The daily, monthly, and annual cost of glaucoma therapy using ocular hypotensive eye drops in the Philippines based on a quantitative method

@#OBJECTIVE: This study aimed to calculate and compare the costs of different brands of ocular hypotensive eye drops available in the Philippines. METHODS: This was a single-center research conducted at a local laboratory. Triplicate samples of 21 different brands of locally-available ocular hypotensive drops were tested. The mass of ten drops, total usable mass, number of drops per bottle, and mass of 200-µL aliquots were measured for each sample. These were used to calculate for the total usable bottle volume, drop volume, and number of drops per milliliter of each sample. Lastly, the daily, monthly, and annual costs were computed and compared. RESULTS: Available brands of β-blockers were the most affordable options for topical glaucoma therapy, with costs ranging from Php1,838 to 8,472 per year. Innovator brands of α-agonists and carbonic anhydrase inhibitors were the most expensive, with annual costs ranging from Php7,641 to 24,295 and Php7,361 to 25,327, respectively. Fixed-combination preparations, with yearly costs ranging from Php4,307 to 22,200, were generally more costeffective than individual preparations. The cost of topical anti-glaucoma therapy can amount up to 3.3 to 66.9% of a minimum-wage earner’s annual income depending on the number and combination of drugs being used. CONCLUSIONS: The price range of ocular hypotensive eye drops available in the Philippines is wide. Cost of therapy is an important consideration for patients who acquire medications through out-of-pocket expenditure. Optimization of bottle designs and volumes is crucial to maximize the cost-effectiveness of eye drop solutions. Information on the cost of therapy should be available to both patients and physicians.

Survey of glaucoma practice patterns among members of The Philippine Glaucoma Society

@#OBJECTIVE: To identify the glaucoma clinical practice patterns among the members of the Philippine Glaucoma Society (PGS) from 2015 to 2016 using an online survey. METHODS: An online link was sent to each consenting PGS member which directed them to two poll sites. These sites asked questions about demographics and their preferred clinical practice patterns. Frequency and percent distributions were used to analyze the data. RESULTS: There was a high response rate from PGS members at 97% (42 out of 43 members). More than half of respondents (51%, n=22) defined glaucoma as glaucomatous optic neuropathy with an evident visual field loss. IOP was routinely measured by 90% (n=38) of the respondents with majority preferring to use the Goldmann applanation tonometer (GAT) (98%, n=41). Gonioscopy was done on all new patients by all PGS members but only 62% did regular gonioscopy on follow-up consultations. Most of the respondents relied on the 90D lens (88%) to assess the optic nerve. Visual field examination (VFE) was routinely requested by all respondents. Pachymetry and anterior segment optical coherence tomography (AS-OCT) were used sparingly at only 43% and 12% respectively. Appositional angle closure was addressed by performing laser iridotomy with majority of the respondents preferring a site that is covered by the upper eyelid (57%). Prostaglandin analogues were the top choice as first-line monotherapy for eyes with open-angle glaucoma. Majority of the respondents (55%) opted to do laser trabeculoplasty (LTP) as an adjunct to medical therapy. Mitomycin-C was the preferred intraoperative antimetabolite for trabeculectomy by 98% (n=41). Ahmed (71%, n=30) was the more favored glaucoma drainage device (GDD) by our respondents over Baerveldt (19%, n=8). CONCLUSION: This survey showed majority of the glaucoma practices of PGS members appear to adhere to the current clinical practice guidelines.

“VisualFields Easy”: an iPad application as a simple tool for detecting visual field defects

