How Do Patients Feel About Visual Field Testing? Analysis of Subjective Perception of Standard Automated Perimetry.

PURPOSE: A high rate of unreliability is an issue in visual field (VF) testing, especially in elderly patients, and warrants patient education. We assessed whether subjective perception of the visual field test (VFT) is a good predictor of its reliability in different age groups and examined age differences in patients' awareness of VF damage. METHODS: This cross-sectional study investigated 107 VFT results of 54 patients with glaucoma or ocular hypertension. Subjective perceptions were compared to reliability indices for cooperation analysis and to mean deviation results for VF damage analysis, and an age-segregated sub-analysis was performed. RESULTS: Kappa coefficients showed poor agreement between subjective and objective parameters. Nevertheless, there were age differences. Younger patients had a higher positive predictive value and sensitivity in cooperation analysis and a higher negative predictive value in VF damage analysis. CONCLUSIONS: Patients' perception of cooperation in VFT is a poor predictor of its reliability. Although young cooperative patients may be aware of their good cooperation, even the youngest are unaware of their poor performance. This emphasizes the importance of giving proper directions to all patients during VFT to obtain better reliability indices. Younger, healthy patients are more aware of their health status, than those with a damaged VF, regardless of age. Therefore, illness education is crucial in all glaucoma patients.

Illness perceptions in people newly diagnosed with glaucoma and ocular hypertension.

BACKGROUND/AIMS: To determine whether self-reported illness perceptions in newly diagnosed patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) are more negative compared with peers who have lived with their diagnosis for more than 2 years. METHODS: A cross-sectional study of 58 newly diagnosed patients with POAG and OHT recruited at their first clinic visit. Electronic patient records were used to identify similar patients (n=58, related by age and severity of visual field loss) who had their diagnosis for >2 years. All participants completed the Brief Illness Perception Questionnaire (BIPQ), EQ5D general health measure and Type D Personality Scale (DS14). RESULTS: Average BIPQ scores were similar for people newly diagnosed with POAG and POAG diagnosed >2 years and were no different to newly diagnosed OHT and OHT diagnosed >2 years POAG (p=0.46). An analysis correcting for personality type (DS14) and general health (EQ5D) indicated newly diagnosed patients with POAG to have marginally better illness perceptions on individual BIPQ items quantifying impact on life in general, experience of symptoms and 'understanding' of their condition (all p<0.01). In contrast, patients with POAG with a diagnosis >2 years understood better their condition to be long-term (p<0.01). CONCLUSIONS: Some illness perceptions differed between newly diagnosed people and patients living with their diagnosis for >2 years. Illness perception for people with manifest glaucoma and at risk of glaucoma (OHT) were similar; the latter might benefit from an intervention at diagnosis that highlights the better prognosis for OHT compared with POAG.

Acute emotional stress as a trigger for intraocular pressure elevation in Glaucoma.

BACKGROUND: Stress-induced activation of the sympathetic nervous system leads to a cascade of metabolic reactions. Emotional stress is a more specific form of stress in which the stressor is a psychological response to a situation subjectively perceived as traumatic. Stress hormones can have a wide range of effects on the body, however, it is still unclear if and how it can affect ophthalmic physiology. This report presents a case of severe ocular hypertension in which emotional stress was the only cause elicited, and explores potential aggravating factors. CASE PRESENTATION: A 78-year-old, personality type A, lady with a history of pseudo-exfoliative glaucoma presented with an acute asymmetrical raise in intraocular pressure (IOP) immediately following a family breakdown. Her IOP had previously remained stable following a deep sclerectomy in the right eye and an Ex-PRESS shunt in the left eye. Her examination was entirely normal otherwise, with a patent filtration and diffuse bleb as confirmed with anterior segment OCT imaging. Near-normalisation of her IOP was observed within 24 h, concomitantly with the reduction of her stress levels. No other cause for the transient acute hypertensive episode were found. CONCLUSIONS: This case report suggests that acute emotional stress could severely affect IOP in patients suffering from glaucoma. This could be important when looking after glaucoma patients. It would also suggest that the personnality types, and the emotional and social context are more factors to take into account in glaucoma studies. These observations are based on a single case report and would need to be verified on a larger scale.

