Lynda Charters

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Websites about glaucoma abound, and their main goal is to raise awareness to prevent visual loss. Many websites are specific to glaucoma, but a few also provide information about other eye diseases as well and how to maintain overall eye health. This article describes these resources and some of the practical information that can be found within the websites.

Websites about glaucoma abound, and their main goal is to raise awareness to prevent visual loss. Many websites are specific to glaucoma, but a few also provide information about other eye diseases as well and how to maintain overall eye health.

This article touches on some of the myriad resources and practical information that can be found within the respective websites.

The society emphasizes resources, research, and support, and instructs patients in finding an American Glaucoma Society doctor in their locality as well as providing links to other organizations such as the American Academy of Ophthalmology’s 

The American Glaucoma Society also provides educational handouts on angle-closure glaucoma that explain the disease and its mechanism of action, risk factors, a technique for possible prevention, signs and symptoms, diagnosis, and treatment as well as numerous other ocular diseases.

Another component of the patient portal is 

, a new public service program described as “dedicated to providing surgical glaucoma care at no cost to uninsured or underserved patients who qualify for such care. The glaucoma care is provided by members of a national network of volunteers comprising glaucoma surgeons who are AGS active or provisional members.” The AGS Cares patient and physician enrollment and eligibility form is now available.

 with answers to the most frequently asked questions about glaucoma. 

, upon us, one awareness activity that the Glaucoma Research Foundation advocates includes a four-step proactive approach for families that begins with having family members talk to each other about the disease. “If you have glaucoma, don’t keep it a secret. Let your family members know,” the website emphasizes.

The next steps are educational in nature and include referring a friend to www.glaucoma.org, requesting that a free educational booklet, “

,” be sent, and becoming involved in your community through fundraisers, information sessions, group discussions, and inviting expert speakers, among others.

This organization provides patients with a great deal of information about living with glaucoma as well as many sobering facts about the increasing prevalence of the disease.

For example, the organization’s report, “

," states that glaucoma already affects nearly 3 million people aged 40 years and older, and that that number will increase alarmingly by nearly 50% to 4.3 million by 2032 and by more than 90% to 5.5 million by 2050.

Living with the disease can be a daunting prospect, and Prevent Blindness recommends some steps that patient can take to help in their daily activities such as remembering to take notes and write down questions before the doctor visit, explaining to ophthalmologists how the medicines they take affect them and conveying the information about prescribed drugs and their effects and all other drugs to other medical specialists, reading about glaucoma, and measures to take to live with it.

,” provides information on maintaining patient independence and quality of life. Resources are also available to caregivers through the program. This program also provides an exhaustive list of resources that includes more than 1,600 links and contacts, such as US and international agencies, centers, organizations, and societies; assistive technology products; doctor search; financial assistance; financial assistance for students; suppliers of reading material in large type and Braille, low-vision devices, reading material in audio; top 12 eye hospitals; vision-related websites; and vision tests.

https://www.preventblindness.org/free-information-available-public-glaucoma-awareness-month

, can answer many questions for patients.

https://www.aao.org/eye-health/diseases/what-is-glaucoma

, provides a wealth of information designed to help patients understand the disease with detailed explanations of primary open angle glaucoma and angle closure glaucoma; prevention tips, articles on glaucoma, answers to questions about glaucoma, patient stories, and the opportunity to ask an ophthalmologist questions about glaucoma. The website is presented in English and Spanish.

 is focused on disseminating educational material on glaucoma such as hand-out articles and fact sheet, infocards and infographics that can be printed and posted in public areas, videos, and webinars.

In addition, information is provided about eye health in general and for glaucoma in particular, the importance of annual dilated eye examinations to detect glaucoma and treatments if the disease is diagnosed.

For more glaucoma information and resources from the NEI, 

The Centers for Disease Control and Prevention (CDC)

The CDC website offers numerous facts about glaucoma as well as the risk factors and the populations that are at elevated risk.

