[Show abstract][Hide abstract] ABSTRACT: We applied the ecologic model of communication in medical consultations to examine how patient, physician, and situational/contextual factors are associated with whether patients ask one or more questions about glaucoma and glaucoma medications during visits to ophthalmologists. Patients with glaucoma who were newly prescribed or already on glaucoma medications were recruited at six ophthalmology clinics. Patients' visits with their doctors were video-recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Two hundred and seventy-nine patients participated. Patients asked one or more questions about glaucoma during 59% of visits and about glaucoma medications during 48% of visits. Patients who were newly prescribed glaucoma medications were significantly more likely to ask one or more questions about glaucoma and glaucoma medications. Whether providers asked patients if they had questions was not significantly associated with patient question-asking. Patients were significantly more likely to ask older providers questions about glaucoma medications and female providers questions about glaucoma. Eye care providers should encourage glaucoma patients to ask questions during their medical visits.
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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 χ = 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 χ = 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 χ = 5.62, p = 0.02).
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.
Optometry and vision science: official publication of the American Academy of Optometry 04/2014; · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many factors influence glaucoma medication adherence. A better understanding of the relationships between health literacy, depressive symptoms, and patient-reported problems in using glaucoma medications may reveal opportunities for intervention that could improve patients' clinical outcomes.
To examine the relationship between patient characteristics (demographics, health literacy, and depressive symptoms) and patient-reported problems in using glaucoma medications and to assess factors related to patients' self-reported adherence to glaucoma medications.
Patients diagnosed with primary open-angle glaucoma (n = 228) currently taking intraocular pressure-lowering medications were recruited at 6 ophthalmology clinics. Patients were interviewed to identify problems using glaucoma medications, and self-reported medication adherence was determined using a Visual Analog Scale. Questionnaires were administered to assess health literacy, depressive symptoms, outcome expectations, and medication self-efficacy.
Younger patients (P = 0.03), patients with depressive symptoms (P = 0.02), and patients who reported more medication problems (P = 0.005) were significantly less adherent to their glaucoma medications. Patients with higher glaucoma medication self-efficacy adherence scores (P = 0.003) and higher outcome expectations (P = 0.03) were significantly more adherent.
Providers should consider using tools to screen glaucoma patients for depressive symptoms and for problems in using medications to identify patients who are at higher risk of nonadherence to treatment and who might benefit from follow-up with primary care providers.
Annals of Pharmacotherapy 04/2014; · 2.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although reporting vision-related quality of life (VRQoL) outcomes has become increasingly common in adult glaucoma studies, little is known about the influence of disease severity, medication burden, and surgical experience on the quality of life of children with glaucoma. We tested the feasibility of administering a self-reported VRQoL instrument and describe the VRQoL in children with glaucoma. Better VRQoL was correlated with higher visual acuity in the better-seeing eye but not the number of surgeries the child had undergone or the number of prescribed eyedrops.
Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 02/2014; 18(1):95-8. · 1.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The learning preferences of ophthalmology patients were examined.
Results from a voluntary survey of ophthalmology patients were analyzed for education preferences and for correlation with race, age, and ophthalmic topic.
To learn about eye disease, patients preferred one-on-one sessions with providers as well as printed materials and websites recommended by providers. Patients currently learning from the provider were older (average age 59 years), and patients learning from the Internet (average age 49 years) and family and friends (average age 51 years) were younger. Patients interested in cataracts, glaucoma, macular degeneration, and dry eye were older; patients interested in double vision and glasses were younger. There were racial differences regarding topic preferences, with Black patients most interested in glaucoma (46%), diabetic retinopathy (31%), and cataracts (28%) and White patients most interested in cataracts (22%), glaucoma (22%), and macular degeneration (19%).
MOST OPHTHALMOLOGY PATIENTS PREFERRED PERSONALIZED EDUCATION: one-on-one with their provider or a health educator and materials (printed and electronic) recommended by their provider. Age-related topics were more popular with older patients, and diseases with racial risk factors were more popular with high risk racial groups.