Is Patient Knowledge of Glaucoma Improved by Using a Glaucoma Logbook?

AIMS: Patient-held records are becoming more commonly used in health care, particularly in chronic diseases like glaucoma. There is a lack of evidence to support their use, however. This study examines the change in knowledge scores within a group following the introduction of a newly designed glaucoma logbook. METHODS: This analysis uses a test and retest method where patients undergoing treatment for glaucoma or ocular hypertension were assessed using a validated knowledge questionnaire. They were then given a personalized glaucoma logbook and their knowledge scores retested after 4 to 8 weeks. The change in knowledge score was examined using a Wilcoxon signed-rank test. RESULTS: A total of 56 patients were recruited and 35 completed both questionnaires equating to a 62.5% retention rate. The analysis showed a significant increase in the knowledge score attained following introduction of the questionnaire (Z=-4.176, P<0.001). CONCLUSIONS: In this format, the glaucoma logbook has a positive impact on patient knowledge. Further research will be necessary to show if this result is maintained in a larger sample group and to investigate whether this improvement in knowledge is associated with any improvement in long-term structural and functional outcomes.

Psychometric properties of the Glaucoma Treatment Compliance Assessment Tool in a multicenter trial.

PURPOSE: To assess the psychometric properties of a new version of the Glaucoma Treatment Compliance Assessment Tool, a survey evaluating health behavior and glaucoma adherence using constructs from the Health Belief Model. DESIGN: Psychometric analysis. METHODS: We administered the 47-statement Glaucoma Treatment Compliance Assessment Tool to 201 participants who were using a single bottle of an ocular hypotensive agent, and objectively measured adherence with medication event monitoring system devices over 60 days. Adherence was the percentage of days with correctly timed bottle openings. We used principal components analysis to determine construct validity, Cronbach's alpha for internal consistency reliability, frequency analysis for floor and ceiling effects, and Spearman rho for test-retest reliability. We determined predictive validity using univariate and multiple regression. RESULTS: The mean (±SD, range) adherence percentage was 79.9% (±18.5%, 20.3%-100.0%). Principal component analysis loaded 24 questions into 6 components that were consistent with the Health Belief Model. All 6 components had Cronbach's alpha reliability between 0.601 and 0.797. No statements had floor or ceiling effects, and all statements had acceptable test-retest reliability. Multiple regression analysis showed 4 Health Belief Model statements, white race, older age, and married marital status to be associated with higher adherence (adjusted R(2) = 0.27, P < .001). CONCLUSIONS: The newest version of the Glaucoma Treatment Compliance Assessment Tool showed acceptable psychometric properties. With further refinement, clinicians and researchers could use it to examine factors related to adherence and measure improvement in adherence with a change in health behavior attitudes.

Provider use of collaborative goal setting with glaucoma patients.

PURPOSE: The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications. METHODS: English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits videotaped and were interviewed after the visits. The videotapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment. RESULTS: Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non-African American patients (Pearson χ² = 4.1, p = 0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non-African American patients (Pearson χ² = 8.2, p = 0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views on glaucoma than non-African American patients (Pearson χ² = 5.62, p = 0.02). CONCLUSIONS: Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views on glaucoma when prescribing treatment for the first time.

Health- and vision-related quality of life in patients with ocular hypertension or primary open-angle glaucoma.

BACKGROUND: The main objective of this analysis was to assess the impact of severity of disease on the quality of life (QoL) of patients with ocular hypertension (OHT) and early, moderate, or advanced primary open-angle glaucoma (POAG). METHODS: This multicenter study was conducted at 2 university hospitals and 13 ophthalmology practices in Germany. QoL data were assessed by the Health Utility Index (HUI3) and the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). RESULTS: 154 patients (17.5% OHT, 27.9% early, 22.7% moderate, and 31.8% advanced POAG) were included. The HUI3 scores for OHT, early, moderate, and advanced POAG were 0.87 ± 0.09, 0.85 ± 0.15, 0.75 ± 0.23, and 0.58 ± 0.32, respectively. Compared to a normal population matched by age and gender, for moderate and severe POAG a difference of -0.06 ± 0.24 and -0.19 ± 0.28, respectively, was observed. NEI-VFQ-25 scores illustrate different dimensions of the impact on QoL; reduced peripheral vision or difficulties to drive a car were more crucial to glaucoma patients than social factors. CONCLUSIONS: The key difference for QoL impairment in glaucoma lies between OHT/early POAG versus moderate/severe POAG, hence every possible effort needs to be made to prevent disease progression over this threshold.

