who self-administered their eye drops. Participants' background information were obtained using an investigator-administered questionnaire before their eye drop instillation technique was assessed. Those with imperfect techniques were counselled by a pharmacist before being reassessed. Differences in eye drop instillation competency were determined using paired T-test. KEY FINDINGS A total of 138 participants were recruited. Participants were on a median of two eye drops (IQR 2-4) for a median of five years (IQR 2-8). Prior to being counselled, they demonstrated a mean total of 8.4/13 steps (SD 2.33) correctly. A statistically significant improvement in eye drop instillation technique was observed post-pharmacists' counselling, with a mean increase of 4.3 steps demonstrated correctly (95% CI, 4.0 to 4.7, P < 0.001). The majority of participants agreed that pharmacists are knowledgeable in providing counselling on eye drop administration techniques. CONCLUSIONS Patients with glaucoma treated at Sarawak General Hospital had imperfect eye drop instillation techniques, despite most having used their eye drops for several years. Interventions by pharmacists to improve eye drop instillation are crucial to optimise the medical treatment of patients with glaucoma.
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Affiliation(s)
- Ying Min Kan
- Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Boon Phiaw Kho
- Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Lillian Kong
- Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Qiao Xuan Chong
- Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Ming Nguong Jonathan Tiong
- Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Ling Mei Joyce Wong
- Department of Pharmacy, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
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Ha A, Jang M, Shim SR, Kim CY, Chang IB, Kim YK. Interventions for Glaucoma Medication Adherence Improvement: A Network Meta-analysis of Randomized Controlled Trials. Ophthalmology 2022; 129:1294-1304. [PMID: 36028393 DOI: 10.1016/j.ophtha.2022.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/30/2022] [Accepted: 06/24/2022] [Indexed: 10/31/2022] Open
Abstract
TOPIC Comparative effectiveness of interventions to improve glaucoma medication adherence. CLINICAL RELEVANCE High adherence to ocular hypotensive therapy is essential for prevention of visual impairment in glaucoma patients. Various types of intervention for adherence enhancement have been proposed, although there is still no firm evidence of their relative efficacies. METHODS We searched PubMed, EMBASE, Scopus, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov on November 30, 2021. Randomized controlled trials (RCTs) entailing interventions for improved adherence to ocular hypotensive therapy were identified. A network meta-analysis (NMA) was performed, and the following 11 interventions (single category or combinations of categories) were compared: (1) standard of care ([SOC] control), (2) short message service, (3) telephone call, (4) device reminder, (5) motivational interview, (6) multimedia education, (7) physician education, (8) provision of own medical records, (9) incentives, (10) tailored care, and (11) enhanced SOC. The primary outcome was the postintervention mean adherence score. The standardized mean differences (SMDs) were analyzed, and the effectiveness was ranked by P-score (probability of being best treatment). We appraised trials using the Cochrane risk-of-bias tool for RCTs. Confidence of results was assessed by Confidence in Network Meta-analysis. RESULTS We obtained data for 19 RCTs (4981 participants). Tailored care, as inclusive of face-to-face needs assessment and a personalized care plan, was superior to SOC in improving adherence (SMD, 1.28; 95% confidence interval [CI], 0.08-2.48; P-score, 0.810). Multifaceted interventions that included tailored care showed further adherence improvement: tailored care + multimedia education (SMD, 1.44; 95% CI, 0.20-2.67; 0.850) and tailored care + multimedia education + device reminder (SMD, 1.61; 95% CI, 0.75-2.47; 0.914). The ranking of the remaining interventions by P-scores was as follows: incentives (0.606), short message service (0.535), enhanced SOC (0.458), multimedia education (0.430), device reminder (0.429), telephone call (0.401), provision of own medical records (0.391), physician education (0.281), SOC (0.230), and motivational interview (0.165). CONCLUSIONS The NMA indicated that tailored care can improve adherence to glaucoma medication compared with SOC. A multifaceted approach might yield additional improvements.
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Affiliation(s)
- Ahnul Ha
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea; Department of Ophthalmology, Jeju National University School of Medicine, Jeju-si, Korea
| | - Mirinae Jang
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Sung Ryul Shim
- Department of Health and Medical Informatics, Kyungnam University College of Health Sciences, Changwon, Korea
| | - Chung Young Kim
- Department of Ophthalmology, Seogwipo Medical Center, Seogwipo-si, Korea
| | | | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; EyeLight Data Science Laboratory, Seoul, Korea.
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Glaucoma Treatment and Hydrogel: Current Insights and State of the Art. Gels 2022; 8:gels8080510. [PMID: 36005112 PMCID: PMC9407420 DOI: 10.3390/gels8080510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
Aqueous gels formulated using hydrophilic polymers (hydrogels) and those based on stimuli-responsive polymers (in situ gelling or gel-forming systems) attract increasing interest in the treatment of several eye diseases. Their chemical structure enables them to incorporate various ophthalmic medications, achieving their optimal therapeutic doses and providing more clinically relevant time courses (weeks or months as opposed to hours and days), which will inevitably reduce dose frequency, thereby improving patient compliance and clinical outcomes. Due to its chronic course, the treatment of glaucoma may benefit from applying gel technologies as drug-delivering systems and as antifibrotic treatment during and after surgery. Therefore, our purpose is to review current applications of ophthalmic gelling systems with particular emphasis on glaucoma.
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Musa I, Bansal S, Kaleem MA. Barriers to Care in the Treatment of Glaucoma: Socioeconomic Elements That Impact the Diagnosis, Treatment, and Outcomes in Glaucoma Patients. CURRENT OPHTHALMOLOGY REPORTS 2022; 10:85-90. [PMID: 35911786 PMCID: PMC9325663 DOI: 10.1007/s40135-022-00292-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
Purpose of Review This article reviews socioeconomic elements that impact the access to glaucoma care, early intervention in susceptible patients, and longevity of treatment and patient compliance in various demographic groups. Recent Findings Socioeconomic factors such as insurance eligibility, education, income, marital status, and access to technology can deeply impact the diagnosis and long-term treatment of glaucoma patients. Depending on the severity, and/or urgency of care, many individuals who face these barriers forgo annual eye exams, leading to a higher incidence of untreated glaucoma. Summary Early intervention and regular follow-up are essential for patient compliance in the management of glaucoma. Routine eye care leads to earlier detection and can improve management options and reduce the severity of disease burden.
