Browsing by Subject "African descent"

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    An Assessment of the Fidelity of Two Different Interventions to Improve Adherence to Glaucoma Treatment in Patients of African Descent
    (Office of the Vice Chancellor for Research, 2015-04-17) Idowu, Eniola; Bigatti, Silvia M.; Racette, Lyne
    Glaucoma is a chronic eye disease, which is asymptomatic and can slowly lead to blindness if left untreated. Glaucoma is caused by damage to the optic nerve and can lead to irreversible loss of sight. The overall objective of this MURI study was to determine the impact of two different interventions on compliance to glaucoma medication in patients of African descent with open-angle glaucoma. Two types of intervention were used – Education and Motivational Interviewing (MI). The educational intervention involved sharing knowledge with patients about glaucoma, its causes, and its treatments, to help patients better understand glaucoma and the importance of adhering to the daily medication regimen. The MI intervention involved communicating with the patients and encouraging them to identify strategies that would help them better adhere to their medications. These sessions were video-recorded and the content of each video was transcribed verbatim. The transcripts were then scored to assess the fidelity of each session with the intervention type that was given; this was done to ensure that each patient in the MI group received intervention consistent with MI, and that each patient in the Education group received an intervention free of MI. The standard Motivational Interviewing Treatment Integrity 3.0 coding sheet was used to code the MI and Education sessions. Global ratings were given for empathy, direction, collaboration, evocation and autonomy/support on a scale ranging from 1 (Low) to 5 (High). The following behaviors were counted within each transcript: giving information, MI adherent (asking permission, affirm, emphasize control, support), MI Non-adherent (advise, confront, direct), questions (closed questions, open questions), and reflections (simple, complex). We expect that the MI interventions would have significantly higher scores on MI adherent behaviors and significantly lower on MI-non-adherent behaviors compared to the Education session.
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    Does Knowledge of the Risk Factors of Glaucoma Impact Adherence in patients of African descent?
    (Investigative Ophthalmology and Visual Science Journal, 2016) Diallo, Kade; Bigatti, Silvia; Sutton, Bradley; Torbit, Julie; Racette, Lyne
    Purpose : The first line of treatment for primary open-angle glaucoma (POAG) is the daily use of eye drops. Adherence to this regimen is known to be challenging for patients. While POAG is more prevalent in people of African descent (AD), worse adherence is reported in this high-risk population. The purpose of this prospective clinical study was to determine whether knowledge of the risk factors associated with glaucoma translates into better adherence. Methods : Twenty-nine patients with POAG were included in the study. Participants were on average 60.38±9.93 years of age, identified as being of AD by self-report and 16 were male. Adherence was measured using Medical Event Monitoring System (MEMS) bottles. The cap of these bottles electronically records the date and time at which the bottle is opened. Each participant filled out the Brief Illness Perception questionnaire in which they were asked to “Please list in rank-order the three most important factors that you believe caused your illness”. The adherence of patients who reported 1) at least one accurate risk factor was compared to that of patients who reported no accurate risk factor, 2) race as a risk factor was compared to that of patients who did not report race, and 3) any risk factor (accurate or inaccurate) was compared to that of patients who reported no risk factor. Groups were compared using two-tailed t-tests. Results : Patients who reported at least one accurate risk factor (n=18) had similar adherence (73.39±25.94%) to those who reported no accurate risk factor (n=11) (55.91±33.10%) (p=0.12). Patients who reported race as a risk factor (n=6) had similar adherence (76.50±24.94%) to those who did not report race (n=23) (64.22±30.64%) (p=0.37). Patients reported any risk factor (n=22) had similar adherence (70.36±26.89%) to those who reported no risk factor (n=7) (55.43±36.78%) (p=0.25). While there was an overall trend for higher adherence in patients with more knowledge, statistical significance was not reached in any of the comparisons. Conclusions : We hypothesized that knowledge of the risk factors of glaucoma would result in better adherence because this knowledge could reflect a better understanding of the disease and of the importance of adhering to treatment. Our results suggest that knowledge of the risk factors of glaucoma does not impact adherence. Future studies will investigate whether educating patients can improve adherence.
