Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .

Initial medication adherence in newly diagnosed glaucoma patients:three adherence measures

AIM:To determine initial medication adherence in newly diagnosed glaucoma patients treated with anti-glaucoma drugs.METHODS:This retrospective and observational study included all patients diagnosed with glaucoma in the Primary Health Care units in Portugal during the years 2012 and 2013,which in consequence received a first prescription for anti-glaucoma drugs.Data was collected from electronic prescribing records of the primary care units and from pharmacy claims records.Initiation of glaucoma treatment and early discontinuation were measured,and the combination of(non)-initiation and early discontinuation accounted for initial medication(non)-adherence.RESULTS:A total of 3548 new glaucoma patients(40.1%male;59.9%female)were included.The 1133(31.9%)patients were initially classified as non-users,since there was no pharmacy claim found for their first prescription for glaucoma treatment.Additionally,277(11.5%)patients early discontinued their treatment,acquiring only their first prescription.Overall,the initial medication non-adherence rate was 39.7%since 1410 patients either didn’t initiate treatment or discontinued it early.CONCLUSION:This study,reveals a major opportunity to improve glaucoma treatment and its control,since a large proportion of patients fail to engage with their prescribed therapy,which implies that implementation of individual or group strategies that enable patients with glaucoma to correctly perform their treatment is still needed.

Epidemiological, Clinical, Therapeutic and Evolutive Profile of Primary Open-Angle Glaucoma in a Cameroonian Population

Background: Sub-Saharan Africa has the highest prevalence of primary open-angle glaucoma (POAG), at 4.2%. The efficacy of medical treatment has been demonstrated and remains one of the treatments of choice for POAG. However, in sub-Saharan Africa, its effectiveness has many challenges, due to multiple factors, including cost and access to care. Thus, the present study aimed to determine the epidemiological, clinical, therapeutic and evolutive profile of primary open-angle glaucoma patients. Methodology: A descriptive cross-sectional study was carried out in two hospitals in western Cameroon. Epidemiological, clinical, therapeutic, and evolutionary data on intraocular pressure at one year after medical treatment were analyzed. SPSS version 23 software was used for statistical analysis, with a significant p-value set at 5%. Results: A total of 201 patients with POAG were included in the study. The population comprised 100 men and 101 women, with a mean age of 54 ± 12 years. At diagnosis, the mean intraocular pressure was 23.9 ± 8.70 mmHg for the right eye and 25.5 ± 9.57 mmHg for the left eye. The mean cup/disc ratio was 0.64 ± 0.2 [0.2-1] and 0.67 ± 0.19 [02-1] in the right and left eyes, respectively. Monotherapy was the most prescribed treatment [59.2%]. After one year of treatment, intraocular pressure was reduced by 15.5% with beta-blockers, 23.66% with prostaglandins, 19.11% with carbonic anhydrase inhibitors, 35, 92% with beta-blockers and carbonic anhydrase inhibitors, 25.92% with beta-blockers and prostaglandins, 48.03% with carbonic anhydrase inhibitors and prostaglandin agonists, and 38.77% with triple therapy. Taking glaucoma severity into account, a significant reduction in intraocular pressure at one year was observed in all participants [p 0.05]. However, the target pressure was obtained in 47%, 20% and 14% of eyes suffering of mild, moderate, and severe grade of POAG respectively. Conclusion: In the present study, there was a significant reduction in intraocular pressure after one year of medical treatment. However, the reduction in intraocular pressure does not allow the target pressure to be reached in severe forms. Thus, alternatives to the medical treatment of POAG should be discussed early in the present context. .

原发性开角型青光眼患者的护理研究进展

青光眼为全球首位不可逆致盲性眼病。病理性眼压升高是原发性青光眼主要的危险因素,主要治疗原则为将眼压控制在正常范围内,减少对视神经的压迫。原发性开角型青光眼患者在住院期间会出现心理、睡眠等一系列的护理问题,在住院期间及时为患者提供生理和心理方面的护理尤为重要。为避免原发性开角型青光眼患者病情进一步进展,方便护理人员更好地为患者提供护理服务,现综合国内外研究现状对原发性开角型青光眼的护理进行综述。本研究主要从原发性开角型青光眼发病机制、治疗进展、护理措施三方面进行阐述,为护理人员在原发性开角型青光眼患者的护理方面提供依据。

青光眼局部用药的依从性及其障碍

目的:评估接受局部眼内压(IOP)降低治疗患者的药物依从性,并确定接受青光眼专家治疗的患者与接受普通眼科医生随访患者之间的药物依从性是否存在差异及导致依从性差的多个障碍。方法:横断面调查研究。纳入2020-10/2021-02共54名患者行局部降眼压药物,且受试者完成了一份定制调查问卷,评估药物依从性及其障碍。结果:约60%受试者未完全依从局部治疗。Pearson检验表明,依从性与是否接受青光眼专家的随访之间无显著关联(χ^(2)=1.2468,P=0.5361)。其次,43%的受试者排斥滴眼液,Logistic回归分析显示,受试者表现出低依从性(β_(1)=3.168,P=0.0367)。结论:问卷可有效评估对局部降IOP治疗的药物依从性及其障碍。本研究药物依从率非常低,因此必须实施策略应对影响依从性最常见的障碍。