Association between rates of binocular visual field loss and vision-related quality of life in patients with glaucoma.

IMPORTANCE: It is reasonable to hypothesize that for 2 patients with similar degrees of integrated binocular visual field (BVF) loss, the patient with a history of faster disease progression will report worse vision-related quality of life (VRQOL) than the patient with slowly progressing damage. However, to our knowledge, this hypothesis has not been investigated in the literature. OBJECTIVE: To evaluate the association between binocular rates of visual field change and VRQOL in patients with glaucoma. DESIGN Observational cohort study. SETTING: Patients were recruited from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. PARTICIPANTS: The study included 796 eyes of 398 patients with diagnosed or suspected glaucoma followed up from October 1, 1998, until January 31, 2012, for a mean (SD) of 7.3 (2.0) years. MAIN OUTCOME MEASURES: The VRQOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at the last follow-up visit. The NEI VFQ-25 was completed for all patients during the period extending from December 1, 2009, through January 31, 2012. Integrated BVFs were calculated from the monocular fields of each patient. Linear regression of mean deviation values was used to evaluate rates of BVF change during the follow-up period. Logistic regression models were used to investigate the association between abnormal VRQOL and rates of BVF change, while adjusting for potentially confounding socioeconomic and demographic variables. RESULTS: Thirty-two patients (8.0%) had abnormal VRQOL as determined by the results of the NEI VFQ-25. Patients with abnormal VRQOL had significantly faster rates of BVF change than those with normal VRQOL (-0.18 vs -0.06 dB/y; P < .001). Rates of BVF change were significantly associated with abnormality in VRQOL (odds ratio = 1.31 per 0.1 dB/y faster; P = .04), after adjustment for confounding variables. CONCLUSIONS AND RELEVANCE: Patients with faster rates of BVF change were at higher risk of reporting abnormal VRQOL. Assessment of rates of BVF change may provide useful information in determining risk of functional impairment in glaucoma.

Efficacy and ocular surface tolerability of preservative-free tafluprost 0.0015%: a 6-month, single-blind, observational study on naïve ocular hypertension or glaucoma patients.

OBJECTIVES: The aim of this study was to evaluate the safety of preservative-free tafluprost in newly diagnosed patients and to confirm its efficacy in lowering intraocular pressure (IOP). METHODS: Naïve patients were submitted to an ophthalmic examination, including ocular surface status and quality of life evaluation. All examinations were performed at baseline and after 1 and 6 months. RESULTS: 28 patients were enrolled and treated with tafluprost, once a day, in the evening. TF-BUT changed from 9 (interquartile range (IQR) 6 - 11) s at baseline to 10 (IQR 7 - 10) s at 1 month (p = 0.106) and 9 (IQR 6 - 12) s at 6 months (p = 0.003). No eye developed corneal staining. Quality of life was (median (IQR)) 91.6 (79.2 - 95.8) at baseline and 95.8 (66.7 - 100) at 6 months (p = 0.62). Only a few adverse events occurred during the follow-up period (three patients experienced ocular burning and one developed redness). The mean IOP reduction was 5.5 mm Hg (95% CI 3.8 - 7.2). The median (IQR) baseline IOP was 18.7 (15 - 23.7) mm Hg; 14 (13 - 16) mm Hg and 16 (14 - 16) mm Hg (p < 0.0001) after 1 and 6 months, respectively. CONCLUSION: No patient developed ocular surface disease and quality of life perception was preserved. Preservative-free tafluprost is therefore an effective drug that is safe for the ocular surface after 6 months of daily therapy.

[The influence of the Travalert(®) dosing aid on medical treatment compliance and the quality of life of glaucoma patients]. / Estudio de la influencia del dispositivo de ayuda a la dosificación Travalert(®) sobre el cumplimiento del tratamiento médico y calidad de vida de los pacientes con glaucoma.