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Affiliation(s)
| | - Surbhi Bansal
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA USA
| | - Mona A Kaleem
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD USA
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Taribagil P, Thomas S, Mathew RG. Glaucoma Health Coaching: A Survey of Eye Drop Instillation Education. J Glaucoma 2022; 31:351-355. [PMID: 34474422 DOI: 10.1097/ijg.0000000000001933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022]
Abstract
PRCIS Health coaching is an effective strategy in supporting glaucoma patients to become champions of their own health. A personalized program should be implemented at the point of diagnosis. PURPOSE Glaucoma is the leading cause of irreversible blindness worldwide. Its mainstay of treatment is intraocular pressure-lowering eye drops. Yet, many patients do not receive education regarding their condition, the importance of their eye drops, and how to instil them. The purpose of this audit was to assess what proportion of glaucoma patients had received any education regarding eye drop usage and whether a health coaching intervention would be beneficial. MATERIALS AND METHODS This prospective audit was conducted during World Glaucoma Week at Moorfields Eye Hospital. Patients diagnosed with glaucoma were given a 6-part questionnaire. Subsequently, they received a coaching session with a pharmacy team member, focusing on eye drop instillation. Patient feedback was recorded. RESULTS The sample size was 262. Overall, 92% of patients who had received teaching found it useful. Approximately half the patients had never been shown how to use eye drops before. In all, 79% of those who had never received a demonstration thought that further coaching would be helpful. When experiencing difficulties with eye drop instillation; 29% of patients felt comfortable asking a relative; 26% would not ask for help, and 16% would consult their glaucoma doctor. Almost 30% of patients had poked themselves in the eye at least once, during self-administration. CONCLUSIONS Experienced and inexperienced patients found glaucoma health coaching beneficial. Health coaching empowers patients with long-term conditions to be champions of their own health condition, and it is important for patients to receive this training from the onset of their treatment.
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Affiliation(s)
- Priyal Taribagil
- Department of General Medicine, Barnet Hospital, Royal Free Foundation Trust
| | - Sarah Thomas
- Departments of Pharmacy
- University College London
| | - Rashmi G Mathew
- Glaucoma, Moorfields Eye Hospital NHS Foundation Trust
- Moorfields Eye Hospital and University College London, London, UK
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Rajanala AP, Prager AJ, Park MS, Tanna AP. Association of the Effectiveness of Eye Drop Self-instillation and Glaucoma Progression. J Glaucoma 2022; 31:156-159. [PMID: 34999663 DOI: 10.1097/ijg.0000000000001982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/28/2022] [Indexed: 11/26/2022]
Abstract
PRCIS Among patients with glaucoma or ocular hypertension, ineffective self-instillation of eye drops was associated with an increased long-term risk of progression or advancement of treatment to incisional surgery. PURPOSE The purpose of this study was to evaluate the association between the efficacy of self-instillation of eye drops and long-term glaucoma outcomes. METHODS In a previous study, video recordings of eye drop self-instillation by patients with glaucoma or ocular hypertension were graded as effective or ineffective depending on whether the patient successfully instilled at least 1 drop on the right ocular surface. Glaucomatous progression was then retrospectively defined as retinal nerve fiber layer thinning as measured by either optical coherence tomography, visual field progression, or need for incisional glaucoma surgery as determined by a glaucoma specialist unaware of patient performance in the eye drop instillation study. Subjects with at least 2 follow-up optical coherence tomography or visual field studies were included in the current study. RESULTS The original study enrolled 119 patients. Sufficient follow-up data were available for 101 patients. Eighty-eight patients (87.1%) were effective in eye drop instillation at baseline. Mean follow-up was 5.1 years, during which time 73 patients (72.3%) had progression or underwent incisional surgery in either eye. A significantly higher proportion of patients in the ineffective group met the criteria for progression or underwent incisional surgery (effective: 68.2%; ineffective: 100%; N=101; P=0.017, Fisher exact test). Kaplan-Meier survival analyses showed a significantly faster time to reaching an endpoint in the ineffective group (N=101; P=0.012, log-rank test). There was no difference in age, baseline intraocular pressure, or baseline retinal nerve fiber layer thickness between the groups. CONCLUSION Ineffective self-installation of eye drops was associated with an increased risk of glaucoma progression or treatment advancement to incisional surgery.
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Affiliation(s)
- Alekya P Rajanala
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL
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McGlumphy EJ, Dosto NO, Johnson TV, Quigley HA. Electronically Monitored Corticosteroid Eye Drop Adherence after Trabeculectomy Compared to Surgical Success. Ophthalmol Glaucoma 2022; 5:379-387. [PMID: 34995818 DOI: 10.1016/j.ogla.2021.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare electronically measured adherence with topical corticosteroid drops to outcomes of glaucoma surgery. DESIGN This prospective cohort study included eyes undergoing surgery from August 2019 to January 2021 and followed for up to 1 year. PARTICIPANTS All patients were recruited from the Glaucoma Center of Excellence at the Wilmer Eye Institute, Johns Hopkins. Eligible patients had either primary open angle or angle closure glaucoma, were ≥18 years old, and underwent either trabeculectomy (with or without cataract surgery) or tube-shunt implantation. INTERVENTION Patients were instructed on use of an eyedrop monitoring device (Kali Drop®), with knowledge that it would be used to record postoperative corticosteroid instillation in real time. MAIN OUTCOMES Adherence to a regimen of corticosteroid eye drops during the first 5 postoperative weeks; achievement of target intraocular pressure (IOP) at 6 weeks, 6 months to 1 year after surgery; and bleb morphology at 1 year. RESULTS Among 90 patients, adherence was 90 ± 14% overall and 81 ± 16% during q2h dosing. Target IOP was achieved at final visit (6 months or 1 year) in 81% (59/73) without reoperation. Eyes with a higher ratio of drops taken vs prescribed were significantly more likely to achieve target IOP at 6 months/1 year (p=0.05). Total adherence was better in younger persons, eyes with less field loss, and patients of one particular surgeon (p<0.03). Percent adherence during every 2 hours (q2h) dosing was higher in eyes with higher target IOP (p=0.01). No adherence outcome was significantly related to race, sex, bleb morphology, postoperative pain, or post-operative anterior chamber inflammation. Adherence values did not significantly correlate with adherence questionnaire data (predicted mean = 70 ± 17%, actual mean = 91 ± 13% adherent, p < 0.001). CONCLUSION Adherence with frequent postoperative eye drops was high and can be successfully monitored remotely. Surgical success was greater among eyes with nearly ideal adherence and was poorer in older persons and those with more advanced glaucoma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03402802.