Patient Preference and Adherence 01/2014; 8:565-74. · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. The purpose of this study was to examine how patient, physician, and situational factors are associated with the extent to which providers educate patients about glaucoma and glaucoma medications, and which patient and provider characteristics are associated with whether providers educate patients about glaucoma and glaucoma medications. Methods. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited and a cross-sectional study was conducted at six ophthalmology clinics. Patients' visits were videotape recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Results. Two hundred and seventy-nine patients participated. Providers were significantly more likely to educate patients about glaucoma and glaucoma medications if they were newly prescribed glaucoma medications. Providers were significantly less likely to educate African American patients about glaucoma. Providers were significantly less likely to educate patients of lower health literacy about glaucoma medications. Conclusion. Eye care providers did not always educate patients about glaucoma or glaucoma medications. Practice Implications. Providers should consider educating more patients about what glaucoma is and how it is treated so that glaucoma patients can better understand their disease. Even if a patient has already been educated once, it is important to reinforce what has been taught before.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to identify risk factors for exposure of glaucoma drainage devices (GDD).
This retrospective, observational study was conducted in the eye clinic of an academic medical centre.
Participants included 1073 consecutive adults who underwent GDD surgery between 1 January 2005 and 1 January 2011. Participants were included if chart review indicated GDD surgery during the study period and excluded if at least 12 months of clinical follow-up was not available in the medical record.
The primary outcome measure was exposure of the GDD occurring at least 1 month after implant surgery. The characteristics of participants who experienced exposure of the implant were compared to the characteristics of participants who did not experience exposure.
Of the 1073 participants having undergone GDD surgery, 67 experienced exposure of the device. Neither the type of GDD, type of patch graft (eye bank sclera, Tutoplast sclera and Tutoplast pericardium), surgeon, location of GDD, number of GDD previously implanted into the eye, nor history of diabetes or uveitis were associated with likelihood of exposure. Women were more likely than men to experience exposure of the GDD (OR 2.004 (95% CI1.170 to 3.431)) in both univariable (p=0.011) and multivariable (p=0.013) analyses. In survival analysis, exposure of the GDD occurred earlier for women than for men (58 vs 61 months; p=0.024).White race (vs black) was also associated with increased risk of GDD exposure (OR 1.693 (95% CI 1.011 to 2.833)) in univariable (p=0.044) and multivariable (p=0.046) analyses.
Women are two times more likely to experience GDD exposure than men, independent of age. White race is also a risk factor for exposure.
BMJ Open 01/2014; 4(5):e004560. · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose: There is a shortage of human eye tissue available for scientists, and it is unknown how willing ophthalmic patients are to donate their eyes for research. Therefore, we assessed eye patient and family member attitudes regarding the establishment of an eye donation registry for research purposes. Materials and Methods: Surveys were distributed to consecutive patients attending the clinics of an academic ophthalmology practice over a period of 8 days. This survey consisted of questions about demographic information of the participant, attitudes regarding eye donation and attitudes regarding a registry for research-specific eye donation. An additional nested survey was administered to family members who accompanied survey participants. Results: A total of 207 patients and 76 accompanying family members returned their respective surveys. Of the patients, 55% indicated that they would consider joining a proposed eye donation registry for research, 30% were undecided and 15% would not consider joining (n = 193). Over 95% of family members indicated that they would support their relative's decision to enroll in the registry (n = 74). Of the potential donors, 41% indicated they would most prefer to learn about the registry from their eye doctor and 37% from a pamphlet (n = 180). Conclusions: A majority of patients with eye disease and their family members support the idea of establishing an advance-directive eye donation registry for research. This registry for research donors could be incorporated into the current eye donation registry. Such an addendum would bridge the current disconnect between ophthalmic patients who want to donate their eyes for research on their disease (and are ineligible to donate for corneal transplantation) and scientists who need more human eye tissue for experimentation.