It also provides a list of “healthy habits” to help avoid vision loss. These include undergoing a comprehensive dilated eye examination for all, but especially for those in a high-risk group; talking to family members about vision health because of glaucoma’s hereditary component; and practical common-sense guidelines that include maintaining a healthy weight, controlling blood pressure, being physically active, and avoiding smoking that will not only help prevent glaucoma but other chronic diseases.

Other website topics include managing and treating glaucoma and learning about low vision.

Reaching people at risk is of special interest to the CDC. The organization funds programs to detect glaucoma and other eye diseases among high-risk communities and provide successful follow-up care. The glaucoma initiatives can be accessed on the website, 

https://www.cdc.gov/features/glaucoma-awareness/index.html

Other initiatives listed are CDC’s Vision Health Initiative, CDC’s glaucoma projects, Low vision resources for glaucomaexternal icon, and Glaucoma Research Foundationexternal icon.

Articles

Raising awareness: Dissemination of information to help patients get ahead of glaucoma

Mobile apps designed to improve and facilitate adherence of patients with glaucoma to their treatment regimens are a step in the right direction but not all may achieve their goal, according to one researcher.

This article was reviewed by Brian Leung, BS

Despite the large number of apps available to help patients, the results of a study of the efficacy of glaucoma mobile apps found a great need for eye-care providers to continue their education efforts with patients regarding the importance of adherence to medication regimens and how glaucoma deteriorates vision.

Clearly, the importance of treatment adherence has long been recognized by the community of glaucoma specialists, judging by the number of mobile apps that have popped up. Of the 325,000 mobile health apps that are available to patients, about 5,800 are dedicated to adherence to medication regimens. This large number prompted Brian Leung, BS, a research assistant from Tufts University in Medford, MA, and colleagues to explore if these free, readily available apps are actually achieving their goal of helping patients with glaucoma.

To do this, the investigators searched the Apple App Store (iOS) and Google Play (Android) to access available medication adherence apps using the search terms medication reminder and medication log and to access glaucoma apps using the search term glaucoma. Both types of apps were evaluated based on the numbers of downloads of the Droid operating system and by the star ratings for the iOS operating system.

The investigators included in their analysis the 10 most popular apps from each operating system. The apps were included if they could be obtained by patients at no cost; apps were excluded if there were no available data on ratings or the number of installations. The medication adherence app analysis included the presence of a pre-populated list of glaucoma medications, that included the brand and generic names of drugs, and the glaucoma apps were analyzed for the inclusion of logs for recording IOP, visual fields, and medications, Leung recounted. 

Of the apps identified using the term medical adherence, only four of the 10 most popular Droid apps included pre-populated lists of glaucoma medications; the other five required manual input of the medications. Five of the 10 most popular iOS apps had prepopulated lists of glaucoma meds and the others required manual entry. Only one app included a complete list of glaucoma medications, that is, both the generic and brand drug names.

Regarding the glaucoma apps, only one Droid app was available and featured an IOP log. Of three iOS apps, two of three had an IOP log; one of three had a VF log; and one of three had a glaucoma medication list; none of the three had a VA log, the investigators reported.

“Medication adherence and glaucoma apps are not tailored to meet the needs of glaucoma patients," Leung concluded. "As clinicians, we need to continue our education efforts about adherence and glaucoma.”

Leung has no financial interest in any aspect of this report. He was joined in this study by Gloria Wu, MD, from the University of California, San Francisco, School of Medicine; Kevin Lu, BS, from University of California, San Diego; Shannon Luu, BS, from Santa Clara University, Santa Clara, CA; and David Lee, MD, MS, MBA, from the University of Texas, McGovern Medical School, Houston.

Mobile glaucoma apps may play limited role in awareness, education

-Use of nepafenac (Nevanac, Alcon Laboratories), a topical nonsteroidal anti-inflammatory drug (NSAID), may decrease macular volume more rapidly after surgery to repair epiretinal membranes (ERMs).			