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Affiliation(s)
- Elyse J McGlumphy
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Niccolo O Dosto
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas V Johnson
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harry A Quigley
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Muir KW, Rosdahl JA, Hein AM, Woolson S, Olsen MK, Kirshner M, Sexton M, Bosworth HB. Improved Glaucoma Medication Adherence in a Randomized Controlled Trial. Ophthalmol Glaucoma 2022; 5:40-46. [PMID: 33892170 DOI: 10.1016/j.ogla.2021.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To test the effectiveness of an intervention designed to improve glaucoma medication adherence. DESIGN Randomized, controlled trial at a Veterans Affairs (VA) eye clinic. PARTICIPANTS Veterans with medically treated glaucoma who reported poor adherence and their companions if applicable. METHODS Participants, and their companions if applicable, were randomized to receive an intervention to improve medication adherence that included glaucoma education, personalized disease management suggestions, and a reminder aid, or the control arm that received education regarding general eye health. MAIN OUTCOME MEASURES The average proportion of prescribed glaucoma medication doses taken on schedule over the 6 months after randomization according to an electronic monitor between participants in the 2 arms. RESULTS The mean proportion of prescribed doses taken on schedule was higher in the intervention group compared with controls (0.85 vs. 0.62, P < 0.0001). The difference in proportions between the 2 groups did not vary in regressions models adjusted for companion status, frequency of dosing, and race. The longitudinal model indicated that the intervention group had significantly higher adherence during the first month after randomization and continued to stay higher through 6 months (month by treatment interaction, P = 0.003). CONCLUSIONS A multifaceted intervention can help improve glaucoma medication adherence.
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Affiliation(s)
- Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Aaron M Hein
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Maren K Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Miriam Kirshner
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Malina Sexton
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Hayden B Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
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Choi WS, Kim JH, Lee CH, Lee CE, Seo S. Adherence Improvement in Glaucoma Patients: Effects of Educational Intervention Using an Eye Drop Chart. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.12.1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To evaluate the effects of an educational intervention using an eye drop chart and supplementary education on glaucoma patients’ adherence.Methods: In this multicenter prospective study, medically treated glaucoma patients were educated on the administration of eye drops using an eye drop chart. At the time of recruitment, all of the patients completed a questionnaire on demographic characteristics and adherence. Three months after the initial educational intervention, the patients were randomly divided into two groups: an education group and a control group. The education group received supplementary education. Immediately thereafter and at 6 months, all of the patients completed the questionnaire on adherence again. Changes in instillation behavior, the relationship between the adherence score and demographic characteristics, and factors contributing to an improvement in adherence and intraocular pressure were then analyzed.Results: The adherence scores were significantly higher in patients with fewer medications, a higher annual income and higher educational level, and an urban residence (p = 0.038, p = 0.033, p = 0.041 and p = 0.047, respectively). Education on the administration of eye drops and use of the eye drop chart improved adherence scores from 23.05 ± 3.52 to 21.30 ± 3.95 (p = 0.021) and significantly reduced the average intraocular pressure from 14.3 ± 2.9 to 12.4 ± 3.1 mmHg (p < 0.001). Working indoors (odds ratio [OR] = 5.47, p = 0.032) and supplementary education at 3 months (OR = 4.53, p = 0.030) were also correlated with improved adherence.Conclusions: An eye drop chart is an effective tool for improving adherence and intraocular pressure control in glaucoma patients. Improvement in adherence was especially notable in patients whose work predominantly involved indoor activity. The effectiveness of the eye drop chart was improved by supplementary education.
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Comparison of the Usability of Eye Drop Aids and the Conventional Bottle. J Clin Med 2021; 10:jcm10235658. [PMID: 34884360 PMCID: PMC8658337 DOI: 10.3390/jcm10235658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Eye drops are the most common route of administration for ophthalmic medications. Administering drops can be a major hurdle for patients, potentially resulting in noncompliance and treatment failure. The purpose of this study is to compare the efficacy and safety of two different aids and the conventional bottle for eye drop instillation; (2) Methods: An interventional crossover study involving standard eye drop bottle, Opticare aid and Autodrop aid. The study included healthy subjects without a history of regular eye drop use; (3) Results: Twenty-six subjects were enrolled. Of those subjects, 96% and 92% were able to assemble the eye drop bottle into the Autodrop and the Opticare aids, respectively. Subjective assessment indicated that Autodrop was significantly easier to assemble than Opticare (95% CI: -1.6802 to -0.1659, p = 0.02). When using either aid, there was no contamination of the bottle tip, which occurred in 46% of subjects when no aid was used (p = 0.0005). Fewer drops were expelled when using the conventional bottle as compared to the aids (p = 0.05 compared to Autodrop, p = 0.1 compared to Opticare); (4) Conclusions: Autodrop and Opticare can assist patients with eye drop placement. These aids completely prevented bottle tip contamination, which was frequently observed when the conventional bottle was used alone.
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Rykowska I, Nowak I, Nowak R. Soft Contact Lenses as Drug Delivery Systems: A Review. Molecules 2021; 26:5577. [PMID: 34577045 PMCID: PMC8472272 DOI: 10.3390/molecules26185577] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 02/07/2023] Open
Abstract
This review describes the role of contact lenses as an innovative drug delivery system in treating eye diseases. Current ophthalmic drug delivery systems are inadequate, particularly eye drops, which allow about 95% of the active substance to be lost through tear drainage. According to the literature, many interdisciplinary studies have been carried out on the ability of contact lenses to increase the penetration of topical therapeutic agents. Contact lenses limit drug loss by releasing the medicine into two layers of tears on either side of the contact lens, eventually extending the time of contact with the ocular surface. Thanks to weighted soft contact lenses, a continuous release of the drug over an extended period is possible. This article reviewed the various techniques to deliver medications through contact lenses, examining their advantages and disadvantages. In addition, the potential of drug delivery systems based on contact lenses has been extensively studied.