PURPOSE: To study compliance in the medical treatment of glaucoma, its possible association with other factors, and quality of life of patients with glaucoma. MATERIAL AND METHODS: Longitudinal prospective study of 60 patients with ocular hypertension or glaucoma who were treated with travoprost, or with a fixed combination of travoprost/timolol nightly. All subjects were given a Travalert(®) dosing aid and were reviewed after one and four months. Strict and relative compliance data were collected on each visit. The relationship between compliance and other variables was studied using univariate analysis. To analyse quality of life, patients were given self-assessment STAI anxiety questionnaires after the first and last visits. RESULTS: Relative compliance for the four months was significantly greater than the strict compliance (P=.001). In the group of least compliance the number of patients on treatment with combination therapy was significantly higher than those on monotherapy. In the lost cases, the number of men was significantly higher than women. No association was found in the other variables. The anxiety was similar to that in the normal population. CONCLUSIONS: Compliance is very important in the treatment of glaucoma, and our study provides objective data through the use of Travalert dosing aid with relative compliances of 70%. Patients with combined therapies have lower compliance than those on monotherapy.

Association of strength of religious adherence with attitudes regarding glaucoma or ocular hypertension.

BACKGROUND: To evaluate the impact of religious adherence on a patient's outlook on disease in a glaucoma population. METHODS: A prospective survey analysis of patients with open-angle glaucoma or ocular hypertension evaluating self-reported global religious adherence, adherence to specific basic activities and knowledge of faith ('maturity') and 'comfort' (ability to cope, attitude toward glaucoma, motivation to take medication and God's concern). This specific analysis was limited to self-professed Christians. RESULTS: 248 patients were included and religious adherence was correlated to religious activity and knowledge (p < 0.0001). Patients who scored as adherent on at least 1 of 4 maturity questions had greater benefit than less adherent patients from each of the 5 comfort questions (p < 0.0001). We found an increased statistical separation on each of the 5 comfort questions between religiously adherent and less adherent individuals for patients who scored as adherent on any 2 (n = 40), 3 (n = 50) or all 4 (n = 57) of the maturity questions (p < 0.001). CONCLUSIONS: This study suggests, at least for the Christian faith, that religious patients are subjectively more prone to cope with treatment and that religiosity increases the self-confidence, and possibly the quality of life, of patients with glaucoma or ocular hypertension. Whether this necessarily translates into better glaucoma practices remains to be demonstrated by further studies.

An exploratory study of factors influencing glaucoma treatment adherence.

PURPOSE: To understand the factors that influence glaucoma treatment adherence with medication taking, prescription refills, and appointment keeping to develop an intervention for a specific population. PATIENTS AND METHODS: In-depth interviews were conducted with 80 individuals diagnosed with open-angle glaucoma, glaucoma suspect, or ocular hypertension. Additional eligibility requirements were that all participants were: between the ages of 18 to 80; white or African American; spoke and understood English; and were taking daily doses of topical glaucoma treatments for at least the past year. Cross-tabulations and chi2 tests were conducted to compare adherent and nonadherent individuals, classified as such based on self-report and medical chart/pharmacy data. RESULTS: Compared with adherent participants, nonadherent participants were less likely to: believe their eye doctors spent sufficient time with them; ask their eye doctor if they had any questions; know of benefits to taking their glaucoma medication regularly; and have someone help them take their glaucoma medications or drive them to eye appointments. Conversely, compared with adherent individuals, nonadherent participants were more likely to have difficulty remembering to take their medications and to believe their glaucoma would affect their eye sight in the future. CONCLUSIONS: Nonadherent glaucoma patients struggle with a variety of issues related to consistent use of glaucoma medicine and routine eye care. Interventions are needed to address these modifiable factors related to glaucoma treatment adherence.

Depression and quality of life in patients with glaucoma: a cross-sectional analysis using the Geriatric Depression Scale-15, assessment of function related to vision, and the Glaucoma Quality of Life-15.

