Medication Adherence in Patients With Glaucoma After Cancer Diagnosis.

PURPOSE: To determine the association between cancer diagnosis and medication adherence in patients with glaucoma. DESIGN: Cohort study. METHODS: Setting: Population-based. StudyPopulation: All patients with confirmed glaucoma in one or both eyes. All patients were aged 20 years or older. Patients who developed cancer within 2 year of a confirmed glaucoma diagnosis or who were dead within 2 year after a confirmed cancer diagnosis were excluded. Intervention orObservationProcedure(s): Individuals without cancer but with a confirmed glaucoma diagnosis were followed until they received a confirmed cancer diagnosis. They were then matched with a group of patients with confirmed glaucoma who did not develop cancer during the study period. MainOutcomeMeasure(s): Secondary adherence measured using medication possession ratio (MPR) at 1-year, 2-year, and 2-year-average intervals. RESULTS: For both patients with cancer and their matches, MPR was the highest when measured at 1-year intervals. MPR was 0.379 (95% CI: 0.370-0.388) for the cancer group and 0.313 (95% CI: 0.308-0.319) for the cancer-free group. MPR measured using 1-year intervals decreased by 17.4% after cancer diagnosis (P < .001). MPR measured using 2-year and 2-year-average intervals decreased by 10.4% (P < .001) and 9.21% (P < .001), respectively. CONCLUSIONS: Cancer diagnosis leads to lower medication adherence in patients with glaucoma. To improve medication adherence in patients with glaucoma who also have cancer, policies should directly target the burden associated with having cancer that tends to create barriers for medication refills, rather than targeting risk factors that are also applicable to patients with glaucoma but without cancer.

Endophthalmitis Incidence of Cancer Patients After Cataract Surgery: A Nationwide Matched Cohort Study in Taiwan.

PURPOSE: To compare the incidence rate of endophthalmitis after cataract surgery between cancer cohort and matched noncancer cohort. DESIGN: Matched cohort study. METHODS: Patients with cataract surgery of both eyes among a nationwide cancer cohort and 1:1 matched noncancer cohort were enrolled from the years 1998 to 2012 in the Taiwan National Health Insurance Research Database. Both the cancer group and the control group were followed for 3 months after the cataract surgery to obtain the rate of endophthalmitis. RESULTS: There were 23 362 patients each in the cancer cohort and in the matched noncancer cohort. The mean age of receiving first cataract surgery was 71 years. The mean duration of receiving cataract surgery was 4.3 years after cancer diagnosis. The mean duration between 2 cataract surgeries was 8-9 months. The rate of endophthalmitis within 3 months after cataract surgery was similar between the 2 study groups: 2.4‰ (95% confidence interval = 1.9‰-2.8‰) for the cancer group and 2.3‰ (95% confidence interval = 1.9‰-2.8‰) for the noncancer group, respectively (P = .892). CONCLUSIONS: Cancer patients have a similar risk of endophthalmitis following cataract surgery as the noncancer population, and the current study suggests that cataract surgery can be considered as appropriately indicated for cancer patients.

Reversal of optic disc cupping after trabeculotomy in primary congenital glaucoma.

BACKGROUND: The phenomenon of reversal of glaucomatous cupping of the optic disc following lowering of the intraocular pressure (IOP) was originally recognized in infants. We evaluated the change in optic disc cupping with normalization of the IOP after trabeculotomy in primary congenital glaucoma and assessed the factors associated with reversal of cupping. METHODS: We reviewed the records of 17 patients (24 eyes) who underwent trabeculotomy between July 1993 and June 1999 and who had been followed for at least 1 year. Surgical success was defined as IOP less than 22 mm Hg without anti-glaucoma medication, stable or reduced optic disc cupping, and lack of further corneal enlargement disproportionate to normal growth. Patients who required more than one surgical procedure to control the IOP and those with cloudy media that precluded documentation of cupping were excluded from analysis. Optic disc cupping was assessed independently before and after surgery by two clinicians. The cup:disc ratio was estimated as the percentage of surface area of the optic disc occupied by cupping in the vertical axis. We accepted a difference of 0.1 or 0.2 in the cup:disc ratio between the two observers in each subjective assessment and used the mean value of the two results for data analysis. If the difference was more than 0.2, the eye was excluded from further study. RESULTS: Of the 17 patients 4 were excluded: 2 because they received antiglaucoma medication to control the IOP postoperatively, 1 because he underwent more than one surgical procedure to control the IOP during follow-up, and 1 owing to disagreement in the assessment of the cup:disc ratio between the two observers. Eighteen eyes of 13 patients were thus included in the analysis. Twelve eyes were from boys and six, from girls. The patients were followed for a mean of 43.2 (standard deviation [SD] 30.4) months (range 12 to 90 months). The mean cup:disc ratios pre- and postoperatively were 0.74 (SD 0.20) and 0.60 (SD 0.21) respectively (p = 0.003). Of the 18 eyes 11 (61.1%) had documented reduction in optic disc cupping. The mean time to stabilization of cupping reversal was 4.8 (SD 2.8) months (range 2 to 12 months). In multivariable analysis the age of the patient at surgery was the only variable significantly associated with reversal of cupping (p = 0.027). The mean age at surgery for the 11 eyes with reduction in cupping was 6.9 (range 3 to 15) months, compared with 23.4 (range 12 to 42) months for the 7 eyes with unchanged cupping. The mean preoperative cup:disc ratio was 0.67 (SD 0.17) in the former group and 0.83 (SD 0.17) in the latter group. Six of the seven eyes with unchanged cupping had advanced cupping. INTERPRETATION: Optic disc cupping can be reversed at an early stage of primary congenital glaucoma following successful reduction of IOP. Younger age at surgery was associated with reversal of cupping.