Quality of life in glaucoma patients after selective laser trabeculoplasty

AIM：To compare quality of life and treatment satisfaction between patients who had selective laser trabeculoplasty（SLT） and those on medication.METHODS：A prospective clinical trial on 143 glaucoma patients that received SLT and a control group that continued using anti glaucoma medication was conducted. Tear break-up time（BUT）, punctuate keratitis, need for help, use of artificial tears and the treatment satisfaction survey of intraocular pressure（IOP） were measured at baseline, 6 and 12 mo. RESULTS：SLT was able to reduce the mean number of medications needed from 1.56±0.81 to 0.42±0.66 at six months and to 0.33±0.69 at one year. Punctuate keratitis was observed significantly less often（12.24%） after SLT than before（35.94%; P=0.03）. Use of artificial tears and BUT did not change significantly after SLT（P〉0.05）. At baseline, patients in the SLT group were significantly less convinced of medication effectiveness（P=0.006） and complained more about side effects（P=0.003）. After SLT, these patients had significantly more confidence in their therapy（P〈0.001）, showed less side effects（P=0.006）, complained less about changes in appearance of the eyes（P=0.003） and were less inconvenienced by the use of eye drops（P〈0.001）.CONCLUSION：SLT is able to improve treatment-related quality of life in glaucoma patients.

新生血管性青光眼的治疗进展

新生血管性青光眼(neovascular glaucoma,NVG)是一种病因复杂、破坏性极强、治疗效果较差的难治性眼病。广泛的视网膜缺血缺氧是其主要病因,早期诊断、积极预防、采取有效措施抑制新生血管生成是其治疗的关键。根据近年来国内外相关文献对NVG治疗的报导,我们对NVG药物、手术、联合治疗的新进展、新思路加以综述。

青光眼药物治疗依从性评估工具的适用性

目的验证青光眼药物治疗依从性评估工具(中文版)在国内的适用性。方法招募112名开角型青光眼或高眼压症患者,所有患者自行完成青光眼药物治疗依从性评估的问卷调查2次,2次调查之间间隔2个月。采用主成分分析(正交旋转)的方法判断青光眼治疗依从性评估工具的各模块是否合理;采用克朗巴哈系数(Cronbach'sα)来判断各模块的内部一致性信度;采用斯皮尔曼等级相关性判断2次问卷调查的稳定性,采用频度分析天花板和地板效应。我们用单变量线性回归的方法统计一般情况中各项指标与用药依从性的关联度。结果本问卷的47个题目中可以提取出24个题目组成6个模块,所有6个模块的内部一致性信度都在可接受的范围(α≥0. 6)。此问卷可重复性也很好,所有的题目都不存在天花板或地板效应。根据线性回归分析结果,发现年龄和婚姻状况与用药依从性相关(P <0. 05)。结论青光眼药物治疗依从性评估工具(中文版)适用于在中文环境下的青光眼患者中应用。如果经过适当的精修,研究者和临床医生都可以将这份问卷用于分析影响患者用药依从性的主要因素和验证干预措施的效果。

新生血管性青光眼的治疗进展

新生血管性青光眼(NVG)是具有严重致盲性的一种青光眼,归因于新生血管生成阻碍房水外流,通常继发于糖尿病性视网膜病变、缺血性视网膜中央静脉阻塞和眼部缺血综合征。NVG主要表现为封闭的房角,虹膜新生血管,严重的眼痛和视力通常较差以及非常高的眼压。因其病因复杂,治疗难度大,对患眼威胁甚大。尽管多年来已提出相当多的药物或手术治疗方式,但仍未找到一种可治疗大多数NVG以及预防失明的治疗方法。

新生血管性青光眼不同治疗方法和疗效评价

新生血管性青光眼(neovascular glaucoma,NVG)是一种继发于其他眼部或全身性疾病的严重类型的青光眼,难以控制的眼压、视力的急剧下降和眼部疼痛症状是其特点。目前国内外对NVG的研究颇多,新的治疗方法不断被探索,然而手术仍是其目前最终的治疗方式,尤其抗血管内皮生长因子(vascular endothelial growthfactor,VEGF)药物与其它手术的联合治疗更是近年NVG治疗的热门话题。本文对NVG的治疗方面的不同方法和疗效进行综述。

右旋噻吗洛尔滴眼液临床观察及与其左旋异构体的比较

目的评价右旋噻吗洛尔（Ｄ－ｔｉｍｏｌｏｌ）治疗青光眼的疗效。方法３６名原发性开角型青光眼或高眼压病人随机分为两组，分别滴用１％ Ｄ－ｔｉｍｏｌｏｌ和０．５％左旋噻吗心安（Ｌ－ｔｉｍｏｌｏｌ）。观察用药前后眼压、视野和眼血流的变化及副作用发生率。结果两组单次滴药眼压均显著降低；长期用药眼压日曲线较用药前降低；随诊３个月降压幅度无显著差异；且Ｄ组降压幅度与用药前眼压呈线性相关。用药前后，两组眼血流无显著变化；视野平均光敏度Ｄ组显著上升而 Ｌ组无显著改变。用药后的副作用轻微。结论 １％ Ｄ－ｔｉｍｏｌｏｌ是有效安全的抗青光眼药物。

