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First Author: J.Salopek Rabatic CROATIA
Co Author(s): K. Novak Laus L. Rabatic
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Glaucoma patients through life develop conditions as presbyopia , or concomitantly have demanding refractive errors, cataract or need for pseudophakia correction. Some of those glaucoma patients are candidates to become contact lens(CL) wearers, replacing glasses. How to fit and how to treat glaucoma patients? In this study we chose patients with once a day(QD) dosing antiglaucoma medications - monotherapy (prostaglandin) and fixed combination (prostaglandin plus timolol). In Croatia recently were introduced prostaglandin monotherapy without BAK (Polyquad as preservative). That fact encouraged us to fit our patients with soft CL. When fitting contact lenses maximum comfort in soft CL must be achieved - the new generation of the silicon-hydrogel disposable CL on the daily wear bases with UVA/UVB protection .
Observational study involved prospectively for 12 months (February 2012 February 2013) a total of 40 glaucoma patients. Inclusion criteria: target IOP achieved for least 3 months with topical prostagandin monotherapy or prostaglandin-timolol fixed combination therapy before the inclusion visit, no side effects.All patients were fitted at baseline visit with soft , disposable (two weeks /one month/one day ) silicon-hydrogel CL / worn on daily basis. Included were ocular hypertension and primary open angle glaucoma patients. All included patients were mild stage of damage on the basis of the Hodapp visual field classification. Demographics: age from 21 to 68 years, gender: 30 female and 10 male, education: 15 high school and 35 college degree. Topical antiglaucoma medication included only prostaglandin monotherapy or prostaglandin plus timolol fixed combination because of once a day (QD) evening application. Patients were instructed to follow the procedure - the first step in the evening was CL removal, the second eye drop application.
Objective and subjective parameters are evaluated at baseline (before CL were fitted), after 3 months and 6 months follow up visits (with CL) - visual acuity(VA) (Snellen test chard ), visual field (VF)comparative findings , biomicroscopy evaluation and subjective visual field expression , IOP(Goldman aplanation tonometer), and treatment satisfaction evaluation through the questionary (Lickert 5 point scale). Compared were results of validated questionnaire, Glaucoma Quality of Life-15 (GQL-15) at the baseline and after 3 and 6 months for each patient .
All objective parameters (VA, VF and biomicroscopy evaluation ) did not show pathological changes or worsening of findings (short period of follow up). Subjective parameters as visual field expression show median score 4,5 at all time points. Patient satisfaction median score of ( Lickert scale: 1= no satisfaction , 5= excellent satisfaction )at baseline was 4,4 (without CL), after 3 months 4,7 and after 6 months 4,9 (with CL respectively). Quality of life improved from the baseline 77.1 ±10.46 (CL were not fitted) through 3rd month 88.2 ±3.41 (wearing CL), to become better after 6 months 93.1 ±4.8 (continuous CL wearing). Higher scores on the GQL-15 indicate better quality of life. We used comparison of questionnaires scores as control within the same group of patients.
Wearing silicon-hydrogel CL can improve quality of every-day life of glaucoma patients (indication criteria chosen visely), when combined with topical therapy dosed once daily. It is important to continuously conduct educational training both for glaucoma and CL wearing at regular IOP and VA visits in order to meet both patients and ophthalmologists expectations .