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Samuels A, Keay L, Faasse K, Carnt N. Effect of text messages designed to change contact lens compliance: A randomised controlled trial. Cont Lens Anterior Eye 2025; 48:102341. [PMID: 39603861 DOI: 10.1016/j.clae.2024.102341] [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: 07/17/2024] [Revised: 10/08/2024] [Accepted: 11/21/2024] [Indexed: 11/29/2024]
Abstract
PURPOSE Contact lens behaviours such as poor hand and lens hygiene are common and are associated with increased risk of microbial keratitis. Evidence for health promotion strategies to address this gap is required. The trial examined the effectiveness of a customised text-messaging intervention on compliance, discontinuation rate and wearer satisfaction in contact lens wearers. METHODS The parallel group, double masked, randomised clinical trial was pre-registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621001719820). Contact lens wearers were recruited using social media and optometry partners in clinical practice. Participants (n = 76) received the intervention and usual care. The control group (n = 75) received usual care. Intervention text messages (range 56-76) were customised, provided education, reminders, and motivation and were delivered over six months. Outcomes were validated self-report online surveys for compliance (0-100), satisfaction (0-100) and discontinuation (Y/N), at 3 months and 6 months. Secondary outcomes were intervention feasibility and acceptability. RESULTS Participants mean age was 38 years, 105/151 (70 %) female and 83 % completed the trial (intervention 60/76, control 65/75). The intervention group demonstrated better compliance than control with an adjusted between-group-difference at 3 months of 5.2, 95 % confidence interval (CI), 1.6-8.7, P = 0.004 and at 6 months 3.9, 95 % CI 0.2-7.6, P = 0.04. This difference in compliance is clinically significant, equivalent to a single change in a behaviour such as starting to handwash or ceasing overnight wear. There was no adjusted between-group-difference in satisfaction at 3 months (0.8, 95 % CI -4.3-6.0, P = 0.75) or at 6 months (-0.4, 95 % CI -5.7-4.9, P = 0.89). Few participants (7/151, 4.6 %) discontinued contact lens wear (3 intervention, 4 control). The messages were delivered successfully (98 %), at A$11 per participant. Participants reported appropriate message content (75 %), language (80 %) and delivery timing (97 %). CONCLUSION This customised text message intervention was a feasible and acceptable method for improving contact lens compliance.
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Affiliation(s)
- Adam Samuels
- School of Optometry and Vision Science, Faculty of Medicine and Health, Level 3, Rupert Myers North Wing, UNSW Sydney, NSW 2052, Australia.
| | - Lisa Keay
- School of Optometry and Vision Science, Faculty of Medicine and Health, Level 3, Rupert Myers North Wing, UNSW Sydney, NSW 2052, Australia
| | - Kate Faasse
- School of Psychology, Faculty of Science, Level 11, Mathews Building, UNSW Sydney, NSW 2052, Australia
| | - Nicole Carnt
- School of Optometry and Vision Science, Faculty of Medicine and Health, Level 3, Rupert Myers North Wing, UNSW Sydney, NSW 2052, Australia
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Kim M, Lee CK, Shin J, Kim D, Rho S. Comparison of Efficacy and Ocular Surface Assessment Between Preserved and Preservative-Free Brimonidine/Timolol Fixed-Combination Eye Drops in Glaucoma Patients: A Parallel-Grouped, Randomized Trial. J Clin Med 2025; 14:1587. [PMID: 40095512 PMCID: PMC11900319 DOI: 10.3390/jcm14051587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 02/12/2025] [Accepted: 02/24/2025] [Indexed: 03/19/2025] Open
Abstract
The objectives of the study were to compare the efficacy and safety using ocular surface assessment between preserved and preservative-free brimonidine/timolol fixed-combination eye drops in glaucoma or ocular hypertension patients. Methods: This study was designed as a prospective, multicenter (three institutions), investigator-masked, parallel-grouped randomized clinical trial. The primary outcomes were corneal and conjunctival staining score, ocular surface disease index (OSDI) score, drug tolerance, and adherence rates at 12-week visits. The secondary outcomes were corneal and conjunctival staining score, OSDI score at 4-week visits and intraocular pressure (IOP), tear-film break-up time (TBUT), and bulbar/limbal hyperemia score at the 4- and 12-week visits. For safety assessment, best-corrected visual acuity (BCVA), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and physical examination at 4 and 12 weeks and adverse events during the whole study period were analyzed. Results: