RESUMO
BACKGROUND: Despite advances in glaucoma management, topical eyedrop treatment has been paramount, with prostaglandin analogues (PGAs) being first-line agents. While late presentation is linked with deprivation, there is no recent research examining associations between deprivation and prescribing within primary care. AIM: To explore PGA prescribing in general practice over a 6-year timeline, assessing for associations with deprivation. DESIGN & SETTING: Analysis of NHS Business Services Authority data for general practice prescribing in England from April 2016-March 2022. METHOD: Glaucoma treatments by GP prescriber were extracted, identifying ~9.11-9.58 million prescriptions/annum. Data were linked to indices of multiple deprivation (IMD) quintiles of GP practices. Crude rates per 1,000 population were calculated using population data from NHS Digital. Time-series analyses facilitated comparison in prescribing nationally and in deprived areas. Autoregressive Integrated Moving Average (ARIMA) modelling facilitated measurement of synchrony between time-series using cross correlation. RESULTS: PGAs and fixed combination eyedrops account for approximately two-thirds of glaucoma-related prescribing. Prescriptions per month increased slightly over a 6-year timeline, but rates per 1,000 of population reduced in 2020-21. PGA prescriptions dispensed in deprived areas is lower than all other quintiles. Cross-correlation analysis indicates a lag of ~12 months between average PGA prescribing nationally versus more deprived areas. CONCLUSION: The rate of PGA prescribing in primary care is substantially lower in deprived versus affluent areas, with delayed uptake of PGAs in more deprived areas of ~12 months. Further research is needed to explore reasons for this discrepancy, permitting strategies to be developed to reduce unwarranted variation.
RESUMO
PURPOSE: To investigate the relationship between clinical impairment measures and reading performance in a large population with age-related macular degeneration. METHODS: The following clinical measures were evaluated on 243 patients with age-related macular degeneration: better eye distance visual acuity (ETDRS chart); threshold near word reading acuity (Bailey-Lovie Word Reading chart); maximum reading speed and critical print size (MNREAD chart); letter contrast sensitivity (Pelli-Robson); and kinetic perimetry (Bjerrum screen) to determine the nearest non-scotomatous point to fovea (NNPF; in degrees) and the central scotoma area (mm2). RESULTS: Distance acuity correlated well to threshold near word acuity (r = 0.71), but word acuity was usually poorer. Critical print size was strongly related (p < 0.001) to near visual acuity (r2 = 0.31 and beta = 0.47) and was poorer than threshold near word visual acuity by a mean difference of -0.41 (range, -1.10 to 0.34), which represents a mean acuity reserve of 2.5:1. On single regression, distance (p < 0.0001, r2 = 0.35, and beta = -102.37) and near acuities (p < 0.0001, r2 = 0.52, beta = -126.53), critical print size (p = 0.0001, r2 = 19, and beta = 0.002), contrast sensitivity (p < 0.0001, r2 = 19, and beta = 79.47), scotoma size (p = 0.006, r2 = 12, and beta = -0.04), and NNPF (p = 0.001, r2 = 12, and beta = -4.39) were all highly significantly related to reading speed although these predicted only a low percentage of variance. Best prediction of reading speed was obtained on multiple regression, where NNPF and near word acuity explained 60% of the variance (p < 0.0001). CONCLUSIONS: Optimal prediction of reading speed with clinical parameters appears to be based on the combination of near word acuity and scotoma area, explaining 60% of the variance. Other factors not measured in this study are likely to account for the rest of the prediction.