PURPOSE: To determine the prevalence of depression and its association with visual field impairment, quality of life, objective assessment of visual function, and glaucoma severity in elderly patients with glaucoma. DESIGN: Cross-sectional study. PARTICIPANTS AND CONTROLS: One hundred sixty-five patients with mild (n=60), moderate (n=43), or severe (n=28) glaucoma and 34 controls with ocular hypertension were enrolled. Severity was stratified according to the Nelson Glaucoma Severity Scale (based on the degree of binocular visual field loss). Groups were substratified according to age. METHODS: Demographic information was collected via interviews; the Geriatric Depression Scale-15 and Glaucoma Quality of Life-15 (GQL-15) questionnaires were administered. Visual function was assessed by clinical examination and visual field testing. A subset of patients (n=68) underwent objective assessment of function related to vision. Group differences were evaluated using analysis of variance; Kruskall-Wallis analysis of ranks was performed with significance set at P<0.05. Age-adjustment of P values was performed using analysis of covariance for parametric data and Kruskall-Wallis analysis on age-stratified nonparametric data. A binary univariate regression analysis modeled depression to suspected risk factors. Significant predictive variables were modeled in a multivariate regression analysis. RESULTS: Depression was more prevalent with increasing glaucoma severity, reaching statistical significance in patients aged 70 to 79 years (P<0.02). Summary and subfactor GQL-15 scores reflected decreased quality of life with increasing glaucoma severity. Assessment of function related to vision scores indicated worsening visual function with increasing glaucoma severity. On multivariate regression analysis, depression status was correlated with age and GQL-15 summary score. CONCLUSIONS: Depression is more common in patients with increasing glaucoma severity (age, 70 to 79 y). In patients with glaucoma or ocular hypertension, age and GQL-15 summary score are independent risk factors for depression.

Persistency rates for prostaglandin and other hypotensive eyedrops: population-based study using pharmacy claims data.

BACKGROUND: Effective management of ocular hypertension requires patients to be persistent with their treatment regimen. We evaluated patients' persistency with hypotensive eyedrops commonly used to treat glaucoma and ocular hypertension. METHODS: This large, population-based, retrospective, cohort study used pharmacy claims data for concessional patients from the Australian Pharmaceutical Benefits Scheme (July 1999-June 2005). Resupply rates for prostaglandins, beta-blockers, alpha-agonists and carbonic anhydrase inhibitors were analysed using life tables and Cox regression. Two populations, based on patients' supply histories, were examined: (i) 'new to this eyedrop'- patients who had used other hypotensive eyedrops before (presumably, previously diagnosed with glaucoma or ocular hypertension); and (ii) 'new to any eyedrop'- patients who were using their first hypotensive eyedrop (presumably, newly diagnosed with glaucoma or ocular hypertension). RESULTS: Data were obtained for 14,359,618 supplies of commonly used hypotensive eyedrops to 357,099 concessional patients. For both populations, resupply rates were highest for prostaglandins or the dorzolamide-timolol combination eyedrops, compared with beta-blockers, alpha-agonists or carbonic anhydrase inhibitors. Among the prostaglandins, there was no significant difference in the risk of ceasing supply between latanoprost and bimatoprost, but the risk was significantly higher for travoprost. CONCLUSIONS: Based on resupply rates from a national pharmacy claims database, patients supplied with ocular hypotensive eyedrops were most persistent with prostaglandin (bimatoprost, latanoprost and travoprost) and dorzolamide-timolol combination eyedrops. Among the prostaglandins, persistency was highest with, and similar between, bimatoprost and latanoprost. Persistency should be taken into account when selecting the most appropriate eyedrop to treat glaucoma and ocular hypertension.

Peripapillary fundus perimetry in eyes with glaucoma.

AIMS: To evaluate, with fundus perimetry, the peripapillary differential light threshold (DLT) in eyes with glaucoma and ocular hypertension (OHT), and compare it with peripapillary retinal nerve fibre layer (RNFL) thickness. METHODS: 35 glaucomatous, 29 OHT and 24 control eyes were included. Peripapillary DLT at 1 degrees from the optic nerve head was quantified with fundus perimetry; peripapillary RNFL thickness was measured over the same area by optical coherence tomography. RESULTS: Mean (SD) peripapillary DLT was 19.2 (1.7), 17.6 (4.2) and 10.1 (6.9) dB in control, OHT and glaucomatous eyes, respectively (p<0.001). Mean (SD) RNFL thickness was 98.4 (35.3), 83.9 (35.1) and 55.8 (28.2) microm, respectively (p<0.001). Mean peripapillary DLT showed higher sensitivity and specificity in differentiating the three groups compared with RNFL thickness. CONCLUSION: Progressive, significant reduction of peripapillary DLT was documented in OHT and glaucomatous eyes compared with controls (p<0.001). DLT reduction parallels RNFL reduction.

