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Journal Francais D'ophtalmologie Mar 2022To explore the national trend in prescriptions for glaucoma and ocular hypertension (OHT) in France between 2014 and 2019.
PURPOSE
To explore the national trend in prescriptions for glaucoma and ocular hypertension (OHT) in France between 2014 and 2019.
METHODS
This is a retrospective descriptive study based on prescription data from the Primary Health Insurance Fund databases. All patients with a social security number who received one or more glaucoma/OHT prescriptions between 2014 and 2019 were identified. Figures for 2020 are not yet available as of the date of submission of this article. Demographic characteristics from Common Classification of Medical Acts information and from National Institute of Statistics and Economic Studies were analyzed. The data analysis was carried out using the R version 3.6.2.software from the available databases of the Information Systems Medicalization Program.
RESULTS
Our results suggest an increase in the number of patients treated with glaucoma drugs, which cannot be explained simply by demographic growth. There is also a change in drug prescription habits, both in the class of medication used and in the use of fixed combinations. We also note the increasing use of SLT (Selective Laser Trabeculoplasty), a relatively newer tool in the therapeutic arsenal. Over the same time period, demographic characteristics remained stable; age and sex distribution for each year remained constant. In addition, the phenomenon of poor therapeutic compliance, which we attempted to explore, remained stable.
DISCUSSION
This study updates the French epidemiologic data available on prescriptions for glaucoma and ocular hypertension, a true public health concern.
CONCLUSION
On the one hand, prescribing practices have evolved over the study period. On the other hand, the number of patients treated has increased faster than the growth of the French population over the same period. These findings are consistent with trends observed in previous studies.
Topics: Antihypertensive Agents; Glaucoma; Humans; Intraocular Pressure; Laser Therapy; Ocular Hypertension; Prescriptions; Retrospective Studies; Trabeculectomy
PubMed: 35063295
DOI: 10.1016/j.jfo.2021.05.012 -
Journal of Glaucoma Sep 2020Glaucoma remains the world's leading cause of irreversible blindness and though intraocular pressure (IOP) is the most prevalent risk factor and only reliable... (Review)
Review
Glaucoma remains the world's leading cause of irreversible blindness and though intraocular pressure (IOP) is the most prevalent risk factor and only reliable therapeutic target, a number of systemic disease associations have been reported. Metabolic syndrome (MetS) is a constellation of findings that includes systemic hypertension, abdominal obesity, glucose intolerance, and dyslipidemia. MetS is becoming increasingly common worldwide, with prevalence up to 40% in some countries. Not only is MetS a significant cause of morbidity, but it is also associated with an increase in all-cause mortality. Reports have been conflicting regarding the association of individual components of MetS, including systemic hypertension and diabetes, with elevated IOP or glaucoma. However, though limitations in the existing literature are present, current evidence suggests that MetS is associated with IOP as well as glaucoma. Additional studies are needed to clarify this association by incorporating additional metrics including assessment of central corneal thickness as well as optic nerve structure and function. Future studies are also needed to determine whether lifestyle modification or systemic treatment of MetS could reduce the incidence or progression of glaucoma.
Topics: Glaucoma; Humans; Intraocular Pressure; Metabolic Syndrome; Ocular Hypertension; Risk Factors; Tonometry, Ocular
PubMed: 32618805
DOI: 10.1097/IJG.0000000000001593 -
Progress in Retinal and Eye Research Jan 2017Elevation of intraocular pressure (IOP) due to therapeutic use of glucocorticoids is called steroid-induced ocular hypertension (SIOH); this can lead to steroid-induced... (Review)
Review
Elevation of intraocular pressure (IOP) due to therapeutic use of glucocorticoids is called steroid-induced ocular hypertension (SIOH); this can lead to steroid-induced glaucoma (SIG). Glucocorticoids initiate signaling cascades ultimately affecting expression of hundreds of genes; this provides the potential for a highly personalized pharmacological response. Studies attempting to define genetic risk factors were undertaken early in the history of glucocorticoid use, however scientific tools available at that time were limited and progress stalled. In contrast, significant advances were made over the ensuing years in defining disease pathophysiology. As the genomics age emerged, it appeared the time was right to renew investigation into genetics. Pharmacogenomics is an unbiased discovery approach, not requiring an underlying hypothesis, and provides a way to pinpoint clinically significant genes and pathways that could not have been discovered any other way. Results of the first genome-wide association study to identify polymorphisms associated with SIOH, and follow-up on two novel genes linked to the disorder, GPR158 and HCG22, is discussed in the second half of the article. However, knowledge of genetic variants determining response to steroids in the eye also has value in its own right as a predictive and diagnostic tool. This article concludes with a discussion of how the Precision Medicine Initiative, announced by U.S. President Obama in his 2015 State of the Union address, is beginning to touch the practice of ophthalmology. It is argued that SIOH/SIG may provide one of the next opportunities for effective application of precision medicine.
