Nurse led intervention on the self-management of glaucoma among patients at federal medical center Idi Aba, Abeokuta, Ogun State, Nigeria

Background: The damaging and insidious nature of glaucoma make it spread gradually without being noticed but causes serious harm. In support to this, failure to have adequate knowledge leads to late detection and poses management problem in preventing blindness from glaucoma among glaucoma patients. This study tends to fill such gap by assessing the effect of nurse-led intervention on the self-management of glaucoma among glaucoma patients at Federal Medical Center Idi Aba Abeokuta, Ogun State, Nigeria.Methods: The study utilized one group pre-test, posttest quasi experimental research design with 97 glaucoma patients. Two research instruments were used to collect data. Data were collected over six weeks in three phases. Descriptive statistics were used to analyze the data for the research questions.Results: Mean score of knowledge level of participants on glaucoma increased from 8.13±3.14 (pre intervention) to 15.91±1.68 (post intervention). Pre intervention knowledge mean score level of participants on glaucoma self-management increased from 9.28±3.76 to post intervention mean score of 18.12±1.09; pre intervention skills' mean score of participants on the effective eye drop instillation increased from 4.23±0.88 to 8.47±0.53 at post intervention mean score.Conclusions: The training package enhanced the general knowledge and self-management of glaucoma, as well as skills in eye drop instillation. It is therefore recommended that there is need for nurses to provide clear and detailed instructions on how glaucoma medication must be effectively instilled.

Effect of Phacoemulsification on Intraocular Pressure in Healthy Subjects and Glaucoma Patients

BACKGROUND: We investigated how cataract surgery might influence long-term intraocular pressure (IOP) change in both healthy subjects and glaucoma patients. METHODS: A retrospective analysis of patients who had had clear corneal phacoemulsification with a minimum of 12 months of follow up was performed. Glaucoma patients with medically controlled open-angle glaucoma and healthy subjects with no glaucoma were included in the analysis. The change of IOP after phacoemulsification and factors associated with postoperative IOP change were investigated. RESULTS: In total, 754 eyes of 754 patients, specifically 106 patients with glaucoma and 648 patients with no glaucoma (i.e., healthy subjects) were enrolled. The phacoemulsification effected a reduction of IOP: 1.03 ± 3.72 mmHg in healthy subjects and 1.08 ± 3.79 mmHg in glaucoma patients at postoperative 1 year (P = 0.656). There were negative coefficients of IOP until 1 year of follow up (all P < 0.001), but the IOP change gradually showed a less steeply decreasing slope (correlation coefficient: −0.993), compared with those for 1 week and 1 month of follow up (correlation coefficients: −1.893 and −1.540, respectively). In the multivariate analysis, age and preoperative IOP showed significant associations with postoperative IOP change (regression coefficients: −0.034 and 0.419 respectively, all P < 0.001). CONCLUSION: Phacoemulsification resulted in IOP reduction, which effect regressed in healthy subjects and glaucoma patients over the course of long-term follow up. Therefore, long-term monitoring of IOP change is needed. In cases of higher preoperative IOP and young patients, phacoemulsification alone is a reliable option for IOP control.

Socioeconomics of long‑term glaucoma therapy in India.

Purpose: To determine the socioeconomic impact of long‑term glaucoma therapy. Materials and Methods: One hundred and fifty consecutive glaucoma patients on medical therapy, following up at our glaucoma service for at least 6 months were recruited. A questionnaire regarding monthly income, cost of glaucoma medications prescribed, availability of medications, travel time, time spent in review clinics, compliance, education status, medical insurance and systemic or local side‑effects was administered. Results: The patients seen at the tertiary government hospital had an average monthly income of Rs. 10,912/‑ (range: Rs. 500/‑ to Rs. 50,000/‑) with approximately 56% of the patients having an income of less than Rs. 5000/month. The expenditure on anti‑glaucoma medications ranged from 0.3% in high income group to 123% of their monthly gross income in low income group (P < 0.0001). The total expenditure including travel, stay, and loss of wages of patients and accompanying persons ranged from 1.6% in high income group to 137% of the monthly income in low income group (P < 0.0001). Mean time required for a glaucoma clinic visit was 15.66 h, (range: 6–96 h/month). About 2.7% experienced systemic side‑effects and 21.3% had complaints of ocular adverse effects. About 90% of the patients were compliant. 92% were not covered by any insurance plan/government reimbursement for their treatment. Conclusions: Medical therapy for glaucoma is an economic burden to many patients and should be individualized, according to the socioeconomic status, availability of drugs and the required distance to travel to reach the specialist clinics.