Overall, 59 patients were enrolled and randomized into each group (29 preserved and 30 preservative-free). At the endpoint, 5 patients in the preserved group and 2 patients in the preservative-free group dropped out, leaving 24 and 28 patients in the preserved and preservative-free groups, respectively. Baseline characteristics showed no significant difference between the groups including age and sex. At the 12-week visit, intra-group change of OSDI scores did not change significantly compared to the baseline scores in both preserved and preservative-free groups (p = 0.791, 0.478, respectively). On the contrary, the corneal staining score and the conjunctival staining score showed a significant increase compared to the baseline score in the preserved group (p = 0.015, 0.009, respectively). Regarding drug satisfaction, higher proportions of patients in the preservative-free group reported convenience of installation (p = 0.002). Also, stinging and burning sensations in drug tolerance showed better results in the preservative-free group with a significant difference (p = 0.011). Safety assessment regarding systemic side effects such as SBP, DBP, and HR showed similar results between the preserved and preservative-free groups (p = 0.711, 0.232, 0.666, respectively). Conclusions: Preservative-free brimonidine/timolol showed comparable efficacy and safety, better corneal and conjunctival staining score with convenience of installation, and lower stinging and burning sensation. It is expected to be a proper treatment option for patients with glaucoma or ocular hypertension.
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Affiliation(s)
- Myungjin Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea; (M.K.); (D.K.)
| | - Chang-Kyu Lee
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea;
| | - Jonghoon Shin
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea;
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
- PNU Busan Eye Clinic, Busan 46241, Republic of Korea
| | - Doah Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea; (M.K.); (D.K.)
| | - Seungsoo Rho
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Republic of Korea; (M.K.); (D.K.)
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Kim M, Kim YK, Rho S, Ha A. Protocol for a systematic review and network meta-analysis comparing the efficacy and safety of benzalkonium chloride-preserved, alternatively preserved and preservative-free eyedrops in the treatment of glaucoma. BMJ Open 2025; 15:e085303. [PMID: 40010813 PMCID: PMC11865778 DOI: 10.1136/bmjopen-2024-085303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 01/10/2025] [Indexed: 02/28/2025] Open
Abstract
INTRODUCTION The primary therapeutic approach to glaucoma involves the long-term use of intraocular pressure (IOP)-lowering eyedrops. However, the prevalent use of benzalkonium chloride (BAK) as a preservative in glaucoma eyedrops has been associated with ocular side effects, prompting a demand for alternatively preserved (AP) or preservative-free (PF) eyedrops. Studies comparing various preservatives have shown conflicting evidence concerning the safety of BAK-preserved (BP) eyedrops, some studies indicating no notable concerns and others reporting adverse effects. The current protocol concerns a network meta-analysis enabling systematic investigation of the IOP-lowering efficacy and safety profiles of BP, AP and PF eyedrops in patients with glaucoma for whom randomised controlled trials (RCTs) are available. METHODS AND ANALYSIS This study will evaluate the IOP-lowering effects of glaucoma eyedrops, comparing formulations with and without preservatives in patients with glaucoma. A systematic search for RCTs, regardless of language or publication date, will be conducted across three electronic databases (Cochrane search engine, Embase and MEDLINE) from 1 March 2024. Two reviewers will conduct a sequential screening of titles and abstracts, followed by full-text papers, to extract useful data. The two reviewers will also assess the internal validity of studies using the relevant and domain-based risk of bias assessment tool. Overall evidence quality will be assessed using the Confidence in Network Meta-Analysis approach and presented in summarised form with network diagrams. Forest plots will be generated for enhanced visualisation of the included glaucoma eyedrops' effects, and pairwise effect sizes will be calculated based on available evidence in the network. ETHICS AND DISSEMINATION No ethics review or approval is required for this work, as it will synthesise evidence obtained from published studies. A paper presenting the findings will be submitted to a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER CRD42024498328.
