Medical therapy cost considerations for glaucoma

56,000 ways to treat glaucoma

To perform a meta-analysis to estimate the intraocular pressure (IOP)-lowering efficacy and safety of alpha(2)-adrenergic agonists (AAs), beta-adrenergic antagonists (BBs), and topical carbonic anhydrase inhibitors (TCAIs) when used in combination with a prostaglandin analog (PGA). MEDLINE, Embase, and the Cochrane Controlled Trials Register were systematically searched for relevant articles in April 2009. Ten observer-masked randomized clinical trials that reported baseline IOP while receiving PGA monotherapy and follow-up IOP while receiving combination therapy were identified. The pooled IOP-lowering efficacy achieved with each class of adjunctive agent was calculated using random-effects models. The frequencies of adverse events were pooled across studies and compared using Fisher exact test. Mean diurnal IOP reduction achieved in all 3 groups was statistically similar (P = .22). At trough, IOP reduction was greater in the TCAI (P < .001) and BB (P < .001) groups than in the AA group. Peak IOP reduction was similar in the 3 groups (P = .66). Eye or eyelid pain or burning and xerostomia were significantly more common in the AA group. Fatigue, weakness, or dizziness was more common in the AA and BB groups compared with the TCAI group. Taste disturbance was significantly more common in the TCAI group. All 3 classes are similarly effective in lowering mean diurnal IOP when used in combination with PGAs. The AA class is statistically significantly less effective in reducing IOP at trough compared with BBs and TCAIs. The types of adverse events that were identified varied among the different classes of adjunctive therapies.

To investigate whether a self-reported history of allergy to sulfa-based drugs is a predictor for subsequent adverse reactions to topical carbonic anhydrase inhibitors (CAIs). A retrospective case-controlled cohort study via chart review was performed on 1,287 patients with a diagnosis of glaucoma. The outcome measure was the development of an adverse reaction (either ocular, systemic, or both) within at least 30 days after receipt of 1 of 4 classes of topical glaucoma medications: CAIs (dorzolamide and brinzolamide), prostaglandin analogues, beta-adrenergic blockers, and alpha2-adrenergic agonists. Patients with a self-reported history of sulfa allergy had significantly more ocular adverse reactions after the initiation of any of the topical antiglaucoma medications when compared to those patients with no reported allergies. Patients with a self-reported sulfa allergy and patients who self-reported other, nonsulfa-related allergies had similar rates of adverse reactions to most of the topical medications. The patients reporting a sulfa allergy who used topical CAIs did not have more adverse reactions compared with patients who reported having other, nonsulfa-related allergies who used topical CAIs. Self-reported sulfa-allergic patients had similar rates of adverse reactions to topical CAIs compared with topical prostaglandin analogues. It may be safe to use a topical CAI in patients who report a history of a sulfa allergy. Patients with medication allergies of any kind may be more likely to develop allergic reactions to other, unrelated drug classes.

To analyze refractive outcomes of wavefront-optimized (WFO) ablation and topography-guided custom ablation (TCAT) profiles using the Allegretto Wave excimer laser platform (Alcon Laboratories, Inc., Fort Worth, TX) in the treatment of myopia. Sixty eyes of 30 patients who underwent LASIK were included in this prospective interventional study. WFO ablation was performed in one eye (WFO group) and TCAT in the fellow eye (TCAT group). The WaveLight FS200 femtosecond laser (Alcon Laboratories, Inc.) was used to create the flap and Allegretto Wave excimer laser (Alcon Laboratories, Inc.) was used for photoablation. The Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany) and Allegretto Topolyzer (Alcon Laboratories, Inc.) were used to measure the corneal aberrations. Refractive visual outcomes were also compared. Accuracy, safety, and efficacy were similar in the two groups. The total root mean square (RMS) and RMS of lower order aberrations were significantly better in eyes that underwent TCAT (P < .05). There was a decrease in individual higher order aberrations in the TCAT group, with a statistically significant difference in the spherical aberrations (P = .02). The corneal asphericity (Q value) was not significantly different between the WFO (0.6 ± 0.1) and TCAT (0.51 ± 0.09) groups. The postoperative total RMS of higher order aberrations was lower in the TCAT group, but this was not statistically significant (P > .05). There was a more positive change in Q value and spherical aberrations in the WFO group, but this was not statistically significant. TCAT and WFO ablation provided essentially equivalent outcomes after myopic LASIK, with induction of fewer lower order aberrations and higher order aberrations following TCAT ablation. [J Refract Surg. 2017;33(1):6-10.].

