RESUMEN
PURPOSE: To determine whether two sessions of a glaucoma educational intervention resulted in better persistence to glaucoma eye drop therapy compared to normal care. METHODS: A total of 165 patients newly diagnosed with glaucoma who required eye drop therapy were recruited into a randomized clinical trial from the glaucoma clinic at Maisonneuve-Rosemont Hospital in Montreal, Canada. Patients were randomized to either an immediate intervention or normal care. The intervention consisted of two 60-90 minute sessions of education on glaucoma and its management, given in a small group format by a non-practicing ophthalmologist. Persistence to glaucoma medication was examined for 1 year by the use of Hospital medical records and by pharmacy claims records from the Régie de l'assurance maladie du Québec (Quebec Health Insurance Program). A questionnaire was administered, and medication possession ratio calculated. The primary outcome was persistence, defined as having medication available at least 75% of the time. Secondary outcomes included eye drop instillation technique and perception of the importance of eye drop therapy. RESULTS: The intervention group achieved better persistence to eye drop therapy, as 77% of controls and 89% of people receiving the intervention were persistent (p = 0.049). The intervention also resulted in better eye drop instillation technique (p < 0.001) and greater perception of the importance of eye drop therapy (p < 0.001). CONCLUSIONS: Brief instructional sessions offered to newly diagnosed glaucoma patients can result in better persistence rates over 1-year follow-up. Strategies to permanently offer these types of initiatives should be considered.
Asunto(s)
Antihipertensivos/administración & dosificación , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Educación del Paciente como Asunto , Administración Tópica , Anciano , Femenino , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Soluciones Oftálmicas , Encuestas y CuestionariosRESUMEN
PURPOSE: To examine whether patients with age-related macular degeneration (AMD), glaucoma, or Fuchs corneal dystrophy report limiting their activity due to a fear of falling as compared with a control group of older adults with good vision. METHODS: We recruited 345 patients (93 with AMD, 57 with Fuchs, 98 with glaucoma, and 97 controls) from the ophthalmology clinics of Maisonneuve-Rosemont Hospital (Montreal, Canada) to participate in a cross-sectional study from September 2009 until July 2012. Control patients who had normal visual acuity and visual field were recruited from the same clinics. Participants were asked if they limited their activity due to a fear of falling. Visual acuity, contrast sensitivity, and visual field were measured and the medical record was reviewed. RESULTS: Between 40% and 50% of patients with eye disease reported activity limitation due to a fear of falling compared with only 16% of controls with normal vision. After adjustment for age, sex, race, number of comorbidities, cognition, and lens opacity, the Fuchs groups was most likely to report activity limitation due to a fear of falling (odds ratio [OR] = 3.07; 95% confidence interval [CI], 1.33-7.06) followed by the glaucoma group (OR = 2.84; 95% CI, 1.36-5.96) and the AMD group (OR = 2.42; 95% CI, 1.09-5.35). Contrast sensitivity best explained these associations. CONCLUSIONS: Activity limitation due to a fear of falling is very common in older adults with visually impairing eye disease. Although this compensatory strategy may protect against falls, it may also put people at risk for social isolation and disability.
Asunto(s)
Accidentes por Caídas , Actividades Cotidianas/psicología , Distrofia Endotelial de Fuchs/psicología , Glaucoma/psicología , Degeneración Macular/psicología , Limitación de la Movilidad , Personas con Daño Visual/psicología , Anciano , Anciano de 80 o más Años , Sensibilidad de Contraste/fisiología , Estudios Transversales , Miedo/psicología , Femenino , Humanos , Masculino , Trastornos de la Visión/psicología , Agudeza Visual/fisiología , Campos Visuales/fisiologíaRESUMEN
PURPOSE: The purpose of this study is to examine whether patients with age-related eye diseases, like age-related macular degeneration (AMD), glaucoma, or Fuchs corneal dystrophy, are more likely to show signs of depression compared to a control group of older adults with good vision, and to determine whether reduced mobility mediates these relationships. METHODS: We recruited 315 eligible patients (81 with AMD, 55 with Fuchs, 91 with glaucoma, and 88 controls) from the ophthalmology clinics of a Montreal hospital from September 2009 until December 2011. Depressive symptoms were assessed using the Geriatric Depression Scale Short Form (GDS-15). Life space was measured using the Life Space Assessment. Logistic regression was used to adjust for demographic, health, and social factors, and mediation was assessed using the methods of Baron and Kenny. RESULTS: There were 78 people (25%) meeting the criteria for depression in the cohort. All three groups with eye disease were more likely to be depressed than the control group after adjusting for age, sex, ethnicity, education, cognitive score, limitations in activities of daily living, social support, and lens opacity (P < 0.05). Life space and limited activities due to a fear of falling appeared to mediate the relationship between eye disease and depression. CONCLUSIONS: Visually limiting eye disease is associated with depression in older adults. Further research on interventions to prevent depression in patients with eye disease is warranted and should consider strategies to alleviate mobility limitation. Greater attention from families, physicians, and society to the mental health needs and mobility challenges of patients with eye disease is needed.
