The Utility of iCare HOME Tonometry for Detection of Therapy-Related Intraocular Pressure Changes in Glaucoma and Ocular Hypertension.

PURPOSE: To assess whether iCare HOME rebound tonometry can detect therapy-related changes during self-monitoring of intraocular pressure (IOP). DESIGN: Prospective clinical trial. PARTICIPANTS: A total of 43 eyes (n = 27 subjects) with open-angle glaucoma or ocular hypertension were enrolled during standard-of-care clinic visits. Participants were grouped into control eyes managed on stable therapy (n = 18 eyes) or therapy change eyes undergoing selective laser trabeculoplasty (SLT, n = 8 eyes), initiating topical therapy (n = 8 eyes), or adding a second medication to existing monotherapy (n = 9 eyes). METHODS: Subjects recorded IOP 4 times daily for 1 week using iCare HOME tonometry. Upon tonometer return, subjects underwent SLT or new medication start; an additional week of iCare HOME measurements was collected after 4 to 6 weeks. Control subjects recorded an additional week of measurements after 6 weeks. Measurements were grouped into 4 time periods (5-10 am, 10 am to 3 pm, 3-8 pm, 8 pm to 1 am). Goldmann applanation tonometry (GAT) was performed at each study visit for comparison. MAIN OUTCOME MEASURES: Detection of therapy response defined as an IOP reduction of ≥20%. RESULTS: For eyes that demonstrated a therapy response by GAT (n = 11), iCare HOME detected a therapy response in 90.9% of eyes in ≥1 time period and 45.5% of eyes in all 4 time periods. In eyes without a GAT-measured therapy response (n = 14), iCare HOME detected a response for 71.4% (n = 10) of eyes in ≥1 time period and for 7.1% of eyes (n = 1) at all 4 time periods. In treatment eyes, intraday and interday average minimum and maximum IOP, as well as interday IOP range, were significantly reduced after therapy without a significant change in intraday IOP range. Control group eyes did not demonstrate a significant change in average IOP minimum, maximum, or range between study weeks. CONCLUSIONS: Home tonometry with iCare HOME reliably detects therapy-related IOP changes in patients with glaucoma and ocular hypertension. Treatment responses correlated well with in-office GAT and may detect treatment responses missed by GAT. Intraocular pressure measurements via home tonometry provide additional clinical information regarding intraday and interday IOP fluctuation beyond standard of care in office GAT measurements. The iCare HOME is a valuable tool to monitor therapeutic efficacy in patients with glaucoma.

Neuropsychiatric effects of tamoxifen: Challenges and opportunities.

Epidemiological, clinical, and basic research over the past thirty years have described the benefits of estrogen on cognition, mood, and brain health. Less is known about tamoxifen, a selective estrogen receptor modifier (SERM) commonly used in breast cancer which is able to cross the blood-brain barrier. In this article, we review the basic pharmacology of tamoxifenas well as its effects on cognition and mood. The literature reveals an overall impairing effect of tamoxifen on cognition in breast cancer patients, hinting at central antiestrogen activity. On the other hand, tamoxifen demonstrates promising effects in psychiatric disorders, like bipolar disorder, where its therapeutic action may be independent of interaction with estrogen receptors. Understanding the neuropsychiatric properties of SERMs like tamoxifen can guide future research to ameliorate unwanted side-effects and provide novel options for difficult to treat disorders.

Ophthalmic medication price variation across the United States: Anti-inflammatory medications.

BACKGROUND: Cost-related nonadherence to medication can impact ophthalmic treatment outcomes. We aimed to determine whether medication prices vary between US cities and between different types of pharmacies within one city. METHODS: We conducted a phone survey of eight nationwide and five independent pharmacies in five cities across the United States: Boston, Massachusetts; Charlotte, North Carolina; Denver, Colorado; Detroit, Michigan; and Seattle, Washington. A researcher called each pharmacy asking for price without insurance for four common anti-inflammatory ophthalmic medications: prednisolone acetate, prednisolone sodium phosphate, difluprednate (Durezol™), and loteprednol etabonate (Lotemax™). RESULTS: Prednisolone sodium phosphate price could only be obtained by a small subset of pharmacies (45.2%) and was excluded from additional analysis; however, preliminary data demonstrated lower cost of prednisolone sodium phosphate over prednisolone acetate. Three-way analysis of variance revealed no interaction between pharmacy type (chain versus independent), city, and drug (F = 0.40, p = 0.92). A significant interaction was identified between pharmacy type and drug (F = 5.0, p = 0.008), but not city and pharmacy type (F = 0.66, p = 0.62) or city and drug (F = 0.27, p = 0.97). Average drug prices were lower at independent pharmacies compared with chain pharmacies for difluprednate (US$211.36 versus US$216.85, F = 1.09, p = 0.297) and significantly lower for loteprednol etabonate (US$255.49 versus US$274.86, F = 14.7, p < 0.001). Prednisolone acetate was cheaper at chain pharmacies, but not statistically significantly cheaper (US$48.82 versus US$51.61, F = 0.34, p = 0.559). CONCLUSIONS: Medication prices do not differ significantly between US cities. High variation of drug prices within the same city demonstrates how comparison shopping can provide cost savings for patients and may reduce cost-related nonadherence.

Optimum time for angle visualization during ab interno glaucoma surgery: Before or after phacoemulsification.

PURPOSE: To determine whether it is more advantageous to perform ab interno glaucoma surgeries involving the angle before or after phacoemulsification. SETTING: University of Colorado Health Eye Center, Aurora, USA. DESIGN: Retrospective case series. METHODS: Video recordings were taken of eyes having phacoemulsification with or without angle surgery. From the videos, still images of the angle before and after cataract surgery were obtained. Four glaucoma physicians independently reviewed the images and were masked to whether the images presented side-by-side were captured before or after cataract surgery. The reviewers used a 5-point rating scale to assess which of the 2 presented images showed the best visualization of the angle. Patient and ocular characteristics were analyzed to determine predictive factors for better view before or after phacoemulsification. RESULTS: Twenty side-by-side comparisons (20 eyes of 20 patients) were reviewed and rated. The mean rating of all surgeons was 2.93, nearing the "3-no difference" response. The most common response was "3-no difference" between each photograph (32.5%), followed by "4-post phacoemulsification image somewhat better" (30%), and "2-pre-phacoemulsification image somewhat better" (27.5%). No ocular characteristic, including anterior chamber depth, angle pigmentation, or cumulative dissipation energy, was found to be predictive of surgeon preference. CONCLUSION: In combination phacoemulsification and angle-based glaucoma procedures, there appears to be no significant angle visualization difference whether the surgeon chooses to complete angle surgery before or after phacoemulsification; therefore, the decision of surgical order should rely on surgeon preference.