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Affiliation(s)
- Myungjin Kim
- Department of Ophthalmology, CHA University School of Medicine, Seongnam, Gyeonggi, Korea (the Republic of)
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Seungsoo Rho
- Department of Ophthalmology, CHA University School of Medicine, Seongnam, Gyeonggi, Korea (the Republic of)
| | - Ahnul Ha
- Department of Ophthalmology, Jeju National University Hospital, Jeju, Korea (the Republic of)
- Department of Ophthalmology, Jeju National University College of Medicine, Jeju-si, South Korea
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Ha A, Lee YJ, Lee M, Shim SR, Kim YK. Digital Screen Time and Myopia: A Systematic Review and Dose-Response Meta-Analysis. JAMA Netw Open 2025; 8:e2460026. [PMID: 39982728 PMCID: PMC11846013 DOI: 10.1001/jamanetworkopen.2024.60026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 12/11/2024] [Indexed: 02/22/2025] Open
Abstract
Importance The association of digital screen time with myopia has been documented, but the dose-response association and safe exposure threshold remain unclear. Objective To evaluate the dose-response association of time spent on digital screens with myopia risk. Data Sources PubMed, EMBASE, Cochrane Library databases, CINAHL, and ClinicalTrials.gov were searched for full-length articles from peer-reviewed journals without restrictions on study design, publication date, or language from inception to November 25, 2024. Study Selection Primary research articles investigating the association of exposure to digital screen devices (ie, smartphones, tablets, game consoles, computers, or television) with myopia-related outcomes (ie, prevalent or incident myopia and the rate of myopia progression) were identified by reviewers. Data Extraction and Synthesis Two independent reviewers extracted data using a standardized procedure in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A random-effects, dose-response meta-analysis (DRMA) was utilized to examine the pattern of the association of screen time with myopia. Main Outcome and Measures Increased odds of myopia per hour of daily screen time. Results In the linear DRMA of 45 studies with 335 524 participants (mean [SD] age, 9.3 [4.3] years), an additional hour of daily screen time was associated with higher odds of myopia (odds ratio [OR], 1.21; 95% CI, 1.13-1.30). The nonlinear DRMA of 34 studies with 314 910 participants also indicated higher odds of myopia with increasing screen time, ranging from 1 hour of daily exposure (OR, 1.05; 95% CI, 1.01-1.09) to 4 hours (OR, 1.97; 95% CI, 1.56-2.40). The dose-response curve showed myopia risk increasing significantly between 1 to 4 hours of daily screen time, and then rising more gradually after 4 hours. Conclusions and Relevance In this systematic review and DRMA, a daily 1-hour increment in digital screen time was associated with 21% higher odds of myopia and the dose-response pattern exhibited a sigmoidal shape, indicating a potential safety threshold of less than 1 hour per day of exposure, with an increase in odds up to 4 hours. These findings can offer guidance to clinicians and researchers regarding myopia risk.