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Affiliation(s)
- Iwona Rykowska
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
| | - Iwona Nowak
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
| | - Rafał Nowak
- Eye Department, J. Strus City Hospital, Szwajcarska 3, 61-285 Poznań, Poland;
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Clinical Efficacy and Safety Outcomes of Micropulse Transscleral Diode Cyclophotocoagulation in Patients With Advanced Glaucoma. J Glaucoma 2021; 30:257-265. [PMID: 33137020 DOI: 10.1097/ijg.0000000000001729] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/11/2020] [Indexed: 12/29/2022]
Abstract
PRECIS Micropulse transscleral cyclophotocoagulation (MPTCP) is only moderately effective in lowering intraocular pressure (IOP) and is useful as an adjunct procedure to other glaucoma surgeries. There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi. AIM The aim of this study was to determine the efficacy and safety of a single MPTCP treatment for an Asian population with advanced glaucoma. METHODS This is a retrospective single-center study of 207 eyes (207 patients) with advanced glaucoma which underwent first-time MPTCP between January 1, 2008, and March 31, 2018. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, and without glaucoma reoperation. The IOP, best-corrected visual acuity, and number of glaucoma medications were also analyzed. RESULTS The mean (SD) age was 64.9±16.9 years. The mean follow-up duration was 18.7±16.2 months. The rate of success at postoperative years 1 and 2 follow-up was 44.1% and 32.6%, respectively. The median survival time of MPTCP was 9.0 months and 85 (40.9%) eyes received reoperation. The mean IOP decreased from 31.5±12.0 mm Hg preoperatively to 22.1±10.3 and 23.8±11.8 mm Hg at postoperative years 1 and 2, respectively (P<0.0001). The mean number of glaucoma medications was reduced from 3.3±1.0 preoperatively to 2.6±1.1 and 2.4±1.1 at postoperative years 1 and 2, respectively (P<0.0001). Significant complications included prolonged hypotony [1 eye (0.5%)], phthisis bulbi [7 eyes (3.4%)], and best-corrected visual acuity reduction [29 eyes (13.9%)]. CONCLUSION Single first-time MPTCP for advanced glaucoma eyes was moderately effective in lowering IOP but >50% failed by 1 year.
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Selleck AM, Dedmon MM. Accuracy and patient perceived difficulty of utilizing ototopical antibiotic therapy. Am J Otolaryngol 2021; 42:103130. [PMID: 34242952 DOI: 10.1016/j.amjoto.2021.103130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine how patients self-administer ear drops, ascertain their perceived difficulty in performing the task and determine if they are able to deliver the correct dosage. MATERIALS AND METHODS This is a prospective cohort study performed in an otology outpatient clinic with twenty-one subjects with a condition requiring ototopical antibiotics. The number of ear drops applied as well as skills performed during ear drop application was measured. Patient reported difficulty and confidence in application of ear drops data was also obtained. RESULTS The mean number of drops applied was 2.91 ± 2.1 (target = 3 drops) with a large variance in drop application, range of 0.6 to 9.2 drops. If "correct dosage" is considered 85-115% of the intended dose, then almost half of patients, 47.6%, underdosed with 23.8% that over dosed. Patients reported that the average difficulty in applying drops to themselves was 3.6 (1 being easy and 10 being difficult). Patients reported a high confidence level in applying the correct dose of ear drops of 6.7 (1 being not confident and 10 being very confident). CONCLUSIONS In our study of 21 patients self-administering ear drops, only 28.6% of patients were able to correctly apply the appropriate treatment dose, with almost half of patients underdosing. Questionnaire data indicated that most patients were unaware they were administering an incorrect dose. Inaccurate administration of ear drops could be problematic and lead to longer durations of symptoms, false treatment failures, and increased costs.
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Affiliation(s)
- A Morgan Selleck
- Department of Otolaryngology Head and Neck Surgery, University of North Carolina at Chapel Hill, NC, USA.
| | - Matthew M Dedmon
- Department of Otolaryngology Head and Neck Surgery, University of North Carolina at Chapel Hill, NC, USA.
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Poleon S, Racette L, Fifolt M, Schoenberger-Godwin YM, Abu SL, Twa MD. Patient and Provider Perspectives on Glaucoma Treatment Adherence: A Delphi Study in Urban Alabama. Optom Vis Sci 2021; 98:1085-1093. [PMID: 34524213 PMCID: PMC8505131 DOI: 10.1097/opx.0000000000001776] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Patients with glaucoma and providers recognized perceived treatment efficacy, patient-provider relationship, psychological stress, instillation skill, good quality of life, and forgetfulness as key determinants of glaucoma adherence. This shared insight could help shape the development of clinical and behavioral interventions for addressing treatment barriers and improving adherence. PURPOSE Despite their impact on adherence in glaucoma, sociobehavioral factors may not be adequately explored during clinical consultations. We aimed to elicit consensus between patients and providers around key determinants of adherence and hypothesized that patients would place greater emphasis on sociobehavioral factors compared with providers. METHODS A two-round Delphi survey was used to assess treatment beliefs, barriers, facilitators, motivators, and needs among 18 patients with glaucoma and providers. In round 1, agreement with 46 statements was scored on a 5-point Likert scale (strongly disagree to strongly agree). Statements with which 80% or more of panelists agreed reached consensus and advanced to round 2, where participants were asked to prioritize them based on their importance to treatment. RESULTS There was consensus regarding the influence of perceived treatment efficacy, good provider relationship, good quality of life, psychological stress, glaucoma knowledge, instillation skill, and forgetfulness on glaucoma adherence. For statements that failed to reach consensus, the Bonferroni-corrected Mann-Whitney U test revealed that the greatest differences between patients and providers pertained to regimen complexity (provider median, 4 [interquartile range {IQR}, 1]; patient median, 1.5 [IQR, 1]; P = .002), instillation skill (providers, 4 [IQR, 0.5]; patients, 2 [IQR, 1]; P = .001), and low motivation (providers, 3 [IQR, 2.25]; patients, 1 [IQR, 0]; P = .003). CONCLUSIONS Although patients and providers prioritized sociobehavioral factors as key determinants of adherence, disagreement between these groups was observed in other areas. Continued juxtaposition of patient and provider perspectives could spotlight underexplored areas and guide the development of successful interventions for improving adherence.
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Affiliation(s)
- Shervonne Poleon
- Department of Optometry and Vision Science, University of Alabama at Birmingham School of Optometry, Birmingham, Alabama
| | - Lyne Racette
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Matthew Fifolt
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Yu-Mei Schoenberger-Godwin
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Sampson Listowell Abu
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Michael D. Twa
- University of Houston College of Optometry, Houston, Texas
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Nguyen DCT, Dowling J, Ryan R, McLoughlin P, Fitzhenry L. Pharmaceutical-loaded contact lenses as an ocular drug delivery system: A review of critical lens characterization methodologies with reference to ISO standards. Cont Lens Anterior Eye 2021; 44:101487. [PMID: 34353748 DOI: 10.1016/j.clae.2021.101487] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/28/2021] [Accepted: 07/04/2021] [Indexed: 01/12/2023]
Abstract
Therapeutic contact lenses for ocular drug delivery have received considerable interest as they can potentially enhance ocular bioavailability, increase patient compliance, and reduce side effects. Along with the successful in vitro and in vivo studies on sustained drug delivery through contact lenses, lens critical properties such as water content, optical transparency and modulus have also been investigated. Aside from issues such as drug stability or burst release, the potential for the commercialization of pharmaceutical-loaded lenses can be limited by the alteration of lens physical and chemical properties upon the incorporation of therapeutic or non-therapeutic components. This review outlines advances in the use of pharmaceutical-loaded contact lenses and their relevant characterization methodologies as a potential ocular drug delivery system from 2010 to 2020, while summarizing current gaps and challenges in this field. A key reference point for this review is the relevant ISO standards on contact lenses, relating to the associated characterization methodologies. The content of this review is categorized based on the chemical, physical and mechanical properties of the loaded lens with the shortcomings of such analytical technologies examined.