Asunto(s)
Trastorno Depresivo/fisiopatología , Distrofia Endotelial de Fuchs/fisiopatología , Glaucoma/fisiopatología , Degeneración Macular/fisiopatología , Trastornos de la Visión/fisiopatología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Sensibilidad de Contraste/fisiología , Trastorno Depresivo/diagnóstico , Femenino , Evaluación Geriátrica , Humanos , Pruebas de Inteligencia , Masculino , Perfil de Impacto de Enfermedad , Visión Binocular/fisiología , Campos Visuales/fisiologíaRESUMEN
PURPOSE: To examine the extent of mobility limitations in patients with age-related macular degeneration (AMD), glaucoma, or Fuchs' corneal dystrophy compared with that in a control group of older adults with good vision. METHODS: Two hundred seventy-two patients (68 with AMD, 49 with Fuchs' dystrophy, 82 with glaucoma, and 73 controls) from the ophthalmology clinics of Maisonneuve-Rosemont Hospital (Montreal, Canada) participated in a cross-sectional study from September 2009 until February 2011. Control patients who had normal visual acuity and visual fields were recruited from the same clinics. Questionnaire (life space, falls, and driving) and performance-based (one-legged balance test, Timed Up and Go [TUG] test) mobility data were collected; visual acuity, contrast sensitivity, and visual field were measured; and the medical record was reviewed. RESULTS: The three eye diseases were associated with different patterns of mobility limitations. Patients with glaucoma had the most types of mobility limitations, as they had reduced life-space scores, had worse TUG scores, were less likely to drive, and were more likely to have poor balance than the control group (P < 0.05). Compared with the controls, patients with AMD and Fuchs' corneal dystrophy had reduced life-space scores and were less likely to drive (P < 0.05). CONCLUSIONS: The results suggest that eye diseases, especially glaucoma, restrain the mobility of older people in many different ways. It is important to further explore the impact of eye disease on mobility in this population, to develop interventions that could help affected older adults maintain their independence.
Asunto(s)
Distrofia Endotelial de Fuchs/fisiopatología , Glaucoma/fisiopatología , Degeneración Macular/fisiopatología , Limitación de la Movilidad , Trastornos de la Visión/fisiopatología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Estudios Transversales , Femenino , Humanos , Masculino , Actividad Motora/fisiología , Encuestas y Cuestionarios , Agudeza Visual/fisiología , Campos Visuales/fisiologíaRESUMEN
OBJECTIVE: A cataract efficiency program was implemented in Montreal in 2003 to decrease surgery wait time. Our goal was to determine whether health, adverse events during wait time, and outcome of patients presenting for cataract surgery differed from 1999 to 2006 in Montreal. DESIGN: Prospective preoperative and postoperative observational study performed at 2 time points 6 years apart. PARTICIPANTS: Patients awaiting first-eye cataract surgery at Maisonneuve-Rosemont Hospital: 509 patients in 1999-2000 and 206 patients in 2006-2007. METHODS: Patients awaiting first-eye cataract surgery were recruited from Maisonneuve-Rosemont Hospital in 1999-2000 (n = 509) and a second cohort was recruited in 2006-2007 (n = 206). Date of entry onto the hospital waiting list and date of cataract surgery were recorded. About 2 weeks before surgery, patients were asked about accidents and falls while waiting, visual difficulty, and satisfaction with vision and wait time. Visual acuity was measured in each eye. Patients also completed interviewer-administered questionnaires: the 5-item Cataract Symptom Scale, Visual Function-14 Questionnaire (VF-14), Short Form Health Survey-36, Geriatric Depression Scale, and the 14-item Systemic Comorbidity Scale. The interview was repeated after surgery. RESULTS: In 1999, 39% of patients waited more than 6 months for cataract surgery, and this was reduced to 29% in 2006. Patients had better preoperative visual acuity in the surgical eye, less visual difficulty, and fewer cataract symptoms, and reported fewer accidents while waiting for surgery in 2006. The change in visual acuity after surgery was nonetheless the same in the 2 cohorts. The 2006 cohort achieved significantly higher VF-14 scores and reported more satisfaction with vision after surgery than did the 1999 cohort. CONCLUSIONS: Patients had cataract surgery sooner in the disease process in 2006-2007 compared with 1999-2000, with changes in visual acuity after surgery that were clinically significant in both cohorts.
