A nationwide survey of factors influencing adherence to ocular hypotensive eyedrops in Japan.

INTRODUCTION: Few reports have investigated the status of adherence in Japan on a large scale. We aimed to investigate the status of adherence to topical glaucoma treatment and its associated factors. METHODS: A nationwide survey was conducted as a prospective fashion. Participants in this survey were subjects with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension or pseudoexfoliation glaucoma who had been prescribed anti-glaucoma ophthalmic eyedrops and whose ophthalmologist considered prescribing any fixed combination of ocular hypotensive eyedrops for the first time between 2011 and 2012. Subjects and their attending ophthalmologists independently completed a questionnaire by utilizing a fixed combination of ocular hypotensive eyedrops. RESULTS: A total of 1358 ophthalmologists from 1071 medical institutions participated in this survey. We registered 4430 subjects (2049 males and 2381 females). In total, data from 3853 subjects (87.6%) were analyzed after inclusion of subjects based on inclusion and exclusion criteria. Good adherence was defined as not forgetting instillation during the past week. Rates of good adherence reported by subjects and ophthalmologists were 72.4 and 78.5%, respectively (P < 0.0001). The consistency of adherence evaluation between subjects and ophthalmologists was moderate [kappa score 0.5025 (95% confidence interval 0.4740-0.5309)]. Significant factors associated with adherence were size of clinic, age, gender, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma. CONCLUSION: Adherence to ocular hypotensive eyedrops among Japanese subjects was relatively good. Concordance of adherence between subjects' reports and ophthalmologists' responses was moderate. Size of clinic, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma were associated with adherence among Japanese glaucoma subjects.

Proptosis in dysthyroid ophthalmopathy: a case series of 10,931 Japanese cases.

PURPOSE: This observational case series investigated the occurrence and distribution of proptosis in Japanese patients with dysthyroid ophthalmopathy (DO). The relationship among lid retraction, lid swelling, and enlargement of extraocular muscles was also analyzed. METHODS: From 1993 to 2002, 10 931 patients (2240 men and 8691 women, average age; 39.9 ± 14.0 years) with abnormal thyroid function were examined for proptosis. Proptosis was measured using a Hertel exophthalmometer, and lid swelling and retraction were classified. Orbital magnetic resonance imaging or computed tomography was used to quantify enlargement of the extraocular muscles. RESULTS: Clinically significant proptosis (≥15 mm) was present in 74.2% patients and was classified as mild (15-17 mm, 39.1%), moderate (18-20 mm, 25.9%), or severe (>20 mm, 9.2%). The average exophthalmometer reading was 17.2 ± 3.2 mm, with proptosis less pronounced with age (p < 0.001) and more pronounced in men than women (18.2 ± 3.4 mm vs. 17.0 ± 3.1 mm; p < 0.001). Lid retraction was present in 57.7% of patients, lid swelling in 46.9%, and muscle enlargement in 40.8% of patients. Multiple regression analysis revealed proptosis was strongly correlated with a young age and the male gender, followed by extraocular muscle enlargement and lid retraction and swelling (p < 0.001). CONCLUSIONS: This study assessed the measurable features of proptosis in Japanese patients with DO and contributes to the understanding by correlating symptoms and signs of DO.

Changes in adherence and associated factors among patients on newly introduced prostaglandin analog and timolol fixed-combination therapy.

PURPOSE: We investigated patient adherence and factors related to a newly introduced prostaglandin analog and timolol fixed-combination eye drops (PGTFC). PATIENTS AND METHODS: The Glaucoma Research on Adherence to fixed-Combination Eye drops in Japan (GRACE) study group performed a nationwide prospective questionnaire survey. Participants in this study were patients with glaucoma who were scheduled to receive any type of PGTFC for the first time. The participants answered a questionnaire on the day of PGTFC introduction and again at a return visit 4-6 weeks after PGTFC introduction. The physicians in charge were asked to complete a separate questionnaire on the day of PGTFC introduction. One of two leaflets was randomly delivered to each participant before the description of the PGTFC. One leaflet explained how to correctly instill the eye drops, and the other explained the clinical meaning of intraocular pressure reduction in addition to explaining how to correctly instill the eye drops. Nonadherence was defined as forgetting to instill the eye drops one or more times during the week before the return visit. RESULTS: In total, 3,597 patients (age, 68.4±12.2 years) met the study protocol requirements. PGTFC introduction significantly reduced the number of antiglaucoma eye drops from 1.93±0.78 to 1.34±0.54 (P<0.0001) and significantly improved adherence (P<0.00001). Factors significantly associated with nonadherence at the return visit included a history of nonadherence as reported by either the patient or their physician before introduction, acceptable instillation times as reported by the patient, and burdensome eye drop instillation as reported by the patient. No significant difference was observed between the two leaflets in terms of their effects on adherence. CONCLUSION: PGTFC significantly improved adherence and some of the factors that were significantly associated with adherence. REGISTRATION NUMBER: UMIN000013696.