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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
| | - Yun Jeong Lee
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Korea
| | | | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Korea
| | - Young Kook Kim
- Ranelagh Center for Biosocial Informatics, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
- Trinity Biomedical Sciences Institute, School of Biochemistry and Immunology, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Katz LJ, Myers JS, Herndon LW, Kresch YS, Hengerer FH. Interventional Glaucoma: Improving the Patient-Provider Educational Exchange. Clin Ophthalmol 2024; 18:3365-3374. [PMID: 39588379 PMCID: PMC11587800 DOI: 10.2147/opth.s491287] [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: 08/13/2024] [Accepted: 11/04/2024] [Indexed: 11/27/2024] Open
Abstract
Glaucoma treatment is beginning to undergo an evolution, moving away from topical medication-based therapies toward more proactive minimally invasive interventions. This shift towards an "interventional glaucoma" treatment paradigm has been shown to benefit patients, providers, and society. A key component of effectively implementing this approach is education about the importance of glaucoma diagnosis and treatment, as well as the various treatment modalities available. Such education is relevant not only for patient but also patients' support networks, ophthalmologists, optometrists, third-party payers, and policy-makers. Education can occur both within and outside the clinical setting. The present article provides an overview of the diverse educational methods available for glaucoma patients, including those based on patient-provider interactions and those based on internet and printed material. Examples of the former could include general and specific verbal instruction, motivational interviewing, or community-based educational workshops, while examples of the latter could include office-based movies or printed materials, virtual reality headset educational videos, artificial intelligence-assisted education, or self-directed internet videos and articles. By empowering patients with knowledge and an up-to-date awareness of treatment options, effective education can be a valuable part of making an interventional glaucoma treatment paradigm possible.
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Affiliation(s)
- L Jay Katz
- Wills Eye Hospital, Philadelphia, PA, USA
- Glaukos Corporation, Aliso Viejo, CA, USA
| | | | | | - Yocheved Shira Kresch
- Department of Ophthalmology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Fritz H Hengerer
- Department of Ophthalmology, Buergerhospital, Frankfurt, Germany
- University Eye Hospital, University of Heidelberg, Heidelberg, Germany
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Sharma A, Roh S, Ramsey DJ. Targeted Telephone-Based Outreach Reconnects Glaucoma Patients With Subspecialty Care. J Glaucoma 2024; 33:28-34. [PMID: 37327477 DOI: 10.1097/ijg.0000000000002256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Abstract
PRCIS A personalized telephone-based intervention is a cost-effective method to return overdue patients with open angle glaucoma (OAG) to subspecialty care. Patients who accepted care overwhelmingly preferred in-person appointments with their provider instead of hybrid visits with telehealth. PURPOSE To evaluate the effectiveness of a telephone-based outreach strategy to reconnect OAG patients with subspeciality care. PATIENTS AND METHODS Established patients with OAG who were seen before March 1, 2021, but had not returned for care in the following year were contacted via a telephone-based intervention. Patients lost to follow-up (LTF) were offered the option of an in-person visit or a hybrid telehealth visit, which combined in-office testing of vision, intraocular pressure, and optic nerve imaging with a virtual consultation with their glaucoma specialist on a separate date. RESULTS Of 2727 patients with OAG, 351 (13%) had not returned for recommended care. Outbound calls reached 176 of those patients (50%). Nearly half of all patients contacted readily accepted care, with 71 scheduling in-person appointments (93%) and 5 selecting hybrid visits (6.6%). Medication refills were requested by 17 of those 76 patients, representing nearly a third of the 56 patients who were treated with topical glaucoma medications. Assessment of the program 90 days later found that 40 patients had returned for care, 100 patients had transferred or declined further care, and 40 patients were identified as deceased, lowering the LTF rate to 6.4%, with 15 patients still scheduled for future visits. On the basis of an average call duration of 2.8±2.0 minutes, the added cost of returning a patient with OAG to care by the program was $28.11. CONCLUSIONS Providing targeted outreach by telephone is an effective and cost-efficient strategy to reconnect OAG patients LTF with subspecialty care.
