Five-Year Treatment Outcomes of Resident-Performed Ahmed Valve Implantation for Glaucoma.

PRCIS: Ahmed Glaucoma valve implantation by residents showed similar complications, success, and failure rates, regardless of their level of expertise. Training programs must encourage ophthalmologists to perform this surgery to enhance competence in their future practices. PURPOSE: To describe outcomes of resident-performed Ahmed Valve implantation over a 5-year period. METHODS: In this cross-sectional observational study we retrospectively reviewed the medical records of patients who underwent resident-performed Ahmed Glaucoma Valve implantation over a 5-year period. The main outcomes were the number of surgeries performed by first, second, and third-year residents, intraoperative and postoperative complications, and the association of level of training with outcomes and complications. RESULTS: 160 eyes were included, with a mean age of 53.8±15.4 years, 63% were men. The most frequent type of glaucoma was neovascular glaucoma (67.5%). Mean follow-up was 23.2±19.6 months. Residents of higher years performed more surgeries and no relationship was found between the surgeon's level of training and type of glaucoma operated on. After the surgical procedure, significant changes in best-corrected visual acuity were noted in surgeries performed by third-year residents (P=0.04). Intraocular pressure and number of medications were significantly reduced in all groups (P=0.01). Complications were registered in 60 eyes; the most frequent being the presence of a transient flat anterior chamber (27.45%). CONCLUSIONS: There were no significant differences in terms of IOP control and the number of complications in the three groups. There was no significant association between the resident's experience and the outcomes of the surgery. The Ahmed valve implant is a procedure that appears to have similar results in surgeons with different levels of training.

Depression and Medical Treatment Adherence in Mexican Patients With Glaucoma.

PRECIS: The prevalence of depression in Mexican patients with glaucoma is higher than that reported in the general population. Depression prevalence and severity are directly associated with glaucoma severity and lower adherence to medical treatment. PURPOSE: To determine the prevalence of depression in patients with glaucoma and to describe the correlation between the severity of depression, glaucoma, and treatment adherence. PATIENTS AND METHODS: This cross-sectional study included 111 patients with glaucoma who answered the Beck Depression Inventory (BDI)-II and the Morisky-Green questionnaire that evaluated their depression severity and medical treatment adherence. Low treatment adherence was defined as having a score of >2 on the Morisky-Green questionnaire. Analysis of variance, Fisher exact test, and linear regression models were used for statistical analyses. The main outcomes were prevalence of depression, prevalence of depression according to glaucoma damage, and the association between depression severity, medical treatment adherence, and glaucoma damage. RESULTS: The average patient age was 67.6±13.8 years. The prevalence of depression was 50.4%. Analysis of variance revealed a statistically significant association between glaucoma severity of the "worse eye" and the BDI raw score. In the "better eye," there was no statistically significant difference in mean BDI raw scores across glaucoma severity categories. There was a statistically significant association between the presence of depression and the level of treatment adherence after adjusting for age, sex, type of glaucoma, and the glaucoma severity in both eyes. The risk of low treatment adherence in patients with depression was 38 times that of patients with no depression. CONCLUSION: Glaucoma is associated with a prevalence of depression nearly 10 times higher than that in the general population. Glaucoma, depression severity, and lower adherence to medical treatment are associated.

Glaucoma Medication Preferences among Glaucoma Specialists in Mexico.

AIM: To determine the glaucoma specialists' preferences for the different brands of topical glaucoma medications available in Mexico. MATERIALS AND METHODS: A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice. RESULTS: Data from 111 (74%) glaucoma specialists were collected. Imot (timolol 0.5%; Sophia, Mexico) was the preferred brand for the beta-blockers (BB) class by 71% (n = 79) of the participants. Azopt (brinzolamide 1%; Alcon Lab, US) was the preferred carbonic anhydrase inhibitor (CAI) by 54% (n = 60) of the glaucoma specialists. Lumigan (bimatoprost 0.01% and 0.03%; Allergan Inc., U.S.) was the first choice for the prostaglandin analogues (PGAs) in 62% (n = 70) of the answers. The most frequently prescribed alpha-agonist (AA) was Agglad (brimonidine 0.2%; Sophia Lab, Mexico) in 44% (n = 49) of the answers. Medication accessibility (31%), cost (29%), and recommended dose (23%) were the three main factors influencing the glaucoma specialists' preferences. CONCLUSION: Medication cost and accessibility, as well as posology, remain the main factors influencing brand preferences among glaucoma doctors. In our professional opinion, the therapeutic effect must be the leading factor when prescribing topical medications in the daily practice, so that patients receive the best treatment option. CLINICAL SIGNIFICANCE: This survey provides an understanding of the decision-making process when prescribing glaucoma medications by glaucoma specialists in a Latin American developing country. Ideally, patient treatment should be individualized and aimed to achieve the best results possible for their specific condition.How to cite this article: Lazcano-Gomez G, Alvarez-Ascencio D, Haro-Zuno C, Turati-Acosta M, Garcia-Huerta M, Jimenez-Arroyo J, Castañeda-Diez R, Castillejos-Chevez A, Gonzalez-Salinas R, Dominguez-Dueñas F, Jimenez-Roman J. Glaucoma Medication Preferences among Glaucoma Specialists in Mexico. J Curr Glaucoma Pract 2017;11(3):97-100.