Asunto(s)
Extracción de Catarata , Atención a la Salud , Aceptación de la Atención de Salud , Listas de Espera , Anciano , Femenino , Implementación de Plan de Salud , Humanos , Masculino , Satisfacción del Paciente , Estudios Prospectivos , Quebec , Encuestas y Cuestionarios , Factores de Tiempo , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: As provinces consider what an acceptable cataract surgery wait time should be, research is needed on the risk of adverse events, such as depression, while waiting for care. We sought to determine whether worse visual acuity is related to depressive symptoms in patients waiting to have cataract surgery. DESIGN: Cohort study. PARTICIPANTS: Six hundred seventy-two patients awaiting cataract surgery were recruited from Maisonneuve-Rosemont Hospital in Montreal, Que. METHODS: About 2 weeks before surgery and 4 months after surgery, patients completed the Visual Function-14 questionnaire, a measure of the self-report of difficulty performing visual tasks, and the 30-item Geriatric Depression Scale. Patients were also asked about systemic and ocular comorbidities. Visual acuity was measured with pinhole correction. Date of entry onto the hospital waiting list and date of cataract surgery were recorded. RESULTS: Forty-one percent of patients had visual acuity of 6/18 or worse in the surgical eye, whereas 26% showed signs of depression before surgery (Geriatric Depression Scale-30 > or = 10). In a logistic regression model, those with visual acuity < or = 6/18 in their surgical eye had a 59% higher adjusted odds of depression (odds ratio 1.59, 95% CI 1.09-2.33). There was statistically significant evidence that the relationship between visual acuity and depression was mediated by greater reported difficulty on the Visual Function-14 (p < 0.05). CONCLUSIONS: Patients with worse visual acuity were more likely to be depressed while waiting for cataract surgery. Shortening the wait time for cataract surgery, especially for those with worse vision, could potentially reduce the risk or shorten the duration of depression.
Asunto(s)
Extracción de Catarata , Catarata/complicaciones , Trastorno Depresivo/etiología , Baja Visión/etiología , Listas de Espera , Anciano , Catarata/fisiopatología , Trastorno Depresivo/fisiopatología , Femenino , Humanos , Masculino , Oportunidad Relativa , Perfil de Impacto de Enfermedad , Encuestas y Cuestionarios , Baja Visión/fisiopatología , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: Estimate patient adherence to glaucoma medications and identify potential determinants of nonadherence. DESIGN: Descriptive study. METHODS: Two hundred patients with open angle glaucoma, ocular hypertension, or glaucoma suspects were interviewed regarding their glaucoma and its treatment and their charts were reviewed. Their ophthalmologist completed a brief assessment form. Drug utilization data were extracted from the provincial drug program database. Patients were defined as adherent if they filled at least 75% of the prescribed medication necessary for their treatment. RESULTS: Data were available for 181 patients. About 62.9% were female and the mean age (+/-SD) was 75.1+/-8.8 years. The mean number of years of glaucoma treatment was 10.7+/-9.3. Self-reported treatment adherence was 88.3%. On the basis of the drug database, the proportion of patients who were adherent to treatment was 71.8%. According to physicians, 74.6% of patients were adherent. Among patients considered by physicians as nonadherent, 71.1% (32/45) were adherent and among patients predicted as adherent, 72.1% (98/136) were adherent. There was no significant difference in adherence according to age, sex, education, and income. However, patients using fewer agents (P=0.041), who were widowed (P=0.041), or who lived alone (P=0.042) were more adherent. Patients using prostaglandins analogs or beta-blockers were more adherent than those using carbonic anhydrase inhibitors (P<0.05). CONCLUSIONS: Fewer medications, use of prostaglandin analogs or beta-blockers, living alone, and being widowed were significantly associated with adherence. Physicians were unable to significantly predict which patients are adherent.