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Affiliation(s)
- Arjun Sharma
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA
- Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA
| | - Shiyoung Roh
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA
- Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA
| | - David J Ramsey
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA
- Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA
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Huh MG, Kim YK, Lee J, Shin YI, Lee YJ, Choe S, Kim DW, Jeong Y, Jeoung JW, Park KH. Relative Risks for Dementia among Individuals with Glaucoma: A Meta-Analysis of Observational Cohort Studies. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:490-500. [PMID: 37899286 PMCID: PMC10721395 DOI: 10.3341/kjo.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
PURPOSE To investigate the relative risks (RRs) for dementia among individuals with glaucoma. METHODS We conducted a search of PubMed, Web of Science, Scopus, and Cochrane databases for observational cohort studies examining the association between glaucoma and dementia until March 2023. Two authors independently screened all titles and abstracts according to predefined inclusion and exclusion criteria. Pooled RR and 95% confidence intervals (CIs) were generated using random-effect models. RESULTS The meta-analysis included 18 cohort studies conducted in eight countries and involving 4,975,325 individuals. The pooled RR for the association between glaucoma and all-cause dementia was 1.314 (95% CI, 1.099-1.572; I2 = 95%). The pooled RRs for the associations of open-angle glaucoma with Alzheimer dementia and Parkinson disease were 1.287 (95% CI, 1.007-1.646; I2 = 96%) and 1.233 (95% CI, 0.677-2.243; I2 = 73%), respectively. The pooled RRs for the associations of angle-closure glaucoma with all-cause dementia and Alzheimer dementia were 0.978 (95% CI, 0.750-1.277; I2 = 17%) and 0.838 (95% CI, 0.421-1.669; I2 = 16%), respectively. No evidence of publication bias was detected in the Begg-Mazumdar adjusted rank correlation test (p = 0.47). CONCLUSIONS Based on current observational cohort studies, there is evidence supporting that glaucoma is a risk factor for dementia in the adult population.
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Affiliation(s)
- Min Gu Huh
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
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 National University College of Medicine, Seoul,
Korea
| | - Jaekyoung Lee
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Young In Shin
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Yun Jeong Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon,
Korea
| | - Sooyeon Choe
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon,
Korea
| | - Dai Woo Kim
- Department of Ophthalmology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu,
Korea
| | - Yoon Jeong
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
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Rathinavelu JK, Muir KW, Majette NT, Woolson S, Olsen MK, Flaharty K, Newman-Casey PA, Kirshner M. Qualitative Analysis of Barriers and Facilitators to Glaucoma Medication Adherence in a Randomized Controlled Trial Intervention. Ophthalmol Glaucoma 2023; 6:626-635. [PMID: 37343624 DOI: 10.1016/j.ogla.2023.06.002] [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: 01/18/2023] [Revised: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE In the Medication Adherence In Glaucoma To Improve Care trial, 200 veterans with medically-treated glaucoma were randomized to an intervention designed to improve glaucoma medication adherence or to usual care. In the 6 months after intervention, the mean proportion of doses taken on schedule was higher for participants in the intervention group compared with controls (0.85 vs. 0.62, P < 0.001). The purpose of this study was to use a mixed-methods approach to compare barriers and facilitators with adherence among participants through qualitative analysis of structured interviews. DESIGN This is an analysis of interviews conducted from patients participating in a clinical trial. PARTICIPANTS Participants from the intervention arm were separated into quartiles based on medication adherence according to the electronic monitor to sample from high and low responders to the intervention. We interviewed 23 participants; 11 participants with low adherence and 12 with high adherence. METHODS Interviews were conducted over telephone and transcribed. Staff members used grounded theory to conduct content analysis and code the transcribed interviews. The iterative process produced categories of common barriers and facilitators for medication adherence. MAIN OUTCOME MEASURES The frequency of responses addressing common barriers and facilitators were compared between participants with high and low adherence. RESULTS In the lowest- and highest-adherence groups, a difficult schedule was the most cited barrier for regular drop usage (63.6% and 58.3%, respectively). In the lowest and highest-adherence groups, the most cited facilitator for adherence was use of the smart bottle (100% and 91.7%, respectively). In the lowest-adherence group, 72.7% of participants cited that improved ability to administer drops was a benefit from the intervention. In the highest-adherence group, 75% of participants cited increased disease knowledge and formation of habits as facilitators from the intervention. Of the 22 of 23 participants who mentioned the smart bottle, 100% cited that they had increased adherence and would continue using the smart bottle. CONCLUSIONS Using dosing reminders and personalized patient education may be important avenues for addressing difficulties with adhering to an eye drop schedule to improve glaucoma self-management. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Kelly W Muir
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.