@#<p style="text-align: justify;"><strong>PURPOSE/OBJECTIVE:</strong> This study aims to determine the reliability of the "VisualFields Easy" application in detecting visual field loss among ophthalmology patients; and to determine the sensitivity, specificity, positive predictive and negative predictive values of this examination using the Humphrey Visual Field Analyzer as the gold standard.</p> <p style="text-align: justify;"><strong>METHODS:</strong> This is an analytical study that enrolled subjects requiring visual field examination as part of the comprehensive evaluation of their ophthalmologic condition. Each subject was tested using the standard automated Humphrey Field Analyzer (Carl Zeiss Meditec, Inc., Germany) with the 30-2 Swedish Interactive Thresholding Algorithm (SITA) and the "VisualFields Easy" application (background = 10 cd / m2 ; size V target; 16-dB stimulus) loaded in an iPad 2 ver. 8.3. The print outs of each test were then interpreted independently by the principal investigator and verified by a glaucoma specialist as positive or negative for visual field defects and computation for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were done.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> The study included 137 eyes of 77 patients, 52 (68%) females and 25 (32%) males, age ranging from 18 to 82 years with a mean (SD) of 58 (+ 14) years. The mean test duration for the standard Humphrey perimetry was 7 minutes 50 seconds (SD + 0.08s), and 3 minutes 21 seconds (SD + 0.01s) for the "VisualFields Easy". Correlations of False Positives and False Negatives between the 2 tests were p=0.02 and p=0.03 respectively and that there was no statistically significant difference between the reliability parameters of the two tests. There were a total of 74 positives and 63 negatives visual field defects for the Humphrey. These were considered as the True Positive (TP) and True Negative (TN) values. For the "VisualFields Easy", there were 67 positives and 70 negatives. The results of the "VisualFields Easy" were plotted against the Humphrey perimetry. Sensitivity was computed at 91% and specificity at 100%. Likewise the Positive Predictive Value (PPV) was computed to be 100% and the Negative Predictive Value (NPV) was computed at 90%.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> The "VisualFields Easy" application is a quick, easily accessible and fairly reliable way of measuring visual field abnormalities, both for glaucoma and neuro-ophthalmology patients. The application is not intended to replace standard automated perimetry machines, but it may have a role in detecting, documenting and monitoring visual field defects in low resource settings where visual field tests are not available.</p>

Clinical profile and demographics of glaucoma patients managed in a Philippine tertiary hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the demographic and clinical profile of glaucoma patients seen in a Philippine tertiary hospital from 2011 to 2014.<br /><br /><strong>METHOD:</strong> Medical records of glaucoma patients managed at the outpatient ophthalmology clinic from October 2010 to August 2014 were reviewed. Diagnosis of glaucoma was based on the International Society of Geographic and Epidemiological Ophthalmology (ISGEO) guidelines. The demographics, clinical profile, functional severity scoring, and initial management of patients were described.<br /><br /><strong>RESULT:</strong> Majority of the 570 patients were females (60.17%), with a mean age of 56.23 years. Eighty-five percent claimed to have no family history of glaucoma. The mean best-corrected visual acuity (BCVA) was 0.40, the mean intraocular pressure (IOP) was 23.56 mmHg, and the mean cup-to-disc (CD) ratio was 0.69. There were more primary type of glaucoma (55.48%) than secondary glaucoma. Mixed pattern was the most common type of visual field pattern at initial presentation. Majority of the defects were under GSS 2 stage 2 of mean deviation (MD) and loss variance (LV). Medical treatment was the most common initial management given to glaucoma patients.<br /><br /><strong>CONCLUSION:</strong> The primary glaucomas were more common than the secondary glaucomas seen in a private tertiary hospital. Most had moderate visual field damage (mixed type pattern) and the most common initial management given was medical treatment.<br /><br /><strong>KEYWORD:</strong> Glaucoma, Epidemiology, Primary open angle glaucoma, Primary angle closure glaucoma, Secondary glaucoma, Normal tension glaucoma, ISGEO guidelines</p>

Correlation between average retinal nerve fiber layer thickness and rim area of the spectral-domain OCT with the Humphrey visual field index in eyes with glaucoma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the correlation between the average retinal nerve fiber layer (RNFL) thickness and optic nerve head rim area (RA) measured with a spectral-domain optical coherence tomography (OCT) with the visual field index (VFI) using the Humphrey Visual Field Analyzer in glaucoma patients.<br /><strong>METHODS:</strong> Eighty-five consecutive patients diagnosed with glaucoma underwent spectral-domain OCT of the optic disc and Humphrey perimetry. A glaucoma specialist confirmed the presence of glaucomatous optic neuropathy based on findings in the optic nerve head photographs, OCT measurements of the RNFL and optic disc, and standard automated perimetry. The correlation of the average RNFL thickness and rim area with the VFI was determined using the Spearman's correlation coefficient analysis.<br /><strong>RESULTS:</strong> A total of 121 glaucomatous eyes of 85 patients were included in the study. There were 47 males and 38 females, ages ranging from 12 to 94 years. The average RNFL thickness, RA, and VFI were 67.9 ± 12.3 ?m, 0.65 ± 0.3 mm2, and 56 ± 32%, respectively. The average RNFL thickness (r = 0.35) showed a stronger positive correlation with VFI than RA (r = 0.15), but the difference was not statistically significant.<br /><strong>CONCLUSION:</strong> The average RNFL thickness and rim area of the spectral-domain OCT demonstrated a positive correlation with the VFI of the Humphrey Visual Field Analyzer. The OCT parameters, exemplified by average RNFL and RA, were not good indicators for VFI.</p>