Risk Factors for Poor Adherence to Eyedrops in Electronically Monitored Patients with Glaucoma

To compare the rate of epithelial healing following photorefractive keratectomy (PRK) with two commercially available fourth-generation fluoroquinolones, gatifloxacin (Zymar, Allergan, Irvine, California) and moxifloxacin (Vigamox, Alcon Laboratories, Fort Worth, Texas). Double-masked, randomized, prospective trial. Thirty-five subjects received gatifloxacin in one eye and moxifloxacin in the fellow eye following PRK with a 9.0-mm epithelial defect. Patients were examined daily after surgery until the epithelium had healed completely in both eyes. Beginning on post-operative day 3, photos were taken and used to confirm epithelial healing or measure the area of residual epithelial defects. Healing times and defect sizes were compared using the Wilcoxon signed-ranks test. Both eyes healed on the same day in 18 of the 35 subjects (51.4%). In 13 of 35 (37.1%) subjects, the moxifloxacin-treated eye healed first, compared with only four of 35 (11.4%) subjects whose gatifloxacin-treated eye healed first. All six of the eyes that took 2 days longer than their fellow eye to heal were gatifloxacin-treated. Median healing time for both groups was 4 days (moxifloxacin range: 3 to 7 days; gatifloxacin range: 3 to 9 days; P = .01), but only 69% of gatifloxacin-treated eyes had healed by day 4 compared with 80% of the moxifloxacin-treated eyes. Overall, on each post-operative day, defect sizes were greater for the gatifloxacin-treated eyes. This difference was statistically significant on day 4 (P = .027). Eyes treated with moxifloxacin healed faster and had smaller defects compared with those treated with gatifloxacin. This provides another factor to consider in selecting antibiotic prophylaxis for corneal refractive surgery.

BackgroundThe aim of this study was to compare the safety and efficacy of 20,000 cuts per minute (cpm) with 10,000 cpm in vitreous cutters.MethodsThis was a prospective, parallel, single masked randomized control trial comparing the 25 gauge 20,000 cpm HYPERVIT Dual Blade from Alcon Laboratories, Fort Worth, TX, USA and 10,000 cpm ULTRAVIT vitrectomy cutter from Alcon Laboratories, Inc, Fort Worth, TX. Standard T-test by SPSS version 27 was used to compare efficiency and safety between two groups.ResultsIn total 72 patients were recruited for the study and among them 71 patients completed the study. This study did not show any significant difference between 20,000 cpm probe and 10,000 cpm probe (p value = 0.347) for the core vitrectomy duration in all included eyes. The mean of core vitrectomy time was 269.28 s in the 25 gauge 20,000 cpm group and 289.44 s in the 25 gauge 10,000 cpm group. However, by comparing the two systems operated on epiretinal membrane eyes, 20,000 cpm probe had a significantly shorter mean core vitrectomy time than 10,000 cpm group (P = 0.03). The majority of all the patients had no intraoperative retinal tear (98.6.8%) and post-operative retinal tear (95.8%). There were no intraoperative iatrogenic breaks, and 3 postoperative retinal tears with rhegmatogenous retinal detachment (RRD) were documented. All the retinal tears belongs to the 20,000 cpm group but no significant difference was found between the two groups in terms of retinal tear and complications.Conclusions25-gauge 20,000 cpm Hypervit dual blade showed a faster trend in vitrectomy time although this was not statistically significant in all included eyes. By comparing vitrectomy time operated on epiretinal membrane eyes, a significant shorter time was found in 25-gauge 20,000 cpm. With more efficient and faster vitrectomy systems, the effect of surgeon factor likely plays a larger role. Our study suggest that the two devices may have a similar efficacy and safety. However, further studies may be needed to compare the core vitrectomy time between them after excluding the surgeon factor influence.