Topics: Disease Management; Genome-Wide Association Study; Glaucoma; Glucocorticoids; Humans; Intraocular Pressure; Ocular Hypertension; Pharmacogenetics; Precision Medicine
PubMed: 27666015
DOI: 10.1016/j.preteyeres.2016.09.003 -
Methods in Molecular Biology (Clifton,... 2023In this chapter, we describe a clinically relevant inducible and reversible ocular hypertension glaucoma model, which mimics the secondary glaucoma that can be a...
In this chapter, we describe a clinically relevant inducible and reversible ocular hypertension glaucoma model, which mimics the secondary glaucoma that can be a postoperative complication when silicone oil (SO) is used as a tamponade agent in human vitreoretinal surgery. First, we detail the procedures for generating SO-induced ocular hypertension (SOHU) in mouse and describe the two variations of this model that simulate common but distinct glaucoma types. We also describe separately the related procedures for measuring IOP and removing SO to return IOP to normal. Lastly, we describe the extension of the SOHU model in nonhuman primate (NHP), which recapitulates the severe neurodegeneration of acute human glaucoma but with unique dynamic changes of IOP due to the tolerance of the NHP ciliary body. The SOHU glaucoma model is, therefore, suitable for assessing experimental therapies for neuroprotection and regeneration, with or without treatment to lower IOP (SO removal), and consequently for translating relevant findings into novel and effective clinical treatments for glaucoma and other neurodegenerations. This model is straightforward, does not require special equipment or repetitive procedures, closely simulates clinical situations, and may be applicable to diverse animal species although minor modifications may be required.
Topics: Humans; Animals; Mice; Silicone Oils; Intraocular Pressure; Rodentia; Glaucoma; Ocular Hypertension; Primates
PubMed: 37558960
DOI: 10.1007/978-1-0716-3409-7_7 -
Expert Opinion on Investigational Drugs Oct 2016Intraocular pressure (IOP) is the most significant modifiable risk factor to prevent onset or progression of glaucoma. Glaucoma prevalence continues to increase,... (Review)
Review
INTRODUCTION
Intraocular pressure (IOP) is the most significant modifiable risk factor to prevent onset or progression of glaucoma. Glaucoma prevalence continues to increase, emphasizing the need for improved ocular hypotensive treatment options. To try to improve on both tolerance and IOP control of currently available therapies, different receptors or mechanisms are being explored to reduce IOP more effectively and to improve tolerance.
AREAS COVERED
We review synthetic topical and oral drugs in early development for the management of ocular hypertension and glaucoma.
EXPERT OPINION
New therapeutic agents for IOP control have been discovered; some appear to be reasonably tolerated. IOP reduction may be limited with some agents, but other benefits although unproven may compensate for this, such as less ocular surface disease, enhanced neuro-protection or increased ocular blood flow. Further product development promises improved treatment options for ocular hypertensives and glaucoma sufferers.
Topics: Animals; Antihypertensive Agents; Disease Progression; Drug Design; Drugs, Investigational; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension
PubMed: 27548834
DOI: 10.1080/13543784.2016.1223042 -
Klinische Monatsblatter Fur... Nov 2017Glaucoma leads to blindness but there are diagnostic and therapeutic developments that aid ophthalmologists in the improved mangement of the disease compared to the... (Review)
Review
Glaucoma leads to blindness but there are diagnostic and therapeutic developments that aid ophthalmologists in the improved mangement of the disease compared to the past. Known risk factors such as age, myopia, dark pigmented skin, genetics, and elevated intraocular pressure play an important role for the individual patient's prognosis, and many yet unknown or not sufficiently investigated risk factors come along. The structured examination of the optic nerve head is crucial for the clincial diagnosis by the ophthalmologist. At least a photo documentation - better imaging of the optic nerve head and its retinal nerve fibers - should be performed in newly diagnosed suspect glaucoma or ocular hypertension. Visual field testing is just as important and it is recommended to perform 6 visual fields in the first two years after diagnosis. Treatment principles are evolving and minimally invasive surgery techniques are upcoming. However, trabeculectomy with mitomycin C is still superior regarding long-term results compared to microstents and minimal shunt procedures.
Topics: Glaucoma Drainage Implants; Glaucoma, Open-Angle; Gonioscopy; Humans; Ocular Hypertension; Ophthalmoscopes; Optic Disk; Refraction, Ocular; Risk Factors; Tomography, Optical Coherence; Visual Field Tests
PubMed: 28931182
DOI: 10.1055/s-0043-118611 -
Current Opinion in Ophthalmology Mar 2017The purpose of this review is to summarize the role of central corneal thickness (CCT) in the clinical management of a glaucoma patient. (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to summarize the role of central corneal thickness (CCT) in the clinical management of a glaucoma patient.