A pilot study indicated that the central subfield macular thickness decreased by 10% and that the macular volume decreased about 5% 3 months postoperatively, according to Daniel M. Miller, MD, PhD. The drug was also found to have a good safety profile. 

"The purpose of this study was to investigate the effects of nepafenac in patients undergoing ERM repair," he said. "Specifically, we were interested in whether nepafenac-treated patients experienced a more rapid reduction in macular volume and central subfield thickness postoperatively." 

Dr. Miller and colleagues designed a single-center, randomized, prospective, double-blinded study to determine if application of topical nepafenac provides a more rapid reduction in macular volume after vitrectomy surgery for ERMs compared with placebo. 

The study included 40 patients who had visually relevant ERMs and a central subfield macular thickness that exceeded 300 µm on spectral-domain optical coherence tomography (SD-OCT [Cirrus HD-OCT, Carl Zeiss Meditec]). All patients underwent 25-gauge pars plana vitrectomy, peeling of the ERM, and peeling of the internal limiting membrane using indocyanine green. 

Patients were randomly assigned to either the placebo group that received balanced saline solution T.I.D. beginning 1 day preoperatively to 3 months postoperatively or the nepafenac group that also received the drug T.I.D. beginning 1 day preoperatively to 3 months postoperatively. 

Postoperatively, the patients in both groups received moxifloxacin (Vigamox, Alcon Laboratories) T.I.D. for 7 days and prednisolone acetate 1% (Omnipred, Alcon) Q.I.D. tapered over 4 weeks. 

Use of nepafenac may decrease macular volume more rapidly after surgery to repair epiretinal membranes.

'Nepafenac may reduce macular volume

-Improved quality of life for patients with allergic conjunctivitis is the name of the game for Stephen V. Scoper, MD, who uses olopatadine hydrochloride ophthalmic solution 0.2% (Pataday, Alcon Laboratories) to treat this patient population because of the increased compliance that the drug affords with its once-daily dosing requirement. 

First, the symptoms of eyes red and itchy from seasonal allergic conjunctivitis are related directly to the level of the pollen count on a specific day. By the time patients arrive for their appointments, the pollen count may have decreased, the patients may no longer have red, itchy eyes, and they may feel better, with no symptoms. 

Second, ECPs also should ask patients if they are self-medicating with over-the-counter (OTC) allergy pills or allergy eye drops and the level of relief they are obtaining.  

"This tells us the diagnosis," he said. "However, by using prescription medications, we generally can do a better job than the OTC products." 

Olopatadine 0.2% is a newer formulation of olopatadine hydrochloride ophthalmic solution 0.1% (Patanol, Alcon Laboratories) and is taken once rather than twice daily. 

"[Olopatadine 0.2%] is the same molecule .  .  . in a different concentration and with a different vehicle for once-daily instillation," he said. "[Olopatadine 0.1%] has been the gold standard for treating allergic conjunctivitis for 13 years." 

The molecule is a combination therapy comprising a mast cell stabilizer and an antihistamine. 

"This combination is a better molecule for the eye than the other combination drugs, which were developed from systemic drugs and converted into eye drops," Dr. Scoper said. "The [olopatadine 0.1%] molecule was originally formulated as an eye drop and was never a systemic formulation." 

He has used olopatadine 0.1% successfully in his practice for years but said prefers the newer formulation because of its once-daily dosing compared with the older version, which is instilled twice daily. 

"Once-daily dosing is a big advantage of [olopatadine 0.2%], which works just as well as [olopatadine 0.1%]," he emphasized. Instillation in the morning prevents the development of red, itchy eyes throughout the day-especially important for patients who wear contact lenses. 

Olopatadine hydrochloride ophthalmic solution 0.2%, a combination mast cell stabilizer and antihistamine, effectively relieves the itching associated with allergic conjunctivitis with once-daily dosing.

Author | Lynda Charters

Articles

Raising awareness: Dissemination of information to help patients get ahead of glaucoma

Mobile glaucoma apps may play limited role in awareness, education

'Nepafenac may reduce macular volume

Olopatadine: Once-daily dosing benefit