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    Glaucoma Treatment Outcomes in Open-Angle Glaucoma Patients of African Descent
    (World Scientific, 2022) Siesky, Brent; Harris, Alon; Belamkar, Aditya; Zukerman, Ryan; Horn, Avery; Verticchio Vercellin, Alice; Mendoza, Kristen Ann V.; Sidoti, Paul A.; Oddone, Francesco; Ophthalmology, School of Medicine
    Open angle glaucoma (OAG), characterized by structural changes to the optic nerve head and retinal nerve fiber layer, is a progressive multifactorial optic neuropathy and leading cause of irreversible blindness globally. Currently intraocular pressure is the only modifiable risk factor; however, others have been identified including genetics and race. Importantly, OAG is much more prevalent in persons of African descent (AD) compared to those of European descent (ED). OAG patients of AD are also known to have a more severe course of the disease, a finding potentially explained by structural and/or vascular differences within eye tissues. In addition, disparities in treatment outcomes have been identified in OAG patients of AD. Specifically, prostaglandin analogues have been suggested to be more effective in patients of AD than in those ED, while beta-adrenergic receptors have been suggested to be less effective, although the evidence is inconsistent. Being of AD has also been identified as a risk factor for trabeculectomy failure while laser trabeculoplasty, has been conversely found to be very effective in lowering IOP in patients of AD. Alternative surgical options including Ex-Press shunt implantation, viscocanalostomy, and canaloplasty are promising in equivalence but require further research to properly evaluate disparity in outcomes. In addition to treatment outcomes, social disparities affecting clinical care also exist for persons of AD in the form of reduced adherence, access, and choice. Overall, data suggests the need for properly designed prospective trials with AD populations as a primary focus to identify the potential mechanisms driving disparities in treatment and address overall potential bias in glaucoma management.
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    Heterogeneity of Ocular Hemodynamic Biomarkers among Open Angle Glaucoma Patients of African and European Descent
    (MDPI, 2023-02-06) Siesky, Brent; Harris, Alon; Verticchio Vercellin, Alice; Arciero, Julia; Fry, Brendan; Eckert, George; Guidoboni, Giovanna; Oddone, Francesco; Antman, Gal; Mathematical Sciences, School of Science
    This study investigated the heterogeneity of ocular hemodynamic biomarkers in early open angle glaucoma (OAG) patients and healthy controls of African (AD) and European descent (ED). Sixty OAG patients (38 ED, 22 AD) and 65 healthy controls (47 ED, 18 AD) participated in a prospective, cross-sectional study assessing: intraocular pressure (IOP), blood pressure (BP), ocular perfusion pressure (OPP), visual field (VF) and vascular densities (VD) via optical coherence tomography angiography (OCTA). Comparisons between outcomes were adjusted for age, diabetes status and BP. VF, IOP, BP and OPP were not significantly different between OAG subgroups or controls. Multiple VD biomarkers were significantly lower in OAG patients of ED (p < 0.05) while central macular VD was lower in OAG patients of AD vs. OAG patients of ED (p = 0.024). Macular and parafoveal thickness were significantly lower in AD OAG patients compared to those of ED (p = 0.006–0.049). OAG patients of AD had a negative correlation between IOP and VF index (r = −0.86) while ED patients had a slightly positive relationship (r = 0.26); difference between groups (p < 0.001). Age-adjusted OCTA biomarkers exhibit significant variation in early OAG patients of AD and ED.