| | - Nadya T Majette
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 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
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Choe S, Kim YK, Chung W, Ko D, Lee M, Shim SR, Ha A. Placebo Effect and Its Determinants in Ocular Hypotensive Therapy: Meta-analysis and Multiple Meta-regression Analysis. Ophthalmology 2023; 130:1149-1161. [PMID: 37343706 DOI: 10.1016/j.ophtha.2023.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/18/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023] Open
Abstract
TOPIC The placebo effect and its potential determinants in ocular hypotensive therapy. CLINICAL RELEVANCE The placebo effect has been studied and documented within a wide clinical context. It remains unclear whether placebo is effective in glaucoma treatment or, if so, which factors are determinative of effect size (ES). METHODS Randomized controlled trials (RCTs) of topical ocular hypotensive therapy for patients with open-angle glaucoma or ocular hypertension, conducted through June 2, 2022, were included. First, a perceived placebo effect was measured as the overall intraocular pressure (IOP) change from the baseline. It was evaluated in terms of the ES (mean difference between the baseline and the end point) and then was compared with the ES, as obtained from the untreated control participant to obtain a true placebo effect. The primary outcome was ES based on 4 weeks of treatment. Meta-analysis-based statistical pooling was performed where appropriate, and 95% confidence intervals (CIs) were used for comparison. Potential placebo effect determinants were scrutinized using a multiple meta-regression model (PROSPERO identifier, CRD42022348098). RESULTS A total of 40 RCTs (7829 eyes) with 33 placebo groups (2055 eyes) along with 7 untreated groups (1184 eyes) were included. Among placebo-controlled trials, placebo was determined to be effective in lowering IOP (ES, -1.30 mmHg; 95% CI, -1.75 to -0.84 mmHg). Using NMA, the ES for placebo was -2.27 mmHg (95% CI, -3.52 to -1.01 mmHg) greater than ES for untreated control participants.. According to the multiple meta-regression model, the active treatment ES was a significant factor to predict the amount of placebo effect. Placebo additionally lowered IOP by -0.45 mmHg per -1 mmHg of active treatment effect. Add-on study design and larger sample size also were associated with greater amount of placebo effect. No publication bias was evident in either a funnel plot or the Begg and Mazumdar adjusted rank correlation test results (P = 0.24). DISCUSSION This meta-analysis indicated that placebo is effective in lowering IOP and is superior to the effect observed for the untreated control participants. However, caution is required in interpreting the results because of the small number of untreated controlled trials and potential bias from the lack of direct comparison between the placebo and untreated arms. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sooyeon Choe
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Ophthalmology, Chungnam National University, Daejeon, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; EyeLight Data Science Laboratory, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Woosuk Chung
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Donghyun Ko
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Marvin Lee
- Allbarun Eye Clinic, Suwon-si, Republic of Korea
| | - Sung Ryul Shim
- Department of Health and Medical Informatics, Kyungnam University College of Health Sciences, Changwon, Republic of Korea
| | - Ahnul Ha
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Republic of Korea; Department of Ophthalmology, Jeju National University School of Medicine, Jeju-si, Republic of Korea.