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Affiliation(s)
- Dan Chau Thuy Nguyen
- Ocular Therapeutics Research Group (OTRG), Pharmaceutical & Molecular Biotechnology Research Centre (PMBRC), Waterford Institute of Technology, Waterford City, County Waterford X91 K0EK, Ireland.
| | - Joseph Dowling
- Research and Development Department, Bausch + Lomb Ireland Ltd., Waterford City, County Waterford X91 V383, Ireland
| | - Richie Ryan
- Ocular Therapeutics Research Group (OTRG), Pharmaceutical & Molecular Biotechnology Research Centre (PMBRC), Waterford Institute of Technology, Waterford City, County Waterford X91 K0EK, Ireland
| | - Peter McLoughlin
- Ocular Therapeutics Research Group (OTRG), Pharmaceutical & Molecular Biotechnology Research Centre (PMBRC), Waterford Institute of Technology, Waterford City, County Waterford X91 K0EK, Ireland
| | - Laurence Fitzhenry
- Ocular Therapeutics Research Group (OTRG), Pharmaceutical & Molecular Biotechnology Research Centre (PMBRC), Waterford Institute of Technology, Waterford City, County Waterford X91 K0EK, Ireland
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Zhu CQ, Sadlak N, Fiorello MG, Lee D, Desai M. A Comparison of Patient Acceptance of 3 Eye Drop Instillation Aids. J Glaucoma 2021; 30:725-731. [PMID: 34049349 PMCID: PMC8366596 DOI: 10.1097/ijg.0000000000001891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
PRECIS Patients can be quite amenable to using eye drop instillation aids. We should consider recommending these devices to patients who otherwise struggle with drop instillation and medication adherence. PURPOSE The purpose of this study was to compare patient acceptance of 3 commercially available eye drop instillation aids in a diverse tertiary care population. METHODS In this prospective, randomized controlled study, 39 patients being treated with topical antihypertensives were assigned to Arm A (no intervention) or Arm B (AutoDrop, AutoSqueeze, or SimplyTouch). Subjects in Arm B were instructed to administer their eye drop with the assigned drop aid at every use for ~6 weeks. Satisfaction surveys were administered at 3 and 6 weeks, where patients also reported the number of drops missed. RESULTS Thirty-two of 39 subjects completed study participation and full data analysis. Within this total group, 24 subjects were randomized to drop aids (AutoDrop N=10, AutoSqueeze N=8, SimplyTouch N=6), and 8 were randomized to no drop aid. At the 3 and 6-week timepoints, patients found instillation easier with AutoDrop (70.0%, 60.0%) followed by the AutoSqueeze (62.5%, 75.0%), and lastly SimplyTouch (33.3%, 33.3%). For the AutoSqueeze, the mean number of drops missed with and without the drop aid were significantly different (P=0.015 at 3 wk, P=0.008 at 6 wk). There was no difference in the mean number of drops missed with the AutoDrop and SimplyTouch at either timepoint. CONCLUSIONS For the AutoDrop and AutoSqueeze groups, over 60% of the patients found the devices helpful and would consider using them long-term. Our results suggest that patients would be amenable to using eye drop instillation aids, although more objective data is needed to determine whether these devices would improve medication compliance and clinical outcomes.
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Affiliation(s)
| | | | | | - Deborah Lee
- Boston Medical Center, Boston University School of Medicine
| | - Manishi Desai
- Boston Medical Center, Boston University School of Medicine
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Aptel F, Villemont AS, Cunnac P, Sallit R, Rabilloud M, Poli M, Denis P. Comparison of Topical Instillation From Single-dose and Multidose Eye Drop Containers in Glaucoma: A Multicenter Randomized Cross-sectional Trial. J Glaucoma 2021; 30:718-724. [PMID: 34001750 DOI: 10.1097/ijg.0000000000001867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
PRECIS We compared the quality of instillation of topical treatments from single-dose (SGD) or multidose (MTD) containers in glaucoma patients and showed neither a significant difference between the type of container nor a significant relationship to upper limb mobility. PURPOSE To describe and compare the quality of instillation of topical treatments with SGD or MTD containers in glaucoma patients. To assess factors likely to influence instillation, particularly the upper limb mobility. MATERIALS AND METHODS This multicenter, cross-sectional study included open-angle glaucoma patients with the same self-instilled treatment over at least 3 months. Patients were asked to successively self-administer a drop of artificial tears from SGD and MTD containers in front of an observer. The order of instillation (eye and container) was randomized. Correct instillation was defined as the administration of 1 drop in the lower fornix, without any contact between the tip of the device and the ocular surface. The Quick Disabilities of the Arm, Shoulder, and Hand self-questionnaire assessed upper limb mobility. RESULTS A total of 239 eyes from 173 patients were included. For the worst eye group 33% of patients performed correct instillation with MTD versus 32% using SGD (P=1). In the best eye group, 31.7% patients performed a correct instillation with MTD administration versus 27.5% with SGD (P=0.327). Multivariate analysis showed a significant association between an inadequate SGD instillation, old age (P=0.021), the severity of the visual field deficits (P=0.035), and a low quality of life score (P=0.028). No association existed between the Quick Disabilities of the Arm, Shoulder, and Hand score and the quality of instillation. CONCLUSIONS These results suggest that the handling of single-use containers should be practiced by patients and evaluated by physicians, especially for the elderly population and those with advanced glaucoma. No difference in instillation quality was found between SGD and MTD.