Research on the Quality of Life of Glaucoma Patients

PURPOSE: To compare subjective quality of life (QOL) of a glaucoma group with a control group. METHODS: The Korean version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) was completed by 105 glaucoma clinic patients including 54 glaucoma group and 56 control group. We compared questionnaire scores and previous performed visual field parameters between a glaucoma group and a control group. RESULTS: The glaucoma group results were: Mean age: 55.73 +/- 15.17 years; mean best corrected visual acuity (BCVA; log MAR) 0.05 +/- 0.09 in better eyes and 0.06 +/- 0.09 in worse eyes; and mean intraocular pressure (IOP) 15.94 +/- 2.93 mm Hg in better eyes and 15.49 +/- 3.18 mm Hg in worse eyes. Control group scores were: Mean age: 51.85 +/- 11.36 years; mean BCVA (log MAR) 0.04 +/- 0.07 in better eyes and 0.06 +/- 0.08 in worse eyes; and mean IOP 16.40 +/- 2.50 mm Hg in better eyes and 16.13 +/- 2.16 mm Hg in worse eyes. Age, BCVA, and IOP were not significantly different between groups, but visual field index (VFI) score and visual function questionnaire (NEI-VFQ-25) total score were significantly lower in the glaucoma group (p < 0.01). Additionally, visual field parameters and QOL had a significant relationship in the glaucoma group, especially in better eyes. CONCLUSIONS: The QOL of glaucoma patients was lower than that of normal controls regardless of visual acuity. The degree of visual field loss in the better eye may affect QOL more significantly.

Research on the Quality of Life of Glaucoma Patients

PURPOSE: To compare subjective quality of life (QOL) of a glaucoma group with a control group. METHODS: The Korean version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) was completed by 105 glaucoma clinic patients including 54 glaucoma group and 56 control group. We compared questionnaire scores and previous performed visual field parameters between a glaucoma group and a control group. RESULTS: The glaucoma group results were: Mean age: 55.73 +/- 15.17 years; mean best corrected visual acuity (BCVA; log MAR) 0.05 +/- 0.09 in better eyes and 0.06 +/- 0.09 in worse eyes; and mean intraocular pressure (IOP) 15.94 +/- 2.93 mm Hg in better eyes and 15.49 +/- 3.18 mm Hg in worse eyes. Control group scores were: Mean age: 51.85 +/- 11.36 years; mean BCVA (log MAR) 0.04 +/- 0.07 in better eyes and 0.06 +/- 0.08 in worse eyes; and mean IOP 16.40 +/- 2.50 mm Hg in better eyes and 16.13 +/- 2.16 mm Hg in worse eyes. Age, BCVA, and IOP were not significantly different between groups, but visual field index (VFI) score and visual function questionnaire (NEI-VFQ-25) total score were significantly lower in the glaucoma group (p < 0.01). Additionally, visual field parameters and QOL had a significant relationship in the glaucoma group, especially in better eyes. CONCLUSIONS: The QOL of glaucoma patients was lower than that of normal controls regardless of visual acuity. The degree of visual field loss in the better eye may affect QOL more significantly.

Clinical Ability of Heidelberg Retinal Tomograph Examination to Detect Glaucomatous Visual Field Change

PURPOSE: We assessed whether Heidelberg retinal tomograph(HRT)is helpful in predicting the progression of glaucomatous field defect. METHODS: The periodic HRT and visual field results were obtained from 103 patients with primary open angle glaucoma (POAG) or glaucoma suspect who had been in our hospital from 1998 to 2000. Except 45 patients who had undergone ocular operation or had a follow-up of less than 1 year, 58 patients (48 eyes with POAG and 29 eyes with glaucoma) were selected. RESULTS: For glaucoma patients, the sensitivity and specificity to HRT on progression of glaucomatous field defect showed 35.7% and 33.3%, respectively. Their positive predictive value was 78.9%, and negative predictive value 6.9%. According to the results obtained after adjusting the cutoff value of classification score in HRT to -0.32 through the ROC curve, the sensitivity and specificity of progression in the glaucomatous field for glaucoma patients were changed to 57.1% and to 33.3%. Furthermore, the positive predictive value was 86% and the negative predictive value was 10% after the adjustment above. CONCLUSIONS: Our results showed that there was no significant correlation between HRT and progression of glaucomatous field defect in POAG patients or glaucoma suspect patients.