湖南省青光眼患者的诊疗现况及疾病负担调查

目的调查湖南省青光眼患者的诊疗现况、依从性、生活质量及疾病负担。设计问卷调查。研究对象2023年12月25日至2024年1月31日就诊于长沙爱尔眼科医院、衡阳爱尔眼科医院和娄底爱尔眼科医院青光眼科门诊的243例青光眼患者。方法采用2022年《青光眼综合防治管理蓝皮书》调研项目的调查问卷,以线上问卷方式进行单纯随机抽样调查,问卷内容包括人口学信息、患者诊疗综合管理、患者依从性和生活质量、疾病负担。主要指标患者诊疗现况的统计描述、用药依从性评分、生活质量评分、视力和视野的损伤程度构成比。结果85.2%的患者在三级医院确诊青光眼,晚期视野损伤的患者目标眼压达标率56.5%~57.1%。95.9%的青光眼患者通过医院就诊面对面咨询医生获取青光眼相关知识,79.4%的患者希望获得健康宣教和74.1%希望获得青光眼筛查服务。31.3%的青光眼患者为低用药依从性,主要影响因素为忘记用药(89.5%)。青光眼患者的平均生活质量评分为58.4±9.3(得分比68.7%),不同治疗方案的患者生活质量评分具有统计学差异(F=4.947,P<0.001),其中仅行激光治疗的患者生活质量评分最高(70.2±10.6)。72.0%的青光眼患者有不同程度的视力损伤,67.5%的患者有不同程度的视野损伤,27.2%的患者至少一眼为盲,不同类型青光眼患者的视野损伤程度存在统计学差异(χ^(2)=11.099,P=0.011),其中原发性开角型青光眼患者的视野损伤比例最高(78.6%)。结论湖南省青光眼患者的用药依从性不高、生活质量偏低,缺乏青光眼知识、获取青光眼知识途径单一,视觉损伤比例高,致盲率高。需针对本区域青光眼患者特点加强青光眼患者管理,降低致盲率。

发育性青光眼首选治疗的临床探讨

对发育性青光眼按治疗经过分为首选手术组（５４例１００眼）和首选药物组（４８例９５眼）二组，术后追踪３年。结果：首选手术组手术成功率７７％，平均眼压２．６７±１．９９ｋＰａ，视力、视野及Ｃ／Ｄ稳定率分别为７１％、６９％、７１％。首选药物组，坚持治疗达３年以上者仅７例１３只眼，这１３只眼的眼压控制率为５３％，视力、视野及Ｃ／Ｄ稳定率分别为４６％、５３％，４６％。药物治疗的其余４１例８２只眼，分别在用药物后半年至一年半时间内，因眼压不能控制，药物顺从性差或药物的副作用等，转行手术治疗。转行手术后眼压控制率与首选手术组无统计学上的差异（Ｐ＞０．０５）。结果表明发育性青光眼首选手术与首选药物治疗相比，在眼压控制，视力、视野及Ｃ／Ｄ稳定方面均优于首选药物治疗组。因药物治疗顺从性差和欠佳。

如何提高青光眼患者的用药依从性

强调原发性青光眼患者严格遵从医嘱用药即提高用药依从性,直接关系到其治疗效果和预后。本文从提高患者对青光眼长期治疗的重要性和必要性认识,选择用药种类和滴用次数少的治疗方案,充分考虑药物副作用、费用及药品供应便利性因素,加强医患沟通、提高患者对治疗满意度等方面探讨如何提高青光眼患者的用药依从性。

中国县级及以上医疗机构青光眼诊疗服务现状分析

目的:统计分析中国县级及以上医疗机构青光眼亚专科建设、诊疗设备配备和服务提供情况,为进一步推动我国青光眼防治工作提供理论依据。方法:调查研究。2015年对全国提供眼科服务的县级及以上医疗机构通过网上填报的方式进行普查,采用描述性统计方法,对我国县级及以上医疗机构青光眼亚专科建设、诊疗设备配备和服务提供情况进行系统整理和统计分析。结果:本次调查覆盖全国6341家县级及以上医疗机构,其中设立青光眼亚专科的医疗机构有672家(10.60%)。在青光眼检查和治疗相关设备中,视力表配置率最高(99.30%),平均每家医疗机构配置3.28台;超声生物显微镜配置率最低(11.50%),平均每家医疗机构配置0.13台。眼压测量、白内障手术和小梁切开术是青光眼主要的诊疗服务类型。结论:我国县级及以上医疗机构青光眼亚专科建设亟待加强,诊疗设备配备不全,诊疗服务能力需要全面提升。