Immunohistologic study of interleukin-1, transforming growth factor-beta, and alpha-smooth muscle actin in lens epithelial cells in diabetic eyes.

PURPOSE: To assess the effects of the cytokines interleukin-1 (IL-1), transforming growth factor-beta (TGF-beta), and alpha-smooth muscle actin (alpha-SMA) in lens epithelial cells (LECs) in normal and diabetic eyes. SETTING: Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan. METHODS: Ten eyes of 10 patients with diabetic mellitus and 20 normal eyes of 20 patients with senile cataract were studied. The anterior lens capsules with LECs obtained by capsulotomy during cataract surgery were cultured. The LECs obtained immediately after surgery and on the third day of culture were immunohistologically studied to assess the activities of the cytokines. RESULTS: Interleukin-1 and TGF-beta staining showed a low level activity in some LECs in diabetic eyes but only a minimum level of activity in those in normal eyes. During culture, LECs in diabetic eyes became small and transformed into fusiform and fibroblast-like cells, and these cells were strongly stained for IL-1 and TGF-beta. Normal eyes showed little changes in cell morphology and were weakly stained for IL-1 and TGF-beta. Both with culture and with no culture, alpha-SMA showed only minimal activity in both diabetic and normal eyes, with no difference. CONCLUSION: Lens epithelial cells after cataract surgery had low IL-1 and TGF-beta activities, and these activities increased during culture. Diabetic eyes showed higher cytokine activities and more marked morphologic changes than normal eyes, suggesting that increased proliferative activity and increased cytokine activity of LECs contribute to strong anterior capsule contraction in diabetic eyes.

Ophthalmic surgery in dysthyroid ophthalmopathy.

The major focus of this study is to evaluate the ophthalmic surgery performed to treat patients with various eye changes of dysthyroid ophthalmopathy (DO) in Japan. The medical charts of DO cases that underwent eye surgery at the Olympia Eye Hospital in 1999 were reviewed. In 1999, 898 patients underwent ophthalmologic examination at the thyroid eye clinic in our hospital, and 51 cases were excluded out of the first visiting cases because they were hyperthyroid only and not associated with ophthalmopathy. This study consists of 847 cases (151 male, 696 female), mean age of 40.9 +/- 14.7 years, age distribution of 10-84 years. Surgical therapy was used on 129 eyes of 93 cases (11%) among the 847 patients. Orbital decompression was performed on 26 eyes of 15 cases. Most Japanese patients are not associated with a strong degree of proptosis, showing on average less than 20 mm. Cases with 25 mm of proptosis were scarcely observed. Extraocular muscle surgery was performed on 84 eyes of 60 cases (bilateral 17 cases, unilateral 33 cases). Types of diplopia are as follows: upward gaze, 28 cases; outward gaze, 10 cases; downward gaze, 2 cases; and complex type, 10 cases. Concerning the pathogenesis of diplopia in DO, fibrotic change plays a dominant role, in which cicatrical adhesion to the surface of the muscle is always observed in extraocular muscle surgery. After removal of cicatrical adhesion, the forced duction is completely recovered. This explains the precise mechanism of this involvement. Eyelid surgery was used on 39 eyes of 30 cases (upper eyelid, 33 eyes; lower eyelid, 6 eyes). Eyelid surgery was indicated for treatment of various anterior eye changes including upper eyelid retraction, entropion of eyelids. Better results and few complications are considered attributable to the stabilization of orbitopathy.