ABSTRACT
IMPORTANCE: Ocular surface disease (OSD) is common and can reduce treatment compliance and quality of life. BACKGROUND: To determine whether a punctal plug improves OSD and reduces intraocular pressure (IOP) in patients using prostaglandin analogue monotherapy. DESIGN: Randomized controlled trial. PARTICIPANTS: Sixty eligible subjects aged >18 years with symptomatic OSD from glaucoma clinics were invited to participate. Lacrimal or glaucoma surgery, lid malposition and contact lens wear were exclusion criteria. METHODS: One eye received an inferior punctal plug, leaving the fellow eye as a control. MAIN OUTCOME MEASURES: Ocular surface disease index (OSDI), tear film breakup time (TF-BUT), Oxford cornea score, tear osmolarity and IOP were compared at baseline and 6 weeks by masked investigators. RESULTS: From 60 eligible, 48 (80.0%) participated (mean age 69.6 years; 60.0% female). OSDI reduced following plug insertion (mean difference [MD] 14.5, 95% confidence interval [CI] 5.06-23.94, P < 0.001). Compared to control eyes, in eyes receiving plugs the TF-BUT increased (MD 2.3 s, 95% CI 1.4-3.2, P < 0.001), the Oxford cornea score decreased (MD 0.5, 95% CI 0.3-0.7, P < 0.001), and tear osmolarity decreased (MD 10 mOsm/L, 95% CI 3.5-16.5, P = 0.003). Punctal plugs resulted in a significantly lowered IOP (MD 1.5 mmHg, 95% CI 0.1-2.9, P = 0.032). Sub-group analyses showed similar efficacy regardless of prostaglandin preservative status or lubricant drop use. Plugs were well tolerated but extrusion occurred in 8.5%, and epiphora increased in 6.5% eyes. CONCLUSIONS AND RELEVANCE: Punctal plug insertion improves subjective and objective measures of OSD and results in a reduced IOP in patients with symptomatic ocular surface disease using prostaglandin analogue monotherapy.
Subject(s)
Dry Eye Syndromes/therapy , Intraocular Pressure/physiology , Prostaglandins, Synthetic/administration & dosage , Punctal Plugs , Quality of Life , Administration, Topical , Adult , Aged , Aged, 80 and over , Dry Eye Syndromes/complications , Dry Eye Syndromes/physiopathology , Female , Glaucoma/complications , Glaucoma/physiopathology , Glaucoma/therapy , Humans , Intraocular Pressure/drug effects , Lacrimal Apparatus , Male , Middle Aged , Ophthalmic Solutions/administration & dosage , Treatment OutcomeABSTRACT
AIMS: The National Diabetic Retinopathy Screening Committee has recommended 19 standards for quality assurance of screening programmes in the United Kingdom. Five of the standards apply to the care provided by ophthalmology departments. This study assesses the quality assurance of the eye care provided by the Wakefield and North Kirklees Screening programme. METHODS: A retrospective audit of case notes of patients for 12 consecutive months in 2007. The outcomes were compared with the five quality standards. RESULTS: Out of a total number of 15,080 patients screened for diabetic retinopathy (DR), 479 (3.17%) required referral to ophthalmology department (screen-positive). Of these, 352 (2.33% of total screened) were referred for diabetic retinopathy. Forty-three patients (13%) were referred for proliferative retinopathy (R3), 279 (79%) for maculopathy (M1), 24 (7%) for non-proliferative retinopathy (R2), and 4 (1%) for a history of previous photo-coagulation (P1). Fifty-eight patients (16%) failed to attend. A timely consultation was achieved in 33% of R3 and 77% of M1 patients. Only 31% of R3 and 8% of M1 at screening were listed at their first visit to ophthalmology clinic and received laser treatment in stipulated time. CONCLUSION: Significant progress is required for timely consultation and management of screen-positive patients. In order to achieve these targets efficiently, it may be appropriate to re-define M1 so that a significant proportion of patients with M1 may be referred to and better managed by primary care physicians or diabetologists.
