Early Vitrectomy for Spontaneous, Fundus-Obscuring Vitreous Hemorrhage.

PURPOSE: To examine the visual outcomes of early intervention in the setting of fundus-obscuring vitreous hemorrhage (VH) presumed to be due to posterior vitreous detachment. DESIGN: Retrospective comparative case series. METHODS: All eyes that presented with a fundus-obscuring VH, defined as vision of 20/400 or worse and requiring a B-scan at presentation from 2003 to 2013, were evaluated. Eyes with any history of retinopathy, macular degeneration, recent trauma, presentation greater than 2 weeks after onset of symptoms, or follow-up of less than 2 months were excluded. The main outcome measure studied was final best-corrected visual acuity (BCVA) as dependent on the time to surgery. RESULTS: Ninety-two eyes met inclusion criteria with a mean follow-up of 490 days. Initial BCVA was logMAR 2.218 (Snellen equivalent 20/3000-20/4000, range 20/400-light perception); final BCVA was 0.318 (Snellen equivalent of 20/40-20/50, range 20/20-light perception, P < .001). Fifty-six patients (60.8%) had either a retinal tear or a retinal detachment. Patients who underwent surgery within 1 week had no significant improvement over all others; however, a significant improvement was found when comparing early vs delayed surgery groups (P < .05). There was a significantly increased risk of developing a macula-off retinal detachment in patients who did not undergo surgery within 1 week of presentation. CONCLUSIONS: Early surgical intervention results in similar visual outcomes compared to a conservative approach. However, early intervention significantly reduces the incidence of severe vision loss related to macula-involving retinal detachment. This study highlights the importance of close follow-up given the high risk of retinal detachment in fundus-obscuring vitreous hemorrhage.

Psychometrics of a new questionnaire to assess glaucoma adherence: the Glaucoma Treatment Compliance Assessment Tool (an American Ophthalmological Society thesis).

PURPOSE: To report the psychometrics of the Glaucoma Treatment Compliance Assessment Tool (GTCAT), a new questionnaire designed to assess adherence with glaucoma therapy. METHODS: We developed the questionnaire according to the constructs of the Health Belief Model. We evaluated the questionnaire using data from a cross-sectional study with focus groups (n = 20) and a prospective observational case series (n=58). Principal components analysis provided assessment of construct validity. We repeated the questionnaire after 3 months for test-retest reliability. We evaluated predictive validity using an electronic dosing monitor as an objective measure of adherence. RESULTS: Focus group participants provided 931 statements related to adherence, of which 88.7% (826/931) could be categorized into the constructs of the Health Belief Model. Perceived barriers accounted for 31% (288/931) of statements, cues-to-action 14% (131/931), susceptibility 12% (116/931), benefits 12% (115/931), severity 10% (91/931), and self-efficacy 9% (85/931). The principal components analysis explained 77% of the variance with five components representing Health Belief Model constructs. Reliability analyses showed acceptable Cronbach's alphas (>.70) for four of the seven components (severity, susceptibility, barriers [eye drop administration], and barriers [discomfort]). Predictive validity was high, with several Health Belief Model questions significantly associated (P <.05) with adherence and a correlation coefficient (R (2)) of .40. Test-retest reliability was 90%. CONCLUSION: The GTCAT shows excellent repeatability, content, construct, and predictive validity for glaucoma adherence. A multisite trial is needed to determine whether the results can be generalized and whether the questionnaire accurately measures the effect of interventions to increase adherence.