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Affiliation(s)
- Florent Aptel
- Department of Ophthalmology, Hôpital Michallon, Grenoble
- University of Grenoble Alpes, Saint-Martin-d'Hères
| | - Anne-Sophie Villemont
- Department of Ophthalmology, Hôpital de la Croix-Rousse
- CNRS UMR 558, Biostatistics Laboratory, Villeurbanne
| | - Pierre Cunnac
- Department of Ophthalmology, Hôpital Michallon, Grenoble
- University of Grenoble Alpes, Saint-Martin-d'Hères
| | - Rébecca Sallit
- Department of Ophthalmology, Hôpital de la Croix-Rousse
- CNRS UMR 558, Biostatistics Laboratory, Villeurbanne
| | - Muriel Rabilloud
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon
- CNRS UMR 558, Biostatistics Laboratory, Villeurbanne
- University Claude-Bernard Lyon 1, Villeurbanne, France
| | - Muriel Poli
- Department of Ophthalmology, Clinique du Val d'Ouest, Ecully
| | - Philippe Denis
- Department of Ophthalmology, Hôpital de la Croix-Rousse
- University Claude-Bernard Lyon 1, Villeurbanne, France
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Kang JM, Chatterjee A, Rosdahl JA, Bosworth HB, Woolson S, Olsen M, Sexton M, Kirshner M, Muir KW. Health Literacy and Success with Glaucoma Drop Administration. Ophthalmol Glaucoma 2021; 5:26-31. [PMID: 34052458 DOI: 10.1016/j.ogla.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the relationship between health literacy and successful glaucoma drop administration. DESIGN Substudy of a single-site interventional randomized controlled trial. PARTICIPANTS Veterans receiving care at the Durham Veterans Affairs Eye Clinic who had a diagnosis of open-angle glaucoma were recruited if they endorsed poor drop adherence. METHODS Participants underwent a health literacy evaluation using the Rapid Estimate of Adult Literacy in Medicine (REALM) as well as a qualitative assessment of eye drop administration technique using 3 different criteria: (1) the drop was instilled in the eye, (2) only 1 drop was dispensed, and (3) the bottle was not potentially contaminated. A multivariate logistic regression model was used to assess the association of REALM score and successful drop administration, adjusting for age, disease severity, and Veterans Administration Care Assessment Needs (CAN) score. MAIN OUTCOME MEASURES Successful drop administration. RESULTS Of the 179 participants with REALM scores and observed drop administration, 78% read at a high school level (HSL) or more and 22% read at less than HSL. Of the 179 participants, 87% (n = 156) successfully instilled the drop into the eye (criterion 1). A greater proportion of participants who read at HSL or more successfully instilled the drop in the eye compared with those reading at less than HSL (90.6% vs. 75.0%; P = 0.02). Rates of success with criterion 1 were similar across different levels of visual field severity. Care Assessment Needs scores were not statistically significant between those who did and those did not have successful overall drop technique. CONCLUSIONS Poor health literacy may be associated with decreased successful drop instillation in the eye in patients with glaucoma. Screening for and considering health literacy in developing interventions to improve glaucoma self-management may improve treatment adherence in a vulnerable population.
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Affiliation(s)
- J Minjy Kang
- Department of Ophthalmology, Northwestern University, Chicago, Illinois
| | - Ayan Chatterjee
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Hayden B Bosworth
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina
| | | | - Maren Olsen
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina
| | - Malina Sexton
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Kelly W Muir
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina.
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Kashiwagi K, Matsuda Y, Ito Y, Kawate H, Sakamoto M, Obi S, Haro H. Investigation of visual and physical factors associated with inadequate instillation of eyedrops among patients with glaucoma. PLoS One 2021; 16:e0251699. [PMID: 33989342 PMCID: PMC8121298 DOI: 10.1371/journal.pone.0251699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/02/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to investigate the frequency of eyedrop instillation failure and its related physical and visual function factors among glaucoma patients who used hypotensive eyedrops daily. Subjects and methods Patients with a history of self-instillation of one or more ocular hypotensive ophthalmic solutions for six or more months were enrolled. Definitions of instillation failure were eyedrop instillation other than on the eye surface; eyedrop contact with eyelashes; eyedrop bottle tip contact with the eyelashes, eye surface or ocular adnexa; or two or more drops instilled with one instillation trial. To clarify factors related to instillation failure, we used visual function tests and investigated cervical spine extension angles during instillation, pinching strength, physical ataxia (evaluated using the Scale for the Assessment and Rating of Ataxia), motor dysfunction of the upper limbs (evaluated using the Disabilities of the Arm, Shoulder and Hand questionnaire), and vision quality (evaluated using the National Eye Institute Visual Function Questionnaire 25). Results Of 103 total subjects, 61.2% satisfied the definition of instillation failure. Instillation of the eyedrop other than at the cul-desac (76.2%) was the most frequent reason for failure, followed by contact of the tip of the eyedrop bottle (22.2%) and instillation of the same or more than two eyedrops in a single attempt (11.1%). Advanced age, a shallow cervical spine extension angle, weak pinching strength, poor motor dysfunction of the upper limbs, the degree of ataxia, poor best-corrected visual acuity, and visual field scores were significant risk factors for instillation failure. Vision quality may have some relation to instillation failure. Conclusion It is highly recommended that instillation failure be routinely investigated even among patients with adequate experience using eyedrops and that correct therapies are chosen in a patient-based fashion.
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Affiliation(s)
- Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
- * E-mail:
| | - Yuji Matsuda
- Division of Rehabilitation, University of Yamanashi Hospital, Yamanashi, Japan
| | - Yuka Ito
- Department of Nursing, University of Yamanashi Hospital, Yamanashi, Japan
| | - Hisami Kawate
- Department of Nursing, University of Yamanashi Hospital, Yamanashi, Japan
| | - Masako Sakamoto
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinji Obi
- Division of Rehabilitation, University of Yamanashi Hospital, Yamanashi, Japan
| | - Hirotaka Haro
- Division of Rehabilitation, University of Yamanashi Hospital, Yamanashi, Japan
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Neurotrophic Keratopathy: Ophthalmology's Diabetic Foot Problem. Eye Contact Lens 2021; 47:136-139. [DOI: 10.1097/icl.0000000000000774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2020] [Indexed: 12/15/2022]
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Leshno A, Gaton D, Singer R, Eliasi E, Vorobichik-Berar O, Madgar S, Stern O, Jaber W, Kapelushnik N, Skaat A. A novel EyePhone© App for improving adherence to glaucoma therapy. Graefes Arch Clin Exp Ophthalmol 2021; 259:1253-1262. [PMID: 33528649 DOI: 10.1007/s00417-021-05091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Despite advances in glaucoma treatment options, patient adherence and compliance remain very low. The EyePhone© App is a free non-commercial reminder application designed specifically for the needs of glaucoma patients. In this study, we evaluated its usefulness in improving adherence to medical treatment among glaucoma patients. METHODS This is a prospective multicenter interventional study. Glaucoma patients were recruited from a tertiary center and a large community glaucoma service center. After a short explanation, the EyePhone© App was installed on their smartphone device, and the notifications for the current medical treatment were entered. After enrollment and at 1-month follow-up, subjects completed the Morisky Medication Adherence Scale (MMAS-8) and the Quality of Life and Glaucoma 17-item (GlauQOL-17) questionnaires for evaluation of adherence and QOL, respectively. RESULTS In the study, 133 patients (71 men and 62 women) aged 62±15.5 years and using 2.0±0.9 IOP-lowering drugs participated. The proportion of highly adherent subjects improved from 29.3% (39/133) at baseline to 42.1% (56/133) at follow-up (P < 0.001), and the proportion of poorly adherent subjects decreased from 29.3 (39/133) to 20.3% (27/133) at follow-up (P = 0.012). QOL also improved, as evidenced by a significant increase in the GlauQOL-17 score (P < 0.05). In a subgroup of patients for whom IOP measurements were available, IOP reduced by 0.92 mmHg (P = 0.069). CONCLUSIONS Significant improvements in glaucoma adherence and QOL were achieved among poorly adherent glaucoma patients after 1 month of using the EyePhone© App.
