Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago.
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
JAMA Ophthalmol. 2020 Apr 1;138(4):358-364. doi: 10.1001/jamaophthalmol.2020.0001.
Glaucoma care for prison inmates is underrepresented in the literature even though managing the treatment of such patients may provide unique challenges.
To evaluate the glaucoma profile of prison inmates treated at an academic ophthalmology center and to report on the medical and surgical management and follow-up metrics.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study assessed data from 82 incarcerated patients treated at the glaucoma clinic, an academic referral center at the University of Illinois at Chicago, between January 2013 and December 2017.
Diagnosis, glaucoma severity, medical and surgical interventions, and patient-reported medication adherence were recorded for each visit. Recommended and actual follow-up times were recorded and compared. Data analyses were conducted from January 2013 to December 2018.
In total, 82 patients (161 eyes) had 375 visits during the study period. All patients were male and ranged from 20 to 75 years of age (mean [SD] age, 50.8 [11.9] years). Most participants were black patients (65 [79.3%]). The most common diagnoses were primary open-angle glaucoma (POAG; 53 eyes [32.9%]) and POAG suspect (52 eyes [32.3%]). Glaucoma severity ranged from mild (25 of 77 eyes [32.5%]) to advanced (41 of 77 eyes [53.2%]). Overall, 59 patients (73.2%) were treated medically with up to 4 topical agents (40.0%). Of those treated, 70.0% of patients (95% CI, 57.7%-81.2%) reported medication nonadherence during at least 1 visit. Medication nonadherence was more common among those taking 4 different topical medications (21 of 24 [87.5%]) compared with others taking fewer medications (20 of 35 [57.1%]), for a difference of 30.4% (95% CI, 7.0%-53.6%; P = .02), and among those with advanced disease (22 of 26 [84.6%]) compared with glaucoma suspect (6 of 13 [46.2%]), for a difference of 38.4% (95% CI, 9.3%-67.5%; P = .02). Nineteen office procedures, including laser peripheral iridotomy and laser trabeculoplasty, were performed on 14 eyes. Seventeen incisional glaucoma procedures were performed on 15 eyes, including glaucoma drainage device implant (11 procedures [64.7%]) and trabeculectomy (3 procedures [17.6%]). Only 26.6% of return office visits (95% CI, 21.3%-32.3%) occurred within the recommended follow-up time frame. Furthermore, 93 patients (34.8%; 95% CI, 28.2%-40.0%) were seen more than 1 month after the recommended follow-up.
Despite incarceration in prison, where medication administration and appointment attendance are theoretically controlled, the results of this study suggested that substantial medication and follow-up nonadherence exists among inmates.
尽管管理此类患者的治疗可能会带来独特的挑战，但监狱囚犯的青光眼护理在文献中仍未得到充分体现。
评估在学术眼科中心接受治疗的监狱囚犯的青光眼情况，并报告其医疗和手术管理以及随访指标。
设计、地点和参与者：本回顾性队列研究评估了 2013 年 1 月至 2017 年 12 月期间，在伊利诺伊大学芝加哥分校的青光眼诊所接受治疗的 82 名被监禁患者的数据，该诊所是一家学术转诊中心。
每次就诊时均记录诊断、青光眼严重程度、药物和手术干预以及患者报告的药物依从性。记录并比较了推荐和实际随访时间。数据分析于 2013 年 1 月至 2018 年 12 月进行。
在研究期间，共有 82 名患者（161 只眼）进行了 375 次就诊。所有患者均为男性，年龄在 20 至 75 岁之间（平均[SD]年龄为 50.8[11.9]岁）。大多数参与者是黑人（65 名[79.3%]）。最常见的诊断是原发性开角型青光眼（POAG；53 只眼[32.9%]）和 POAG 疑似病例（52 只眼[32.3%]）。青光眼严重程度从轻度（25 只眼[32.5%]）到晚期（41 只眼[53.2%]）不等。总体而言，59 名患者（73.2%）接受了多达 4 种局部药物治疗（40.0%）。在接受治疗的患者中，有 70.0%（95%CI，57.7%-81.2%）的患者在至少一次就诊中报告药物不依从。与服用较少药物（20 名患者[57.1%]）的患者相比，服用 4 种不同局部药物的患者（24 名患者中的 21 名[87.5%]）药物不依从更为常见，差异为 30.4%（95%CI，7.0%-53.6%；P = .02），并且与疾病晚期患者（22 名患者[84.6%]）相比，青光眼疑似患者（13 名患者中的 6 名[46.2%]）药物不依从更为常见，差异为 38.4%（95%CI，9.3%-67.5%；P = .02）。在 14 只眼中进行了 19 次眼部手术，包括激光周边虹膜切开术和激光小梁切开术。在 15 只眼中进行了 17 次切开性青光眼手术，包括青光眼引流装置植入术（11 例手术[64.7%]）和小梁切除术（3 例手术[17.6%]）。仅 26.6%（95%CI，21.3%-32.3%）的复诊在推荐的随访时间内进行。此外，93 名患者（34.8%；95%CI，28.2%-40.0%）在推荐的随访后超过 1 个月就诊。
尽管在理论上可以控制囚犯的药物管理和预约，但这项研究的结果表明，囚犯中存在大量药物和随访不依从的情况。
