Eyeworld

3 3 Supported by Aerie Pharmaceuticals, Alcon Laboratories, Allergan, and Bausch + Lomb References 1. De Moraes CG, et al. Visual field change and 24-hour IOP-related profile with a contact lens sensor in treated glaucoma patients. Ophthalmology. 2016;123:744– 753. 2. Stewart WC, et al. Patient and ophthal- mologist attitudes concerning compliance and dosing in glaucoma treatment. J Ocul Pharmacol Ther. 2004;20:461–469. 3. Patel SC, et al. Compliance in patients prescribed eyedrops for glaucoma. Oph- thalmic Surg. 1995;26:233–236. 4. Konstas AG, et al. Compliance and viewpoint of glaucoma patients in Greece. Eye (Lond). 2000;14:752–756. 5. Kholdebarin R, et al. Multicenter study of compliance and drop adminis- tration in glaucoma. Can J Ophthalmol. 2008;43:454–461. 6. Richter A, et al. The impact of reducing dose frequency on health outcomes. Clin Ther. 2003;25:2307–2335. 7. Arici MK, et al. Adverse effects of topical antiglaucoma drugs on the ocular surface. Clin Experiment Ophthalmol. 2000;28:113– 117. 8. Tsai JH, et al. Incidence and prevalence of glaucoma in severe ocular surface disease. Cornea. 2006;25:530–532. Dr. Lewis practices with Sacramento Eye Consultants in Sacramento, California. He can be contacted at rlewiseyemd@yahoo.com. missed the eye when instilling drops. 5 To enhance compliance, clinicians need to tailor dosing regimens to patients' regular schedules and choose medications that require less frequent dosing. 6 In addition, they need to explain to patients how therapy is expect- ed to impact the disease and how to properly instill eye drops. It is also important to recognize that some glaucoma medications may cause ocular surface disease, with redness and irritation. 7 Furthermore, a 65.7% prevalence of glaucoma has been reported in patients with severe ocular surface disease. 8 Ophthalmologists need to identify and treat ocular surface disease and determine whether glaucoma medications should be changed. Future drug-delivery options will help reduce ocular surface exposure to medications. Conclusion Advanced technology has en- hanced the diagnosis of glauco- ma. Patient compliance remains a critical component of effective treatment, and we need to be alert for risk factors and modify treatment accordingly. angle closure and its treatment to patients. The non-mydriatic camera has been a huge boost to our practice, providing an image within 30 to 60 seconds. I can identify more pathology because I can see farther into the periphery than I can with my ophthalmo- scope, which is a useful feature in patients with small pupils. In ad- dition, I can show patients their optic nerves, which motivates compliance with medication regimens. Fundus perimetry correlates the optic nerve fiber layer defect with visual field. This will allow us to pinpoint where the visual field defect is occurring on the retina. Compliance challenges Non-compliance remains a chal- lenge, compromising treatment outcomes. Stewart et al. stated that 34% of 500 patients reported non-compliance; Patel et al. re- ported that 59% did not use drops as prescribed; and Konstas et al. reported that 44% missed more than 2 doses per week. 2–4 In research by Kholdebarin et al., almost 29% of patients contaminated the tip of the bottle and approximately 7% of patients disc hemorrhage in his left eye and a branch retinal vein occlusion in the right eye, which caused no symptoms (Figure 1). This demonstrates what happens to the nerve fiber layer with disc hemorrhages. Diagnostic and monitoring advances Diagnosis of glaucoma and iden- tification of progression remain challenging, but they are critical to prevent damage and irrevers- ible vision loss. Initially we need to diagnose the type of glaucoma and treat it, as well as monitor adherence. IOP continues to drive treat- ment, but applanation tonometry measurements vary widely. Diur- nal fluctuation, patient activity, caffeine intake, and other factors influence measurements and, consequently, therapy. In March 2016, the Food and Drug Administration approved a contact lens device (Triggerfish) that monitors IOP-related changes for 24 hours, which may provide a more comprehensive view of IOP. It is based on the assumption that a 1-mm Hg IOP change caus- es a 3-µm change in the corneal radius of curvature. De Moraes et al. reported that the parameters measured by the device in pa- tients with glaucoma during a 24- hour period corresponded to the rate of visual field progression. 1 Visual field progression analysis is another valuable tool. Included on visual field machines, it allows us to monitor treatment efficacy. During the last decade, ad- vances in spectral domain optical coherence tomography (OCT) have allowed us to image the disc. I strongly recommend OCT imaging, allowing us to diagnose glaucoma, determine the area of abnormality and degree of injury, and monitor and document glaucoma progression and decide whether we need to advance treatment. OCT is useful for ana- lyzing the optic nerve and angle. We also can use it to explain Figure 1. Non-mydriatic camera image shows an inferior disc hemorrhage in left eye and a branch retinal vein occlusion in the right eye.

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