RECENT FINDINGS
The prognostic value of CCT is well recognized in patients with ocular hypertension. However, its predictive value in other glaucoma suspects and patients with established glaucoma is less certain. Tonometry artefacts can result from variations in CCT. However, an adequately validated correction algorithm for Goldmann applanation tonometry measurements does not exist. Newer methods of tonometry are potentially less influenced by CCT but are limited in their clinical use. There may also be biological and genetic associations between corneal thickness and glaucoma. Demographics, environmental factors, glaucoma treatment and the measurement device used have a significant influence on CCT, and should be considered when interpreting the effect of cornea thickness in patients with glaucoma. New measurements of the biomechanical properties of the cornea are likely to be better approximations of the globe biomechanics than CCT, but these require further evaluation.
SUMMARY
The clinical significance of CCT is well recognized in the context of glaucoma diagnosis and management, though the extent of its importance remains debatable. Corneal biomechanical properties may be more significantly associated with glaucoma than CCT.
Topics: Cornea; Corneal Pachymetry; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Tonometry, Ocular
PubMed: 27764022
DOI: 10.1097/ICU.0000000000000335 -
Current Opinion in Ophthalmology Mar 2016The review evaluates the past 18-month literature related to cost-effectiveness of treating ocular hypertension (OHT) and give an opinion of the state of research. (Review)
Review
PURPOSE OF REVIEW
The review evaluates the past 18-month literature related to cost-effectiveness of treating ocular hypertension (OHT) and give an opinion of the state of research.
RECENT FINDINGS
Three studies question the value of intensive monitoring in OHT and glaucoma. One study suggests that implementing Ocular Hypertension Treatment Study - European Glaucoma Prevention Study (OHTS-EGPS) risk prediction in every day practice overestimates the risk of open-angle glaucoma. While two models suggest that treating all intraocular pressures above 21 mmHg would be cost-saving (but disagree on the impact of this strategy on conversion to glaucoma), another study in turn suggests than we could safely reduce medications in almost half of the patients. Two studies suggest that effective early treatment could decrease follow-up costs in OHT and one modeling study suggests that using laser in preference to medication would be cost effective in glaucoma.
SUMMARY
The results of this time-limited review are confusing as they challenge many current beliefs to continue to do more than what we are currently doing. We have a huge gap in understating whether we are currently doing the 'right' things in our every day practices.
Topics: Cost-Benefit Analysis; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension; Treatment Outcome
PubMed: 26569531
DOI: 10.1097/ICU.0000000000000233 -
Asia-Pacific Journal of Ophthalmology... 2015Glaucoma is a group of progressive optic neuropathies, characterized by the degeneration of retinal ganglion cells related to the level of intraocular pressure and other... (Review)
Review
Glaucoma is a group of progressive optic neuropathies, characterized by the degeneration of retinal ganglion cells related to the level of intraocular pressure and other factors. The exact pathogenesis of glaucoma is not known, and current therapeutic options are not sufficient to prevent or recover vision loss in glaucoma patients. Functional, repeatable, and easy-to-use animal models are therefore needed. Because of their inherent advantages, rodent animals, including mice and rats, have been widely developed as models to study various aspects of glaucoma and to evaluate possible novel therapies. However, no single model has been shown to emulate all aspects of glaucoma. In this review, we discuss currently available rodent animal models of glaucoma, their strengths and weaknesses, and the possible implications for current glaucoma research.
Topics: Animals; Disease Models, Animal; Glaucoma; Intraocular Pressure; Mice; Mice, Transgenic; Ocular Hypertension; Rats; Retinal Ganglion Cells
PubMed: 26147015
DOI: 10.1097/APO.0000000000000122 -
Ophthalmic Plastic and Reconstructive...Current literature lacks a summary of knowledge on intraocular pressure (IOP) elevation and glaucoma in thyroid eye disease (TED). This review aims to augment existing... (Review)
Review
PURPOSE
Current literature lacks a summary of knowledge on intraocular pressure (IOP) elevation and glaucoma in thyroid eye disease (TED). This review aims to augment existing literature by providing such a summary. It qualitatively evaluates current knowledge on the pathogenesis, prevalence, and management of concomitant ocular hypertension or glaucoma in TED patients.
METHODS
In this narrative review, relevant publications were identified through a computerized database search. Search results were screened for relevance. Correspondence, Editorials, and Letters to the Editors were excluded. References cited within the identified articles were used to further augment the search. Information extracted for qualitative analysis included epidemiologic data, methods of IOP assessment, management protocols, and response to treatment.
RESULTS
Studies in current literature are relatively heterogenous, differing in country of origin, TED cohort sizes, and IOP measurement techniques. Further studies are required to elucidate the true epidemiologic relationship between TED and ocular hypertension or glaucoma. Proposed models of IOP elevation include elevation of episcleral venous pressure, mucopolysaccharide deposition within the trabecular meshwork, restrictive myopathy, steroid-induced glaucoma, and secondary glaucoma. IOP-reducing effects of TED treatment options are discussed.
CONCLUSIONS
While raised IOP in TED is a common phenomenon, the diagnosis of glaucoma in TED requires a high index of suspicion before any intervention.
Topics: Glaucoma; Graves Ophthalmopathy; Humans; Intraocular Pressure; Ocular Hypertension; Trabecular Meshwork
PubMed: 34406153
DOI: 10.1097/IOP.0000000000002049