Association of strength of religious adherence with attitudes regarding glaucoma or ocular hypertension.

BACKGROUND: To evaluate the impact of religious adherence on a patient's outlook on disease in a glaucoma population. METHODS: A prospective survey analysis of patients with open-angle glaucoma or ocular hypertension evaluating self-reported global religious adherence, adherence to specific basic activities and knowledge of faith ('maturity') and 'comfort' (ability to cope, attitude toward glaucoma, motivation to take medication and God's concern). This specific analysis was limited to self-professed Christians. RESULTS: 248 patients were included and religious adherence was correlated to religious activity and knowledge (p < 0.0001). Patients who scored as adherent on at least 1 of 4 maturity questions had greater benefit than less adherent patients from each of the 5 comfort questions (p < 0.0001). We found an increased statistical separation on each of the 5 comfort questions between religiously adherent and less adherent individuals for patients who scored as adherent on any 2 (n = 40), 3 (n = 50) or all 4 (n = 57) of the maturity questions (p < 0.001). CONCLUSIONS: This study suggests, at least for the Christian faith, that religious patients are subjectively more prone to cope with treatment and that religiosity increases the self-confidence, and possibly the quality of life, of patients with glaucoma or ocular hypertension. Whether this necessarily translates into better glaucoma practices remains to be demonstrated by further studies.

Is there any difference in target intraocular pressure for exfoliative glaucoma patients with cardiovascular disease history?

PURPOSE: To investigate if patients with exfoliation glaucoma (XFG) with cardiovascular disease (CVD) require different target intraocular pressure (IOP) compared to patients with XFG with no CVD for long-term stability. METHODS: A retrospective, multicenter, observational cohort analysis included consecutive patients with XFG from 9 European academic centers, with a minimum of 5 years follow-up. RESULTS: In 201 patients, there was a statistical difference between progressed and non-progressed patients in mean (p=0.0049) and peak (p=0.015) IOP, variance of IOP (p=0.028), and number of medicine changes/year (p=0.0037). At a mean IOP ≥22 mmHg, patients progressed in 84% (32/38), between 14 and 21 mmHg in 54% (81/151), and at ≤13 mmHg in 33% (4/12). There was no difference in the rate of progression between groups based on CVD history (p=0.65). However, IOP that allowed ≤50% progression rate for patients with mild or no CVD was ≤20-21 mmHg and ≤18 mmHg for patients with severe disease. Further, at IOP ≥20 mmHg, 8% (1/12) of patients with severe CVD remained stable in contrast to 38% (16/42) of patients with mild and 21% (4/19) with no CVD history (p=0.0093). By multivariant regression analysis of the IOP and CVD measures, mean IOP was a risk factor for progression (p=0.0097). CONCLUSIONS: Although IOP is the main determinant of progression in XFG under treatment, history of severe CVD should be further investigated as potential risk factor for glaucomatous progression.

Meta-analysis of timolol on diurnal and nighttime intraocular pressure and blood pressure.

PURPOSE: To evaluate the nighttime intraocular pressure (IOP) and blood pressure (BP) response to timolol treatment in patients with ocular hypertension or primary open-angle glaucoma. METHODS: This was a meta-analysis of previously published studies that must have been randomized, prospective, crossover or parallel, single or double-masked trials. The treatment period must have been ≥2 weeks with ≥19 patients per treatment arm for a crossover, and ≥50 patients for a parallel designed trial. Studies must have included both baseline and treated 24-hour curves. RESULTS: For the IOP analysis, we included 8 articles with 340 patients. A reduction from baseline was observed for timolol at each time point and for the 24-hour curve (p≤0.009). When 2 studies, in which timolol was used adjunctively, were removed, a similar difference was observed as above at each time point and for the 24-hour curve (p≤0.003). In 2 studies, there were small reductions from baseline for the mean diastolic and systolic BPs at most time points and for the 24-hour curve (3.9 and 4.2 mmHg, respectively) with timolol treatment. The ocular perfusion pressure did not show any difference between baseline and timolol treatment at any time point or for the 24-hour curve (p>0.05). CONCLUSIONS: This meta-analysis suggests that topical timolol therapy provides an ocular hypotensive effect over the 24-hour curve, including the nighttime hours, and while small reductions in the systolic and diastolic pressures occur, the ocular perfusion pressure is not altered over 24 hours.

Long-term benefit of reduced intraocular pressure in primary open-angle glaucoma patients in Ethiopia.

PURPOSE: To determine the incidence of progression of primary open-angle glaucoma at individual levels of mean intraocular pressure (IOP) in patients in Ethiopia. METHODS: A retrospective, multicenter, cohort analysis of patient records with at least 5 years of potential follow-up were evaluated for risk factors associated with progressive optic disc and visual field loss. RESULTS: There were 300 patients with the potential of 5 years of follow-up. In total, 166 patients progressed before 5 years and 134 remained stable for the full 5-year follow-up period. Of the total sample, 84% of patients with IOPs < or =19 (n=117/139), 53% of patients with IOPs of 20 (n=9/17), 14% of patients with IOPs of 21-24 (n=9/63), and 0% of the patients with IOPs of > or =25 mmHg (n=0/79) remained stable over at least 5 years. The mean IOP was 17.4+/-2.1 in the stable group and 25.0+/-5.9 mmHg in the progressed group (p<0.0001). The highest average peak IOP was 24.5+/-4.5 in the stable group and 29.0+/-6.1 mmHg in the progressed group (p<0.0001). A multivariant regression analysis to determine risk factors for progression was positive for mean IOP (p=0.0097). CONCLUSIONS: This study suggests that IOP reduction in a developing country, despite potential limitations in diagnostic techniques, follow-up, and compliance, can be effective in reducing the risk of glaucomatous progression over long-term follow-up.

Incidence of conjunctival exposure following drainage device implantation in patients with glaucoma.

PURPOSE: To evaluate prior studies including a glaucoma drainage device and to describe the timing and incidence of conjunctival exposure. A meta-analysis of previously published articles. METHODS: Articles included were prospective, single cohort, or comparative parallel design, with a mean treatment period of at least 3 months and at least 30 patients per treatment arm. We limited our analysis to studies that evaluated the most common devices, including Ahmed, Baerveldt, and Molteno. RESULTS: We included 38 studies containing 45 treatment arms (16 Ahmed, 12 Baerveldt, and 17 Molteno). These studies included 3,105 patients and 3,255 eyes with an average follow-up of 26.1+/-3.3 months. The overall incidence of exposure was 2.0+/-2.6% (n=64) of eyes with an average exposure/month of 0.09+/-0.14%. There was no significant correlation between study length and incidence of exposure (p=0.11), although multivariate regression analysis identified length of follow-up as a risk factor for exposure (p=0.001). Among individual drainage devices, there was no significant difference in the incidence of exposure (p=0.22) or percent exposure per month (p=0.18). In addition, no difference existed in the incidence of exposure between sizes for the Baerveldt 250, 350 or 500 mm (p=0.7), number of plates for the Molteno Single or Double (p=0.3), nor between the composition of the Ahmed Silicone or Polypropylene (p=0.7). CONCLUSIONS: This study suggests that tube exposure of glaucoma implants is unusual and the incidence does not differ between the Ahmed, Baerveldt, and Molteno implants. However, exposure appears to occur at any time within the first 5 years following implantation.