Current eye research 06/2013; · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE OF REVIEW: This review discusses the concept and measurement of health literacy, with a focus on the care of patients with glaucoma. RECENT FINDINGS: Nearly one-fourth of adults in the USA lack the skills needed to fully comprehend and act on verbal or written information in the healthcare environment. This problem, referred to as poor health literacy, is associated with worse health-related outcomes in many chronic diseases, including glaucoma. Patients with glaucoma and poor literacy skills are less likely to refill their prescribed medications and miss more scheduled appointments than their more literate peers. Moreover, ophthalmic educational materials are often written at a level of readability that surpasses the skills of many patients with glaucoma. SUMMARY: Patients with chronic eye diseases such as glaucoma and limited health literacy skills are vulnerable to poor visual outcomes. Attention to health literacy may improve the care and outcomes of these patients.
Current opinion in ophthalmology 12/2012; · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess glaucoma medication adherence in children, hypothesizing that poor parental health literacy and eye drop instillation by the child are associated with worse adherence.
This prospective, observational study enrolled pediatric patients with glaucoma who were prescribed eye drops. Parent(s) reported who was responsible for eye drop instillation (parent vs child), took the Rapid Estimate of Adult Literacy in Medicine, and were instructed on the use and purpose of the Medication Event Monitoring System. Calculations included average adherence (proportion of prescribed doses taken), dosing errors (number of overdosing or underdosing events in 24 hours), and proportion of doses taken on schedule (doses taken within 2 hours of prescribed dosing interval). Results are reported as mean (SD) or median.
The study included 46 of the 50 enrolled children who used the Medication Event Monitoring System for 30 days or more. Adherence ranged from 43% to 107% (93% [12%]) and was not associated with age (slope, 0.09 [0.52]; P = .86) but decreased with the parent's lower health literacy (slope, 0.62 [0.24]; P = .01).The mean number of dosing errors for medications prescribed daily vs twice daily was similar (3.3 vs 2.9; P = .66). The proportion of doses taken on schedule (within 2 hours of prescribed dosing interval) ranged from 3% to 97% (median, 34%; mean, 41% [24%]) and was better when the parent vs the child instilled eye drops (46% [26%] vs 23% [19%]; P < .001).
Time-dependent glaucoma medication adherence was better when the parent was responsible for eye drop instillation. Overall decreased adherence was associated with decreased parental health literacy. Children of parents with poor health literacy are vulnerable to poor medication adherence; efforts to address poor health literacy may improve outcomes.
Archives of ophthalmology 03/2012; 130(3):306-11. · 3.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. The objectives of the study were to (a) describe various factors potentially related to objectively measured adherence to glaucoma medications and self-reported glaucoma medication adherence self-efficacy and (b) examine the relationship between patient race, the number of patient reported-problems, and adherence in taking their glaucoma medication. This was a cross-sectional study conducted at two glaucoma subspecialist referral ophthalmology practices. Methods. We measured subjects' reported problems in using glaucoma medications, adherence to glaucoma medications utilizing the Medication Events Monitoring System (MEMS) devices, and general glaucoma medication adherence self-efficacy using a previously validated 10-item scale. Multivariable logistic and linear regression was used to analyze the data. Results. Seventy-one percent of patients self-reported at least one problem in using their glaucoma medications. White patients were more than 3 times more likely to be 80% adherent in using their glaucoma medications than non-White patients. Patients who had glaucoma longer reported significantly higher glaucoma medication adherence self-efficacy. Patients who reported more problems in using their medications had significantly lower glaucoma medication adherence self-efficacy. Conclusions. Eye care providers should assess patient reported problems and glaucoma medication adherence self-efficacy and work with patients to find ways to reduce the number of problems that patients experience to increase their self-efficacy in using glaucoma medications.
