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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Glaucoma: Looking Ahead to Improved Compliance and Visual Outcomes


GOAL
To provide glaucoma specialists and comprehensive ophthalmologists with up-to-date information on the treatment and management of patients with glaucoma.

TARGET AUDIENCE
This activity is designed for glaucoma specialists and comprehensive ophthalmologists. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, the participant should be able to:

  • Assess patients at risk for developing glaucoma and detect the disease in its
    earliest stages.
  • Express the importance of patient compliance with glaucoma treatment, and provide ophthalmologists with practical strategies to improve compliance.
  • Identify how industry and organized medicine can work together to improve patient care.
  • Discuss current and emerging medical therapies in the management of glaucoma.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The estimated time to complete this educational activity: 2 hours.

Release date: April 15, 2007. Expiration date: April 15, 2009.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Pfizer, Inc.

Full Disclosure Policy Affecting CME Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

Henry D. Jampel, MD, MHS
Odd Fellows and Rebekahs
Professor of Ophthalmology
Johns Hopkins University School of Medicine
Baltimore, Maryland
• Dr Jampel reports serving as a consultant for Alcon Laboratories; and holding stock in Allergan, Inc.

PARTICIPATING FACULTY

Paul P. Lee, MD, JD
Professor of Ophthalmology
Duke University Eye Center
Durham, North Carolina
• Dr Lee reports receiving grants/research support from Allergan, Inc, Merck & Co, Inc, and Pfizer, Inc; serving as a consultant for and receiving honoraria from Alcon Laboratories, Allergan, Inc, and Pfizer, Inc; and holding stock in Merck & Co, Inc.

Harry A. Quigley, MD
A. Edward Maumenee Professor of Ophthalmology
Director, Glaucoma Service
Director, Dana Center for Preventive Ophthalmology
Wilmer Eye Institute
Johns Hopkins University School of Medicine
Baltimore, Maryland
• Dr Quigley reports receiving grants/research support from and serving as a consultant for Alcon Laboratories, Allergan, Inc, Pfizer, Inc, and Zeiss/Meditec.

Gail F. Schwartz, MD
Glaucoma Consultants
Greater Baltimore Medical Center
Assistant Professor
Wilmer Eye Institute
Johns Hopkins University School of Medicine
Baltimore, Maryland
• Dr Schwartz reports receiving grants/ research support from Allergan, Inc, Pfizer, Inc, and Santen; serving as a consultant for Pfizer, Inc; and receiving honoraria from Merck & Co, Inc, Pfizer, Inc, and Santen.

James C. Tsai, MD
Robert R. Young Professor and Chair
Department of Ophthalmology and Visual Science
Yale University School of Medicine
New Haven, Connecticut
• Dr Tsai reports receiving grants/research funding and serving as a consultant for Alcon Laboratories, Allergan, Inc, and Pfizer, Inc; and serving on the speakers' bureau for Alcon Laboratories, Allergan, Inc, Merck & Co, Inc, and Pfizer, Inc.

Notice: No faculty member has indicated that his/her article will reference unlabeled/unapproved uses of drugs or devices.

Johns Hopkins Advanced Studies in Ophthalmology provides disclosure information from contributing authors, lead presenters, and participating faculty. Johns Hopkins Advanced Studies in Ophthalmology does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Glaucoma: Looking Ahead to Improved Compliance and Visual Outcomes
Henry D. Jampel, MD, MHS*

Glaucoma has become the second leading cause of preventable vision loss worldwide. In the United States, glaucoma prevalence is increasing because of the aging population, and by 2020, nearly 80 million people worldwide will be diagnosed with the disease.1

Because glaucoma is asymptomatic through the early disease stages, one of the key challenges in glaucoma management is to identify patients at risk. Early detection of glaucoma is important to not only ensure optimal visual outcomes but also control healthcare costs. In our review of medical records from 151 patients with glaucoma (ie, primary open-angle glaucoma, normal-tension glaucoma, or glaucoma suspect), we found that medication costs comprised 24% to 61% of the total direct costs for glaucoma, and the direct costs of glaucoma management increased with worsening disease severity (Figure 1).2 Importantly, we also found that the proportion of costs from medication varied when realistic assumptions of medication adherence were considered (Figure 2); the costs shift toward surgery and low-vision services, indicating that the patient has reached a disease stage with very limited options.2 Therefore, early and effective use of glaucoma medications could not only potentially significantly reduce the economic burden of glaucoma but also delay the burden of disease for several years. Indeed, patients in all stages of the disease deserve appropriate treatment.

Adherence can be defined as the extent to which the patient's behaviors correspond with the provider's recommendations. Glaucoma presents several challenges to optimal adherence, including measuring adherence (eg, measuring eye drops instead of pills) and improving adherence in a disease area that is affected by several non-etiologic factors.

This issue of Johns Hopkins Advanced Studies in Ophthalmology includes proceedings from a symposium held during the American Academy of Ophthalmology's Annual Meeting on November 13, 2006, in Las Vegas, Nev. Gail F. Schwartz, MD, an ophthalmologist in private practice, opens with a review of our current knowledge of adherence in glaucoma and highlights ophthalmologists' ability to evaluate patients at risk for poor adherence. She also provides practical strategies to improve adherence based on her own experience. James C. Tsai, MD, from Yale University School of Medicine, then considers some of the challenges in measuring adherence, including the role of diurnal fluctuation of intraocular pressure. He also continues the offering of practical strategies for improved adherence based on his own clinical and research experience and outlines his recommended approaches. Next, Paul P. Lee, MD, JD, from Duke University Eye Center, describes a joint effort between industry and organized medicine, through the Patient Care Improvement Project, which seeks to identify the most effective ways to improve patient adherence in glaucoma by soliciting ideas from ophthalmologists, ophthalmology technicians, and patients with glaucoma. We also include a summary of the lively question and answer session from the symposium.

Finally, for this monograph, I had the opportunity to interview Harry A. Quigley, MD, a thought leader in the field of glaucoma adherence and epidemiology. Dr Quigley provides us with a first-hand view of the practicalities in addressing glaucoma adherence.


REFERENCES

1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262-267.
2. Lee PP, Walt JG, Doyle JJ, et al. A multicenter, retrospective pilot study of resource use and costs associated with severity of disease in glaucoma. Arch Opthalmol. 2006;124:12-19.

Figure 1

Figure 2

The content in this monograph was developed with the assistance of a staff medical writer. Each author had final approval of his/her article and all its contents.

*Odd Fellows and Rebekahs, Professor of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Address correspondence to: Henry D. Jampel, MD, MHS, Odd Fellows and Rebekahs, Professor of Ophthalmology, Johns Hopkins University School of Medicine, Maumenee B-117, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-9205. E-mail: hjampel@jhmi.edu.





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