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Purpose To determine whether enrollees with open-angle glaucoma who switched from brand name to generic prostaglandin analogues (PGAs) exhibited a change in medication adherence compared to those who remained on brand name products when generics became available Design Longitudinal cohort analysis Participants 8427 beneficiaries age >40 years with open-angle glaucoma continuously enrolled in a nationwide managed-care network from 2009–2012 who were taking PGAs prior to generic latanoprost availability Methods We calculated the mean adherence rates for topical PGAs during the 18 months prior to generic latanoprost availability (September 2009–February 2011). We then determined the mean adherence rates during the subsequent 18 months after generic latanoprost first became available (July 2011–December 2012) for those enrollees who were exclusively maintained on brand name PGAs and compared these adherence rates to those who switched exclusively to generic latanoprost. Multivariable logistic regression identified factors affecting adherence rates. Main Outcome Measures Mean medication adherence rates, odds of experiencing ≥25% improvement or worsening of adherence with 95% confidence intervals Results 8427 enrollees met the study eligibility criteria. Compared to enrollees who switched to generic latanoprost once it became available, enrollees remaining on brand name PGAs were 28% less likely to experience an improvement of adherence (odds ratio (OR)=0.72, 95% CI 0.55–0.94) and 39% more likely to experience worsening of adherence (OR=1.39, 95% CI 1.04–1.86). Other factors associated with improved adherence during the post-generic period included higher monthly medication copay during the pre-generic period (p=0.02), lower monthly medication copay during the post-generic period (p<0.0001), and black race (OR=1.25, 95% CI 1.04–1.50). A total of 612 patients (7.3%) completely discontinued all interventions for glaucoma at the time generic latanoprost became available. Conclusions With cost often being a significant barrier to adherence, switching patients to generic medications may help improve adherence. The ophthalmologic community should be aware of the large number of patients who completely discontinued glaucoma medication use altogether during the transition period when generic latanoprost became available and work with insurers and pharmacists to prevent this from happening when other PGAs become available as generics.

Purpose of review: Approximately 10% of patients become blind despite using evidence-based guidelines developed from clinical trials and epidemiology studies. Our purpose is to review opportunities to decrease glaucoma-related blindness using the emerging principles of precision medicine.Recent findings: This review focuses on three topics: 1) candidate biomarkers for angle-based surgeries, 2) head-mounted display (HMD) technology for vision and testing, and 3) glaucoma risk alleles discovered by genome-wide association studies (GWAS). First, in angle-based surgeries, tracers injected into the anterior chamber or Schlemm's canal (SC) have allowed visualization of aqueous veins. We describe an innovative use of optical coherence tomography angiography (OCTA) to visualize aqueous veins in a case with 6-year successful outcome following catheter-based trabeculotomy. Second, HMD technology can augment perceived vision and can be used for perimetry testing. Third, developing genetic risk scores that characterize

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Purpose: To report a case of herpes zoster ophthalmicus (HZO) reactivation after recombinant zoster vaccination. Methods: A 78-year-old woman, with a history of HZO 20 years ago, was referred for progressive corneal thinning in her left eye that started 1 week after her second dose of recombinant zoster vaccination. Results: At presentation, visual acuity was counting fingers. Corneal sensation was markedly decreased. Slit lamp examination revealed a temporal paracentral epithelial defect 1.5 × 2.0 mm in size with 40% thinning and surrounding stromal inflammation suggestive of stromal keratitis with ulceration. The patient was started on oral valacyclovir, topical erythromycin ointment, and hourly topical lubrication. A bandage contact lens was placed and was replaced 1 week later with self-retained cryopreserved amniotic membrane ring. The ring was removed in the following week when the thinned area was epithelialized with no further evidence of stromal lysis. Conclusions: HZO reactivation after recombinant zoster vaccination is uncommon but possible. Ophthalmologists should remain aware of potential risks of zoster vaccination and take special precautions in patients with HZO history.

Multiple MDAs significantly reduce trachoma prevalence and appear to increasingly protect children born into these communities. The youngest children show declining/stable rates of infection but increasing rates of trachoma, which may reflect longer duration of clinical signs.

Methods: This retrospective study analysed all patients with culture-positive AK seen between 2012 and 2019 at a tertiary referral centre. Patient demographic information, clinical history, risk factors, symptom duration, referral patterns, slit lamp examination findings, visual acuity and need for surgery were collected. Results: The study included 45 eyes of 43 patients. On average, patients were symptomatic for 52.6 days before culture collection. Thirty-one percent of patients were diagnosed within 28 days of symptom onset while 69% were diagnosed after 28 days. Before presentation to a tertiary care centre, 69% of patients were evaluated by an ophthalmologist outside of this institution and 27% were evaluated by a provider other than an ophthalmologist. AK was most commonly misdiagnosed as herpetic keratitis, occurring in 38% of patients. The strongest risk factor for AK was contact lens use. Only 11% of patients presented with the classic ring infiltrate and 82% had pain. Patients with an early versus late diagnosis had a mean Snellen visual acuity (VA) of 20/224 versus 20/296 at presentation (p = 0.33) and a mean Snellen VA of 20/91 versus 20/240 at final visit (p = 0.07). 11% of patients required a therapeutic penetrating keratoplasty. Conclusion: Delayed diagnosis of AK in our cohort occurred due to a misdiagnosis as herpetic keratitis, non-specific clinical signs including the lack of pain in a number of patients, and a delay in referral to a tertiary care centre. Any contact lens wearer with an atypical keratitis should be referred promptly for Acanthamoeba cultures.