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Affiliation(s)
- Ari Leshno
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Gaton
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Glaucoma Institute, "Clalit" Healthcare Services, Century Tower, Tel Aviv, Israel
| | - Reut Singer
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elior Eliasi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofri Vorobichik-Berar
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Shiran Madgar
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ori Stern
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wasim Jaber
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Kapelushnik
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Skaat
- The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rosdahl JA, Hein AM, Bosworth HB, Woolson S, Olsen M, Kirshner M, Hung A, Muir KW. Randomized controlled trial of an education-based intervention to improve medication adherence: Design considerations in the medication adherence in glaucoma to improve care study. Clin Trials 2021; 18:343-350. [PMID: 33487050 PMCID: PMC10048058 DOI: 10.1177/1740774520988291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Glaucoma treatment requires patients to follow daily, often times complex, eye drop regimens, but adherence is poor for many patients, putting them at risk for irreversible vision loss. A comprehensive approach is needed to address the challenges in the self-management of glaucoma. The purpose of this study is to improve glaucoma medication adherence in Veterans with medically treated glaucoma using an education-based intervention. METHODS/DESIGN This study is a single-site randomized controlled trial enrolling 200 Veterans and their companions, if companions are involved in their care. It has two arms: an intervention group and a control group. Participants in the intervention group receive an educational session with a non-physician interventionist and are provided with an AdhereTech smart bottle with the reminder functions activated. The control group is designed as an attention control such that they have a session on general eye health and are provided with a smart bottle but without the reminder functions activated. The primary outcome is the proportion of prescribed doses taken on schedule over 6 months following randomization according to the smart bottle. Secondary outcomes include intensification of glaucoma treatment, cost of intervention delivery, and cost-effectiveness of the intervention over 12 months. DISCUSSION The education-based intervention that we are testing is comprehensive in scope, to encompass a variety of barriers to adherence that glaucoma patients encounter, but personalized to address issues facing individual patients. Particular attention was given to feasibility in the real-world setting, as the high throughput of patients and lack of reimbursement for educational encounters in ophthalmology would limit implementation of a resource-intensive intervention.
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Affiliation(s)
- Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Aaron M Hein
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Miriam Kirshner
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Anna Hung
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
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Sanchez FG, Mansberger SL, Kung Y, Gardiner SK, Burgoyne CF, Cunningham ET, Rees JP, Jones EP, Kinast RM. Novel Eye Drop Delivery Aid Improves Outcomes and Satisfaction. Ophthalmol Glaucoma 2021; 4:440-446. [PMID: 33444854 DOI: 10.1016/j.ogla.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare a nose-pivoted drop delivery device (NPDD) with traditional eye drop delivery in glaucoma subjects. DESIGN Repeated-measures case series. PARTICIPANTS Fifty glaucoma subjects (100 eyes) who reported difficulty self-administering eye drops. METHODS We compared eye drop delivery using a NPDD against traditional delivery techniques at baseline (baseline traditional) and after standardized teaching (post-teaching traditional). Subjects used a 1-to-10 scale (10 being easiest) to rate the ease of delivery with each technique and completed a satisfaction survey. Two graders used digital video to independently review eye drop delivery and recorded: (1) accurate placement: the eye drop reached the ocular surface; (2) no contact: no bottle tip contact against the ocular or periocular surface; and (3)number of eye drops dispensed. We defined primary success as accurate placement and no contact; secondary success as primary success with only 1 drop dispensed. MAIN OUTCOME MEASURES We used logistic-transformed generalized estimating equation (GEE) regression to compare technique satisfaction, accuracy, no contact, and primary and secondary success. Number of drops dispensed was compared using a Cox model. RESULTS Forty-seven of 50 subjects (94%) preferred the NPDD over traditional eye drop delivery. The mean score for ease of use was higher for the NPDD (8.9 ± 1.1) than baseline traditional (6.7 ± 2.1; P < 0.001) and post-teaching traditional (7.0 ± 2.0; P < 0.001). Forty-nine of 50 (98%) subjects thought the NPDD was comfortable to use and would recommend the device. The eye drop reached the ocular surface in a similar percentage of subjects (>90%) with each method. The bottle tip contacted fewer eyes with the NPDD (10 eyes) than baseline traditional (33 eyes; P < 0.001) and post-teaching traditional (25 eyes; P = 0.009). The number of drops dispensed was lower with the NPDD (1.7 ± 1.2) than baseline traditional (2.2 ± 1.6; P = 0.017) and post-teaching traditional (2.4 ± 1.8; P = 0.006). The NPDD increased primary and secondary success of eye drop delivery (86% and 54%, respectively) compared to baseline traditional (66% [P = 0.001] and 28% [P < 0.001]) and post-teaching traditional (70% [P = 0.005] and 40% [P = 0.018]). CONCLUSIONS Eye drop users preferred the NPDD over traditional eye drop delivery. The NPDD improved eye drop delivery success, reduced bottle tip contact, and decreased the number of eye drops wasted.
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Affiliation(s)
- Facundo G Sanchez
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Steven L Mansberger
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | | | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Claude F Burgoyne
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; The Francis I. Proctor Foundation, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Jack P Rees
- Legacy Devers Eye Institute, Portland, Oregon
| | | | - Robert M Kinast
- Legacy Devers Eye Institute, Portland, Oregon; Discoveries in Sight Research Laboratories, Devers Eye Institute, Portland, Oregon.