The clinical validity of the treatment satisfaction survey for intraocular pressure in ocular hypertensive and glaucoma patients.

PURPOSE: To provide initial validation of the Treatment Satisfaction Survey-Intraocular Pressure (TSS-IOP) quality-of-life survey that analyses specific issues related to side effects, patient satisfaction, and compliance. METHODS: A prospective, observational cohort of 250 consecutive patients with primary open-angle glaucoma or ocular hypertension was administered the TSS-IOP survey. RESULTS: Factors that correlated with patient satisfaction included perceived effectiveness of the medicine (F=7.47, P<0.001), ocular irritation (F=6.06, P<0.001), conjunctival hyperaemia (F=4.40, P<0.001), ease of use (F=8.52, P<0.001), and convenience of use (F=6.90, P<0.001). Patient compliance, acceptance of their illness, and knowledge of glaucoma were also related to perceived effectiveness of the medicine (P<0.001), ease of use (P<0.05) and convenience (P<0.001). Physician ratings of patient pressure control, side effects, and instillation problems also were significantly correlated to patient satisfaction (R=0.13-0.26, P=0.05-0.001). The physician ratings of patient compliance, however, were not significantly related to any dimension of patient satisfaction (P>0.05). Among monotherapy prostaglandin treatments, latanoprost demonstrated statistically greater satisfaction than bimatoprost or travoprost regarding conjunctival hyperaemia (P<0.05) and eye irritation (P<0.01). CONCLUSIONS: This study provides initial evidence that patient satisfaction may be related to compliance, perceived effectiveness of treatment, adverse side effects, ease and convenience of use, acceptance of illness, and knowledge of glaucoma.

Psychometric Validation of the National Eye Institute Visual Function Questionnaire - 25 (NEI VFQ-25) French version: in a population of patients treated for ocular hypertension and glaucoma.

OBJECTIVE: Physicians need reliable, valid and sensitive questionnaires to assess QOL related to glaucoma or ocular hypertension. This article presents the psychometric properties of the French version of the National Eye Institute Visual Function Questionnaire - 25 (NEI VFQ-25). METHODS: A mail survey was sent to 20000 households. The survey identified 581 residents with glaucoma or ocular hypertension. Of these a random sample (n = 204) took part in a telephone survey during which the NEI VFQ-25 was completed by eligible patients (those taking at least one topical treatment for glaucoma or ocular hypertension on the day of the interview). Multi-trait analysis was performed to assess the construct validity of the questionnaire. Internal consistency reliability was assessed using Cronbach's alpha and the average inter-item correlation. Known groups validity was assessed by comparing patients grouped by duration of glaucoma, adjusted for age and gender. RESULTS: One hundred and seventy-three patients participated in the survey. Analysis of convergent validity showed that all of the items in each scale correlated above 0.40 with their own scale except for the 'driving' scale. The success rate of the discriminant validity ranged from 57.1% to 100% except for the 'driving' scale, which was 7.1%. Cronbach's alpha coefficients were all above 0.70 except the 'driving' score. Participants with glaucoma for less than 20 years consistently had better 'global', 'near vision', 'distant vision', 'driving', 'social function' and 'peripheral vision' scores than those with disease of 20+ years duration, indicating better QOL in patients with a shorter disease duration. CONCLUSION: The NEI VFQ-25 is a validated instrument to measure vision-targeted QOL in French populations with glaucoma.

[Use of brimonidine 0.2% in treatment of glaucoma or ocular hypertony after poorly tolerated beta-blocker treatment]. / Intérêt de la brimonidine 0,2% dans le traitement du glaucome ou de l'hypertension intraoculaire après intolérance à un traitement par beta-bloquant.