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    Impact of self-efficacy and demographic factors on adherence to treatment in glaucoma patients of African descent
    (Investigative Ophthalmology and Visual Science Journal, 2017) Alkhairy, Sameerah; Chu, Fang-I; Ramezani, Koosha; McIntyre, Elizabeth; Sutton, Bradley; Torbit, Julie; Bigatti, Silvia
    Purpose : To determine whether self-efficacy and demographic factors influence adherence to the medical treatment of glaucoma in patients of African descent. Methods : 37 patients with a clinical diagnosis of primary open-angle glaucoma were included in this cross-sectional study. All patients were of African descent, used self-administered once-daily prostaglandin analog eye drops. Adherence was measured in 34 patients during a one-month period (mean 28.8 days) using Medical Event Monitoring System (MEMS) caps. The caps of these bottles electronically record the date and time at which the bottle is opened. All patients completed the four following questionnaires: Q1) glaucoma medication self-efficacy scale, Q2) eye drop technique self-efficacy scale, Q3) reported adherence to medication questionnaire and Q4) brief illness perception questionnaire. All answers were treated as ordinal variable and total scores for each questionnaire were computed. The impact of these four self-efficacy scores on adherence was assessed using linear regression models. We also determined how demographic factors (age, gender, education, marital status, employment status, and income) modulated this relationship. Finally, we assessed the influence of these demographic factors on the self-efficacy scores. Results : The mean age was 60.89±9.81 and 45.95% of patients were female. Eye drop technique self-efficacy (Q2) had a borderline negative impact on adherence (slope=−3.64, p=0.05), such that higher self-efficacy resulted in lower adherence. This result was minimized by being older (p=0.03) or divorced/separated (p=0.04) compared to being single/widowed (increase in the impact of self-efficacy on adherence). Similarly, the relationship between glaucoma medication self-efficacy (Q1) and adherence was negatively modulated by being married/partnered (p=0.04) compared to being single/widowed (decrease in the impact of self-efficacy on adherence). A negative impact of being male was also observed on Q1 (score=−6.28, p=0.05). Conclusions : Overall, patients who were confident in how to administer their eye drops had worse adherence, but this effect was minimized in older and divorced individuals. Overall, being male had a negative impact on self-efficacy as it relates to glaucoma medication. These results suggest that the relationship between self-efficacy and adherence is complex and affected by several factors. This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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    A pilot study of the effectiveness of motivational interviewing to improve adherence to glaucoma treatment in patients of African descent
    (Investigative Ophthalmology and Visual Science Journal, 2015) Altaras, Ira; Bigatti, Silvia; Sirk, Emily; Hosty, Elizabeth; Payton, Chloe; Grow, Shelbi; Sutton, Bradley; Torbit, Julie; Idowu, Eniola; Racette, Lyne
    Purpose: The first line of treatment for open-angle glaucoma is the use of daily hypotensive eye drops to control intra-ocular pressure. Adherence to this treatment is known to be challenging for patients, and has been reported to be worse in patients of African descent (AD), a segment of the population that is disproportionately affected by the disease. Motivational interviewing (MI) can improve adherence and has been shown to be more effective in minority populations. The purpose of this prospective, longitudinal and interventional pilot study was to determine whether MI might improve adherence in glaucoma patients of AD. Methods: Thirteen patients of African descent (AD) who received a clinical diagnosis of open-angle glaucoma within the past five years were included in this study. All patients used once-daily prostaglandin analog eye drops and administered their medication. Adherence was measured using Medical Event Monitoring System (MEMS) bottles. The cap of these bottles electronically records the date and time at which the bottle is opened. At visit 1, patients were instructed to place their eye drop bottle in the MEMS bottle and to otherwise use their eye drops as usual. At the 4-weeks visit, baseline adherence was assessed. Patients with adherence levels below 75% (n=9) received an approximately 20-minutes MI intervention and those with adherence levels over 75% served as controls (n=4). At the 12-weeks visit, patients returned and the final adherence was assessed. The difference between baseline and final adherence was compared between the groups using one-tailed paired t-tests. Results: In the group who received MI, final adherence (67.9% ± 7.68) was significantly higher than baseline adherence (55.95% ± 22.16) (p=0.03). Adherence improved in all but one of these patients (the adherence of one patient decreased by 0.2%). In controls, no significant difference between baseline adherence (81.38% ± 5.52) and final adherence (82% ± 17.33) (p=0.46) was observed. In this group, adherence improved in two patients (by 11.3% and 10.7%) and decreased in two patients (by 3.6% and 15.9%). Conclusions: These preliminary results obtained in a small sample suggest that MI may be effective in improving adherence in glaucoma in patients of African descent.