[Show abstract][Hide abstract] ABSTRACT: Purpose. We hypothesized that lower trust in the physician is associated with worse visual outcomes in glaucoma. Methods. Subjects completed the Trust in Provider Scale (TPS) and performed visual field tests at least two years apart. The primary outcome was glaucoma-related blindness. Results. Subjects with glaucoma-related blindness scored lower on the TPS (74.9 ± 7.4, n = 21) than subjects without blindness (78.8 ± 6.9, n = 39; P = 0.04). In white subjects, TPS scores were similar for blind (77.1 ± 7.7, n = 12) versus not blind subjects (76.4 ± 6.7, n = 10; P = 0.82). For nonwhite subjects, TPS scores were lower for blind (72.0 + 6.2, n = 9) versus not blind subjects (79.6 ± 6.9, n = 29; P = 0.005). In multiple regression models, the interaction between race and trust was significant (P = 0.007), indicating that the increase in odds for blindness with each unit decrease in TPS score was different for white versus nonwhite subjects. Discussion. Glaucoma patients' trust in the physician is associated with glaucoma-related blindness in this study. The association between lower trust in the physician with blindness in patients of nonwhite race deserves further attention as we strive to reduce disparities in visual outcomes.
[Show abstract][Hide abstract] ABSTRACT: To test an educational intervention targeted to health literacy level with the goal of improving glaucoma medication adherence.
One hundred and twenty-seven veterans with glaucoma were randomized to glaucoma education or standard care. The intervention included a video scripted at a 4th, 7th, or 10th grade level, depending on the subject's literacy level. After six months, the number of days without glaucoma medicine (DWM) according to pharmacy records for the intervention and control groups was compared.
The number of DWM in the six months following enrollment was similar for control and intervention groups (intervention, n=67, DWM=63 ± 198; standard care, n=60, DWM=65 ± 198; p=0.708). For each subgroup of literacy (adequate, marginal, inadequate), subjects in the intervention group experienced less mean DWM than subjects in the control group and the effect size (ES) increased as literacy decreased: adequate literacy, ES 0.069; marginal, ES 0.183, inadequate, ES 0.363. Decreasing health literacy skills were associated with decreasing self-reported satisfaction with care (slope=0.017, SE=0.005, p=0.002).
Patients with decreased health literacy skills may benefit from educational efforts tailored to address their health literacy level and learning style.
Providers should consider health literacy skills when engaging in glaucoma education.
Patient Education and Counseling 10/2011; 87(2):160-4. · 2.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to examine (1) how patient adherence and eye drop technique were associated with visual field defect severity and (2) how general glaucoma adherence self-efficacy and eye drop technique self-efficacy were related to visual field defect severity.
Cross-sectional study conducted at a single private practice site.
Patients using eye drops for their glaucoma.
Subject adherence to glaucoma medications through Medication Events Monitoring System (MEMS) devices were measured, and eye drop instillation technique was assessed by video recording. General glaucoma medication adherence self-efficacy was measured using a 10-item scale, and eye drop technique self-efficacy was measured using a 6-item scale. Multivariate logistic regression was used to analyze the data.
Visual field defect severity.
Patients who were less than 80% adherent according to the MEMS devices were significantly more likely to have worse defect severity. Patients with lower scores on the general glaucoma medication adherence self-efficacy scale also were significantly more likely to have worse defect severity. Eye drop technique and eye drop technique self-efficacy were not related significantly to visual field defect severity.
Eye care providers need to assess patient adherence and to work with those patients with poor adherence to find ways to improve their ability and self-efficacy in using their glaucoma medications.
Proprietary or commercial disclosure may be found after the references.
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were: (1) to examine whether the original glaucoma medication adherence and eye drop technique self-efficacy scales could be shortened for easier use in practice settings; and (2) to validate these scales against objective medication adherence measures.
Prospective study conducted at a single private practice site. We measured subjects' adherence to glaucoma medications through Medication Event Monitoring System (MEMS) devices and assessed eye drop instillation technique by video-recording. Principal components factor analysis and logistic and linear regression were used to analyse the data.
Our results yielded a 10-item Glaucoma Medication Adherence Self-Efficacy Scale that was strongly associated with subject adherence measured using MEMS (β coefficient 8.52, 95% CI 1.94 to 15.1). In addition, the six-item Eye Drop Technique Self-Efficacy Scale was strongly associated with video-recorded subject eye drop installation technique (OR 10.47, 95% CI 1.78 to 61.63).