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Gedde SJ, Vinod K, Wright MM, Muir KW, Lind JT, Chen PP, Li T, Mansberger SL. Primary Open-Angle Glaucoma Preferred Practice Pattern®. Ophthalmology 2021; 128:P71-P150. [DOI: 10.1016/j.ophtha.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
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Gedde SJ, Lind JT, Wright MM, Chen PP, Muir KW, Vinod K, Li T, Mansberger SL. Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern®. Ophthalmology 2021; 128:P151-P192. [DOI: 10.1016/j.ophtha.2020.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022] Open
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Matossian C, Hovanesian J, Bacharach J, Paggiarino D, Patel K. Impact of dexamethasone intraocular suspension 9% on intraocular pressure after routine cataract surgery: post hoc analysis. J Cataract Refract Surg 2021; 47:53-64. [PMID: 32818346 PMCID: PMC7889288 DOI: 10.1097/j.jcrs.0000000000000363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To characterize intraocular pressure (IOP) response after treatment with dexamethasone intraocular suspension 9% vs placebo (vehicle) injection or topical prednisolone acetate 1% and to identify factors associated with increased IOP after cataract surgery. SETTING Data were pooled from two multicenter phase 3 clinical trials of patients undergoing routine cataract surgery. DESIGN Randomized, double-blind study and open-label study. METHODS Subjects were randomized to treatment with dexamethasone intraocular suspension or placebo in the double-blind study 1 and to dexamethasone intraocular suspension or topical prednisolone acetate in the open-label study 2. Subjects who experienced 10 mm Hg or greater, 15 mm Hg or greater, or 20 mm Hg or greater postoperative IOP increase from baseline were stratified by baseline IOP. Univariate and multivariate logistic regression models of patient variables were applied to identify independent risk factors predictive of IOP elevation of 10 mm Hg or greater or 15 mm Hg or greater. RESULTS The study comprised 414 subjects. Dexamethasone intraocular suspension was associated with a slightly higher mean IOP at the first postoperative visit vs prednisolone (P < .05); however, mean IOP was not statistically different between the 2 groups by postoperative day 8 (P = .5006) or thereafter. Univariate analysis showed that both prednisolone and dexamethasone intraocular suspension increased risk for postoperative IOP elevation compared with placebo; however, there was no statistically significant increased risk with dexamethasone intraocular suspension vs prednisolone. Aside from antiinflammatory treatment, risk factors for postoperative IOP elevation by univariate and multivariate analyses were higher baseline IOP, high myopia, and, when defining IOP increase as 15 mm Hg or greater from baseline, male sex. CONCLUSIONS Dexamethasone intraocular suspension was associated with IOP elevation patterns comparable with topical prednisolone. High myopia, higher baseline IOP, and male sex were significant predictors of postoperative IOP elevation in this cohort.
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Affiliation(s)
- Cynthia Matossian
- From Matossian Eye Associates (Matossian), Doylestown, Pennsylvania; Harvard Eye Associates (Hovanesian), Laguna Hills, California; North Bay Eye Associates (Bacharach), Petaluma, California; and EyePoint Pharmaceuticals (Paggiarino, Patel), Watertown, Massachusetts, USA
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Ganugula R, Arora M, Lepiz MA, Niu Y, Mallick BK, Pflugfelder SC, Scott EM, Kumar MNVR. Systemic anti-inflammatory therapy aided by double-headed nanoparticles in a canine model of acute intraocular inflammation. SCIENCE ADVANCES 2020; 6:eabb7878. [PMID: 32923645 PMCID: PMC7449680 DOI: 10.1126/sciadv.abb7878] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/10/2020] [Indexed: 05/10/2023]
Abstract
Novel approaches circumventing blood-ocular barriers in systemic drug delivery are lacking. We hypothesize receptor-mediated delivery of curcumin (CUR) across intestinal and ocular barriers leads to decreased inflammation in a model of lens-induced uveitis. CUR was encapsulated in double-headed polyester nanoparticles using gambogic acid (GA)-coupled polylactide-co-glycolide (PLGA). Orally administered PLGA-GA2-CUR led to notable aqueous humor CUR levels and was dosed (10 mg/kg twice daily) to adult male beagles (n = 8 eyes) with induced ocular inflammation. Eyes were evaluated using a semiquantitative preclinical ocular toxicology scoring (SPOTS) and compared to commercial anti-inflammatory treatment (oral carprofen 2.2 mg/kg twice daily) (n = 8) and untreated controls (n = 8). PLGA-GA2-CUR offered improved protection compared with untreated controls and similar protection compared with carprofen, with reduced aqueous flare, miosis, and chemosis in the acute phase (<4 hours). This study highlights the potential of PLGA-GA2 nanoparticles for systemic drug delivery across ocular barriers.
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Affiliation(s)
- R. Ganugula
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Reynolds Medical Building, Texas A&M University, Mailstop 1114, College Station, TX, USA
- Corresponding author. (M.N.V.R.K.); (E.M.S.); (R.G.)
| | - M. Arora
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Reynolds Medical Building, Texas A&M University, Mailstop 1114, College Station, TX, USA
| | - M. A. Lepiz
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Y. Niu
- Department of Statistics, Texas A&M University, College Station, TX, USA
| | - B. K. Mallick
- Department of Statistics, Texas A&M University, College Station, TX, USA
| | - S. C. Pflugfelder
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - E. M. Scott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
- Corresponding author. (M.N.V.R.K.); (E.M.S.); (R.G.)
| | - M. N. V. Ravi Kumar
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Reynolds Medical Building, Texas A&M University, Mailstop 1114, College Station, TX, USA
- Corresponding author. (M.N.V.R.K.); (E.M.S.); (R.G.)
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Abstract
Glaucoma is an optical neuropathy associated to a progressive degeneration of retinal ganglion cells with visual field loss and is the main cause of irreversible blindness in the world. The treatment has the aim to reduce intraocular pressure. The first therapy option is to instill drugs on the ocular surface. The main limitation of this is the reduced time of the drug staying on the cornea. This means that high doses are required to ensure its therapeutic effect. A drug-loaded contact lens can diffuse into the post lens tear film in a constant and prolonged flow, resulting in an increased retention of the drug on the surface of the cornea for up to 30 min and thus providing a higher drug bioavailability, increasing the therapeutic efficacy, reducing the amount of administered drug, and thereby provoking fewer adverse events. Several different systems of drug delivery have been studied in recent decades; ranging from more simple methods of impregnating the lenses, such as soaking, to more complex ones, such as molecular imprinting have been proposed. Moreover, different drugs, from those already commercially available to new substances such as melatonin have been studied to improve the glaucoma treatment efficacy. This review describes the role of contact lenses as an innovative drug delivery system to treat glaucoma.
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