Outcomes of Bilateral Cataract Surgery in Tanzanian Children

Inferior Pseudophakic Retinal Detachment

This study aimed to compare ocular wavefront aberrations for pupil diameters of 4 mm and 6 mm, and contrast sensitivity, in eyes with AcrySof IQ and AcrySof Natural intraocular lenses (IOLs). Sixty eyes of 60 patients were enrolled in this prospective randomized study. After phacoemulsification the eyes received either AcrySof IQ SN60WF or AcrySof Natural SN60AT IOLs. One month after surgery, all patients underwent complete ophthalmological examination including corneal topography, wavefront analysis for pupil diameters of 4 mm and 6 mm, and contrast sensitivity measurements with the CSV 1000E instrument under photopic and mesopic conditions with and without glare. There was no statistically significant difference between groups in age, sex or other preoperative ocular characteristics (p > 0.05). Patients with AcrySof IQ IOLs had higher contrast sensitivity at 6 c.p.d. under photopic conditions, at 6 c.p.d. and 18 c.p.d. under mesopic conditions, and at 6 c.p.d., 12 c.p.d. and 18 c.p.d. under mesopic conditions with glare (p < 0.05). Corneal spherical aberration was 0.273 ± 0.074 μm in the AcrySof Natural group and 0.294 ± 0.086 μm in the AcrySof IQ group (p = 0489). Ocular spherical aberration was 0.362 ± 0.141 μm and 0.069 ± 0.043 μm (p < 0.001) for 6-mm diameter pupils and 0.143 ± 0.091 μm and 0.017 ± 0.016 μm (p < 0.001) for 4-mm diameter pupils, with AcrySof Natural and AcrySof IQ IOLs, respectively. There were no significant differences in other higher-order aberrations between the groups (p > 0.05). Aspherical AcrySof IQ IOLs significantly reduced spherical aberration for pupil diameters of both 4 mm and 6 mm and also improved contrast sensitivity more than spherical AcrySof Natural IOLs, especially in mesopic conditions.

Incidence of Dislocation of Intraocular Lenses and Pseudophakodonesis 10 Years after Cataract Surgery

Carbonic anhydrase inhibitors (CAIs) have been used for many decades in the treatment of glaucoma. Systemic CAIs were an early treatment option to lower intraocular pressure by reducing aqueous humour...

Dorzolamide, a topically active carbonic anhydrase inhibitor, is an effective new glaucoma medication that creates a decrease in intraocular pressure similar to that produced by beta-blockers. When beta-blockers are contraindicated, dorzolamide may be used as a first-line therapy. It has excellent additivity with other topical ocular hypotensive medications, including beta-blockers and pilocarpine. Systemic side effects are minimal, particularly compared with those of oral carbonic anhydrase inhibitors. However, local side effects, including corneal edema in patients with borderline endothelial function, may occur. Decreased visual acuity and allergic reactions, which occur frequently, may curtail the use of dorzolamide in some patients.

To investigate the effect of perioperative intraocular pressure (IOP) lowering medications on controlling postoperative IOP following uncomplicated phacoemulsification. Ovid MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched up until November 2022. Randomised controlled trials (RCTs) that assessed IOP change via applanation tonometry in medicated and control arms following uncomplicated cataract surgery in healthy eyes were included. The primary outcome was the weighted mean difference (WMD) of IOP at 2-8 h, 12-24 h, and 1-7 days postoperatively within each medication class or common fixed-combination formulations. Risk of bias was assessed using the revised risk of bias in randomised trials (RoB-2). Level of evidence was rated using theGrading of Recommendation, Assessment, Development and Evaluation (GRADE) RESULTS: From 702 screened articles, 30 RCTs involving 2986 eyes were included. There was a statistically significant reduction in IOP favouring treatment arms at 2-8 h (WMD = -3.87 mmHg; 95% CI [-4.75, -3.00]; p < 0.001) and 12-24 h (WMD = -2.69 mmHg; 95% CI [-3.36, -2.02]; p < 0.001), with the effect wearing off beyond 1 day (p = 0.18). Between medication classes, the largest effect at both 2-8 h and 12-24 h was observed with intracameral cholinergics or fixed-combination carbonic anhydrase inhibitor-beta-blocker (FCCB) formulations. Conversely, the smallest effect was observed with prostaglandin analogues, alpha-agonists, and topical carbonic anhydrase inhibitors (CAIs). Prophylaxis against acute IOP elevations following uncomplicated cataract surgery is effective. FCCB and intracameral cholinergics are the most effective ocular antihypertensive agents, while alpha-agonists, prostaglandin analogues, and topical CAIs were found to be the least effective. These findings may inform future surgical guidelines.

Comparison of novel digital microscope using integrated intraoperative OCT with Ngenuity 3D visualization system in phacoemulsification