Eye care providers and researchers could use these shorter scales to identify subjects with either poor glaucoma medication adherence and/or eye drop instillation technique. This could help to identify those who may benefit most from education and training on both adherence and eye drop instillation.
The British journal of ophthalmology 05/2011; 96(2):258-62. · 2.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate central corneal thickness (CCT) in children with congenital/developmental cataracts before and after cataract removal, to correlate CCT with corneal diameters before cataract surgery in this same group, and to evaluate CCT over time in a separate group of children who were already aphakic or pseudophakic at study entry.
Children with cataract (Group 1, with pre-cataract-removal CCT) and aphakia/pseudophakia (Group 2, presenting after cataract removal) were included. CCT measurements were performed using ultrasound pachymetry. Normal fellow eyes of unilaterally affected cases served as controls. In bilateral cases, right eyes were used for analyses.
Group 1 comprised 66 children. Before cataract surgery, unilateral cases (n = 31) showed similar CCT and strong association between the affected and fellow eyes (552.0 ± 32.9 μm vs 550.9 ± 40.4 μm, respectively; r(2) = 0.71, P = .0001). After cataract surgery, affected eyes (n = 13) showed mean CCT increase of 29.7 ± 43.1 μm (P = .03) while fellow eyes remained unchanged. Similarly, before cataract surgery, bilateral cases (n = 35) showed similar CCT between the right and left eyes. After cataract surgery, mean CCT increase was 27.4 ± 39.4 μm for first operated eyes of bilateral cases (n = 17, P = .01). Group 2 comprised 50 aphakic/pseudophakic children lacking pre-cataract-removal CCT. CCT was higher in eyes with glaucoma vs those without, at both first and last measurements (ΔCCT 58.9 ± 27.0 μm at first examination, P = .034, and 56.4 ± 27.1 μm at last examination, P = .043, respectively). There was no statistically significant CCT change over the study interval (median 28 months) for either Group 2 eyes with or those without glaucoma.
CCT in children with cataracts increases after cataract surgery while the fellow eye remains stable. This increase seems to occur early after surgery, likely remaining stable thereafter, though glaucoma can accentuate the increase.
American Journal of Ophthalmology 03/2011; 151(3):434-41.e1. · 4.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate central corneal thickness (CCT) in children with glaucoma and at risk for glaucoma.
The study included 139 children with glaucoma: 66 at risk for glaucoma (ie, aphakia, aniridia, or uveitis) and 66 normal children. CCT was measured by ultrasound pachymetry and intraocular pressure (IOP) by applanation. Analysis of variance was used to compare CCT between groups. Correlation analysis assessed associations between CCT and ocular factors including spherical equivalent, cup-to-disc ratio, glaucoma medications, and number of intraocular surgeries.
CCT was significantly higher for 141 eyes with glaucoma (mean: 0.598 mm, P < .001) and 76 eyes at risk for glaucoma (mean: 0.604 mm, P = .001) than for 66 normal eyes (mean: 0.558 mm). No significant difference was observed between at-risk (P = .989) and glaucoma eyes. Eyes with aphakia (0.653 mm) and aniridia (0.639 mm) had the thickest CCT values. Thinnest CCT was found in anterior segment dysgenesis and uveitis (mean: 0.541 mm). A significant positive correlation between CCT and spherical equivalent was found for glaucoma (r = 0.413; P < .001) and at-risk (r = 0.412; P < .0003) eyes, and between CCT and intraocular surgery for at-risk eyes (P = .0066). A significant negative correlation was found between CCT and cup-to-disc ratio for glaucoma eyes (r = -0.223; P = .01).
This is the largest series of CCT in pediatric glaucoma and related disorders. The data suggest caution in application of standard formulas for IOP-to-CCT correction when evaluating children with glaucoma because their mean CCT values extend far beyond values reported for normal eyes.