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Stingl JV, Greslechner R, Brandl C, Heid IM, Hoffmann EM, Pfeiffer N, Schuster AK. [Awareness for glaucoma in the general population]. DIE OPHTHALMOLOGIE 2023; 120:1088-1097. [PMID: 37847376 DOI: 10.1007/s00347-023-01943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Glaucoma is not a rare entity but because very few symptoms occur and visual field defects are frequently first recognized at a late stage, a large proportion of glaucoma diseases remain undetected. The aim of this study was to identify the proportion of undiagnosed glaucoma in German population-based cohort studies and to contextualize them in the context of the literature. MATERIAL AND METHODS The prevalence of glaucoma in the Gutenberg Health Study (GHS) and the age-related investigations on health of the University of Regensburg (AugUR) was evaluated based on visual field examinations and optic disc color photography according to the ISGEO criteria. Furthermore, the self-reported glaucoma diagnoses were collected and the proportion of undiagnosed glaucoma was determined. RESULTS The proportion of undiagnosed glaucoma was 55% in the GHS, and 53% in the AugUR study. The results correlate with results from previous studies from other countries in which the proportion of unrecognized glaucoma ranged from 33% to 78%. In the GHS and the AugUR study the proportion of undiagnosed glaucoma was higher in younger age groups and in women. DISCUSSION Roughly every second case of glaucoma is undetected. As the symptoms are often nonspecific or take a long time to appear, there is a risk of advanced glaucomatous visual field defects or blindness due to a lack of glaucoma awareness. Studies have shown that a systematic screening can halve this risk.
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Affiliation(s)
- Julia V Stingl
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - R Greslechner
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Caroline Brandl
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Lehrstuhl für Genetische Epidemiologie, Universität Regensburg, Regensburg, Deutschland
| | - Iris M Heid
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Esther M Hoffmann
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Norbert Pfeiffer
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Alexander K Schuster
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Andoh JE, Ezekwesili AC, Nwanyanwu K, Elam A. Disparities in Eye Care Access and Utilization: A Narrative Review. Annu Rev Vis Sci 2023; 9:15-37. [PMID: 37254050 DOI: 10.1146/annurev-vision-112122-020934] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This narrative review summarizes the literature on factors related to eye care access and utilization in the United States. Using the Healthy People 2030 framework, this review investigates social determinants of health associated with general and follow-up engagement, screenings, diagnostic visits, treatment, technology, and teleophthalmology. We provide hypotheses for these documented eye care disparities, featuring qualitative, patient-centered research. Lastly, we provide recommendations in the hopes of appropriately eliminating these disparities and reimagining eye care.
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Affiliation(s)
- Joana E Andoh
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Agnes C Ezekwesili
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Angela Elam
- Department of Ophthalmology, WK Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA;
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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: 1] [Impact Index Per Article: 0.5] [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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Liu P, Wang F, Song Y, Wang M, Zhang X. Current situation and progress of drugs for reducing intraocular pressure. Ther Adv Chronic Dis 2022; 13:20406223221140392. [PMID: 36479139 PMCID: PMC9720821 DOI: 10.1177/20406223221140392] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022] Open
Abstract
Glaucoma, the most common cause of irreversible blindness worldwide, usually causes characteristic optic nerve damage. Pathological intraocular pressure (IOP) elevation is a major risk factor. Drug reduction of IOP is the preferred treatment for clinicians because it can delay the progression of disease. However, the traditional IOP-lowering drugs currently used by patients may be poorly tolerated. Therefore, in recent years, some new drugs have been put into clinical application or in clinical phase I–III studies. They have a better IOP-lowering effect and fewer adverse reactions. Because glaucoma is a chronic disease, drugs need to be administered continuously for a long time. For patients, good compliance and high drug bioavailability have a positive effect on the prognosis of the disease. Therefore, clinicians and scientists have developed drug delivery systems to solve this complex problem. In addition, natural compounds and dietary supplements have a good effect of reducing IOP, and they can also protect the optic nerve through antioxidant action. We summarize the current traditional drugs, new drugs, sustained-release drug delivery systems, and complementary drugs and outline the mechanism of action and clinical effects of these drugs on glaucoma and their recent advances.
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Affiliation(s)
- Peiyu Liu
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Feifei Wang
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Yuning Song
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Menghui Wang
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Xu Zhang
- Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang University School of Ophthalmology & Optometry, Jiangxi Research Institute of Ophthalmology & Visual Science, Affiliated Eye Hospital of Nanchang University, 463 Bayi Road, Nanchang 330006, China
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