Evidence Table 23Patient Views

Study detailsPatientsInterventionOutcome measuresEffect sizeComments
Day et al., 200632

Study design:
Prospective observational cohort

Evidence level:

Duration of follow-up:
N/A
Patient group:
Consecutively recruited patients from outpatient clinics.

Setting: USA

Inclusion criteria:
  • > 18 years
  • On medication in at least 1 eye for 30 days prior to study
  • Adequate visual acuity
  • Mental ability to read and understand English
Exclusion criteria:
  • Patients with clinically significant medical or psychiatric condition
  • Those who had participated in another trial within 30 days prior to study
  • Unable to give informed consent
  • Unable to understand trial procedures
  • Those with previous laser or surgery with previous 2 months
All patients
N: 250
Age (mean ± SD): 64.6 ± 13.1
M/F: 109/141
History of elevated IOP (years): 8.4 ± 7.8
Race
White: 138
African-American: 109
Hispanic: 3
Iris Colour
Brown: 142
Blue: 67
Other: 41
Employment
Retired: 134
Full or part time: 99
Unemployed: 17
Number of medications
Monotherapy (n=148):
β-blockers: 34
PGA: 80
CAI: 22
Sympathomimetics: 12
Adjunctive therapy (n=102):
β-blockers: 48
PGA: 85
CAI: 49
Sympathomimetics: 31
The Treatment Satisfaction Survey- Intraocular Pressure (TSS-IOP) - owned by Pfizer, Inc. - is a survey focussing on patient satisfaction and perception of their glaucoma medication and patient compliance. The survey consists of 15 validated questions falling under categories below:
  • Effectiveness (satisfaction scale)
    • Preventing future vision problems
    • Reducing current vision problems
  • Side effects – eye irritation (bother scale)
    • Prolonged burning or stinging
    • Grittiness or sandiness
    • Stickiness or crustiness
    • Dry eyes
  • Eye appearance – hyperaemia (bother scale)
    • Peoples’ reaction to red eye
    • Self-consciousness of red eye
    • Overall cosmetic appearance
  • Ease of administration (satisfaction scale)
    • Number of times drops applied
    • Time of day for application
    • Ease of remembering to use
  • Convenience of use (satisfaction scale)
    • Ease of delivery of correct amount rather than missing or too much
    • Ease of angling head when sitting or standing to apply
    • Ease of consistently applying correct amount
Items were scored on either a 5 or 7 point scale from ‘Extremely satisfied’ or ‘Extremely Bothered’ to ‘Extremely dissatisfied’ or “Not bothered’

Patients had a full medical and ocular history taken and completed a supplemental non-validated questionnaire about their expectations of topical medication.
Patients then completed the TSS-IOP validated questionnaire.
Patients had a clinical examination as part of routine care and then completed a questionnaire regarding assessment of the patients’ treatment, tolerance of medicine and compliance.

25 patients were asked to return for ±a second visit to complete the questionnaire again to evaluate test- retest reliability
Treatment satisfaction and dosing frequency Mean TSS-IOP score ± SDTSS-IOP Effectiveness
Single medications (n=151) 79.1 ± 15.4
Multiple medications (n=99) 73.7 ± 18.0 P =0.01
TSS-IOP Side Effects
Single medications (n=151) 93.4 ± 12.7
Multiple medications (n=99) 88.7 ± 15.2 P =0.01
TSS-IOP Irritation
Single medications (n=151) 93.4 ± 11.1
Multiple medications (n=99) 87.5 ± 17.8 P =0.001
TSS-IOP Convenience of use
Single medications (n=151) 82.54 ± 14.2
Multiple medications (n=99) 77.1 ± 16.8 P =0.007
TSS-IOP Ease of use NR
Funding: Pfizer, Inc. CA, USA.

Limitations:
  • Statistical analysis was not explained.
  • TSS-IOP scoring system was not clearly explained
  • Study reports correlation analysis between TSS-IOP items and items from an invalidated additional questionnaire
Additional outcomes:
Correlation between TSS-IOP items and physician reported ratings of IOP control, side effects, compliance and problems with self-administration

Notes:
Differences between specific single glaucoma medications (n=148)
Mean TSS-IOP score ± SD
TSS-IOP Convenience of use
Beta-blockers (n=34) 85.8 ± 14.5
PGA (n=80) 83.6 ± 14.0
CAI (n=22) 79.3 ± 14.3
Sympathomimetic (n=12) 73.6 ± 11.1
P values NR. NCC-AC calculate using t test with equal variance
BB v PGA p=Not signif.
BB v CAI p=Not signif.
BB v sympathomimetics p=0.01
PGA v CAI p=Not signif.
PGA v sympathomimetics p=0.02
CAI v sympathomimetics p=Not signif.
Differences between specific glaucoma medications Mean TSS-IOP score ± SDTSS-IOP Eye appearance
Beta-blockers (n=34) 99.3 ± 3.2
PGA (n=80) 90.7 ± 17.8
CAI (n=22) 93.6 ± 8.1
sympathomimetics (n=12) 88.2 ± 27.2
P values NR. NCC-AC calculate using t test with unequal variance
BB v PGA p=0.0001
BB v CAI p=0.004
BB v sympathomimetics p=0.19 Not ignif.
PGA v CAI p=Not signif.
PGA v sympathomimetics p=Not signif.
CAI v sympathomimetics p=Not signif.

Abbreviations: NR=not reported, NA=not applicable, M/F=male/female, N=total number of patients randomised, SD=Standard Deviation, SE(M)=Standard Error (of the mean), ITT – Intention to Treat etc

From: Appendix D, Evidence tables

Cover of Glaucoma
Glaucoma: Diagnosis and Management of Chronic Open Angle Glaucoma and Ocular Hypertension.
NICE Clinical Guidelines, No. 85.
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