New World Medical (United States)

To compare postenhancement visual acuity between patients who underwent postcataract laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). A private, tertiary referral practice in Sioux Falls, South Dakota. 3-year, retrospective chart review. Patients who underwent postcataract extraction excimer laser enhancement surgery targeted for emmetropia (±0.50 diopter). Postenhancement uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) was recorded for all available follow-ups and compared for both groups. 822 postcataract enhanced eyes (491 LASIK; 331 PRK). For patients with at least 6-month follow-up, mean UDVA was 0.05 ± 0.13 logMAR in LASIK-enhanced patients and 0.15 ± 0.20 in PRK-enhanced patients ( P < .001). Mean absolute value MRSE was 0.22 ± 0.36 and 0.48 ± 0.62 for LASIK-enhanced and PRK-enhanced patients at or beyond 6 months, respectively ( P < .001). 330 (67%) LASIK-enhanced patients achieved 20/20 or better postenhancement UDVA, compared with 142 (43%) PRK-enhanced patients ( P < .001). Controlling for pre-enhancement UDVA, LASIK-enhanced patients showed significantly better postenhancement UDVA than PRK-enhanced patients, except in those with pre-enhancement vision of 20/20 or better, or those worse than 20/50. LASIK-enhanced virgin corneas had mean postenhancement of 0.05 ± 0.14 UDVA compared with 0.13 ± 0.19 UDVA in PRK-enhanced virgin cornea patients ( P < .001). LASIK provides better and more predictable outcomes in UDVA than PRK in postcataract enhancement patients, even when controlling for pre-enhancement visual acuity and prior ocular procedures.

AimsUsing a pragmatic approach, the LIRA‐PRIME trial aims to address a knowledge gap by comparing efficacy in controlling glycaemia with glucagon‐like peptide‐1 analog liraglutide vs oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) uncontrolled with metformin monotherapy in primary care practice. We report the study design and patient baseline characteristics.Materials and methodsThis 104‐week, two‐arm, open‐label, active‐controlled trial is active in 219 primary care practices across nine countries. At screening, eligible patients with T2D were at least 18 years of age, had been using a stable daily dose of metformin ≥1500 mg or the maximum tolerated dose for ≥60 days, and had a glycated haemoglobin (HbA1c) of 7.5% to 9.0%, measured ≤90 days before screening. Patients were randomized (1:1) to liraglutide or OAD, both in addition to pre‐trial metformin. Individual OADs were chosen by the treating physician based on local guidelines. The primary endpoint is time to inadequate glycaemic control, defined as HbA1c above 7.0% at two scheduled consecutive visits after the first 26 weeks of treatment.ResultsThe trial randomized 1997 patients with a mean (standard deviation) age of 56.9 (10.8) years, T2D duration of 7.2 (5.9) years (range, <1‐47 years), and HbA1c of 8.2%. One‐fifth of patients had a history of diabetes complications, and most were overweight (24.8%) or had obesity (65.3%).ConclusionsThis pragmatically designed, large‐scale, multinational, randomized clinical trial will help guide treatment decisions for patients with T2D who are inadequately controlled with metformin monotherapy and treated in primary care.

Glaucoma continues to exert a heavy disability and economic burden and is the most frequent cause of irreversible blindness worldwide. In 2015, 57.5 million people globally were affected by open-angle glaucoma and this is predicted to increase to 65.5 million by 2020. The prevalence of glaucoma increases with age in all populations and generally more men and people of Hispanic and Black race are affected. Effective treatments to lower and maintain intraocular pressure (IOP) and convenient means of continuously monitoring it remain substantial unmet medical needs. In this expert interview Kin Sheng Lim from Guy’s and St Thomas’ Hospitals, London, UK, discusses the new developments to improve this situation and are therefore of great interest to ophthalmologists and to the wider population who are at risk from glaucoma.

Patients often bemoan about having to live with the daily disturbances and challenges required of diabetes self-management. Counting carbs, taking medications with names longer than Greek Gods none of which are covered by insurance, having to monitor blood glucose levels three to six times daily and even having to incorporate healthy foods and exercise into daily living can elicit a feeling of distress in most patients with diabetes. Those individuals who are suffering from diabetes are indeed living on the edge. When asked, “what is your biggest fear regarding your chronic disease” patients will universally respond that they do not want to lose their vision or their leg from a non-traumatic amputation. They want to live long enough to see their children graduate college or their grandchildren start a family. Thus, diabetes is considered by some patients to be a fatalistic disease which will result in devastating complications which are beyond their self-control.