This study intended to evaluate the advantages of brimonidine tartrate 0.2% (Alphagan((R))), a selective alpha-2 receptor agonist, relaying a poorly tolerated beta-blocker treatment. Effectiveness, as assessed by intraocular pressure, local and general tolerance of the treatment, and the quality of life of the patients included in the study, was compared for these two eye drops. This multicenter and prospective study, performed by 450 ophthalmologists, included 807 adults presenting with glaucoma or ocular hypertony over 8 months. After a poorly tolerated beta-blocker treatment, which had started at least 6 months before, these patients received brimonidine over 8 weeks. At 3 successive visits, intraocular pressure, biomicroscopic examination results, and visual acuity were recorded. A quality-of-life questionnaire evaluating breathlessness, fatigue, depressive mood, loss of appetite, and satisfaction with the treatment was also given to patients. In the 731 patients observed in the study, the analysis concluded a statistically significant decrease in intraocular pressure (-2.5mmHg) and in the cardiovascular parameters during brimonidine treatment: blood pressure was reduced by 3mmHg and 1.1mmHg for systolic and diastolic pressure, respectively. The heart rate rose by 1.7 beats/min. The quality-of-life questionnaire revealed less breathlessness (-26%), fatigue (-24.9%), depressive mood (-19.3%), and better appetite (+8.2%). The feeling of satisfaction with the brimonidine treatment was significantly improved for 95 patients. However, 12% of all patients stopped their treatment because of adverse effects. Brimonidine improved the glaucomatous patients' quality of life, at least in some areas. Improved intraocular pressure could at least in part result from better compliance with the treatment. Brimonidine is an encouraging alternative after an unsatisfactory beta-blocker treatment.

Movement detection threshold and ocular hypertension.

PURPOSE: To determine whether patients with ocular hypertension (OH) have elevated oscillatory movement displacement thresholds (OMDT) indicative of early neural damage. METHODS: Evidence of early neural loss was sought using OMDT. The OMDT of 29 normotensive individuals were compared with those obtained from 44 untreated age-matched OH eyes (20 male, 24 female). RESULTS: A mean OMDT at 15 sec arc at 40 years of age was obtained in normotensive individuals, the age trend increasing by about 4 sec arc per decade. About one-third of all ocular hypertensives (13 cases; 6 male, 7 female), who were dismissed without treatment, exhibited abnormal OMDT. An equal proportion of abnormal thresholds were observed in individuals in each decade, although the age trend diverges from that established for normotensives with increasing age. Mean OMDT for ocular hypertensives (37.1 sec arc) were significantly different (t = 2.7, p < 0.007) from the mean obtained from normotensives (22.2 sec arc). CONCLUSION: The results emphasise the need for more rigorous differentiation of OH using psychophysical techniques indicating early neural damage.

Spatial and temporal visual filtering in patients with glaucoma and ocular hypertension.

PURPOSE: To investigate the spatial and temporal response characteristics in patients with glaucoma and ocular hypertension (OHT), in order to demonstrate the earliest specific measure of vision loss and to elucidate the precise mechanism of early glaucomatous damage. METHODS: The Open Optical View System was used to assess changes in spatial and temporal vision in patients with clearly defined glaucoma (30 eyes), patients with OHT (30 eyes) and 30 eye-matched normal control eyes. The psychophysical methods applied were developed by Barber and Ruddock, who showed that the responses called ST1 and ST2 have similar characteristics to those found in the parvocellular and magnocellular pathway respectively. The measurement of spatial and temporal responses rests upon the measurement of a target that moves across a background, itself modulated spatially (gratings) and temporally (flicker). RESULTS: The results reported, taken together with the current data on retinal ganglion cell function, reveal damage to both the parvocellular and magnocellular pathway in patients with glaucoma. In the OHT groups only marginal changes were found in the parvocellular response, but significant changes in the magnocellular response. In both OHT and glaucoma, the temporal processing shows greatest abnormalities at a small number of low flicker frequencies. CONCLUSION: We provide psychophysical evidence of the detectable ganglion cell damage in patients with OHT who remain normal on testing with automated perimetry. The psychophysical method chosen (which measures the function of specific sub-divisions of the visual pathway) may prove useful in screening for glaucomatous damage.