Background: Resource utilisation and direct costs associated with glaucoma progression in Europe are unknown. As population progressively ages, the economic impact of the disease will increase. Methods: From a total of 1655 consecutive cases, the records of 194 patients were selected and stratified by disease severity. Record selection was based on diagnoses of primary open angle glaucoma, glaucoma suspect, ocular hypertension, or normal tension glaucoma; 5 years minimum follow up were required. Glaucoma severity was assessed using a six stage glaucoma staging system based on static threshold visual field parameters. Resource utilisation data were abstracted from the charts and unit costs were applied to estimate direct costs to the payer. Resource utilisation and estimated direct cost of treatment, per person year, were calculated. Results: A statistically significant increasing linear trend (p = 0.018) in direct cost as disease severity worsened was demonstrated. The direct cost of treatment increased by an estimated J86 for each incremental step ranging from J455 per person year for stage 0 to J969 per person year for stage 4 disease. Medication costs ranged from 42% to 56% of total direct cost for all stages of disease.Conclusions: These results demonstrate for the first time in Europe that resource utilisation and direct medical costs of glaucoma management increase with worsening disease severity. Based on these findings, managing glaucoma and effectively delaying disease progression would be expected to significantly reduce the economic burden of this disease. These data are relevant to general practitioners and healthcare administrators who have a direct influence on the distribution of resources.

Purpose: To evaluate the retinal blood flow before and after the increase in systemic blood pressure to assess the autoregulation in healthy young subjects. Methods: Twenty eyes of 20 healthy volunteers were examined. The retinal blood flow was assessed by a Heidelberg retina flowmeter (HRF), while the systemic pressure was assessed by a portable electronic sphygmomanometer. Furthermore intraocular pressure (IOP) was always measured by a Goldmann tonometer immediately after HRF assessments. All measurements of physiological and flow parameters were performed with the subjects seated at rest and then immediately after stair climbing. Results: The IOP decreased significantly after dynamic exercise, while the heart rate and the systemic artery pressure increased significantly. At the baseline, the mean retinal blood flow was 276.8 ± 80.7 arbitrary units (AU) in the superotemporal area, 243.4 ± 63.68 AU in the superonasal area, 258.2 ± 67.37 AU in the inferotemporal area and 243.9 ± 72.24 AU in the inferonasal area. After dynamic exercise the mean retinal blood flow was 249.8 ± 86.78 AU in the superotemporal area, 248.7 ± 63.87 AU in the superonasal area, 245.4 ± 83.85 AU in the inferotemporal area and 228.8 ± 62.53 AU in the inferonasal area. No significant change in retinal blood flow was found. Conclusion: Our data support the hypothesis that in normal subjects autoregulation is sufficient to compensate the increase in blood pressure and maintain a stable retinal blood flow after exercise.

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PURPOSE: To evaluate the long-term outcome of myopic photorefractive keratectomy (PRK). METHODS: This prospective study included 31 patients (49 eyes) who underwent PRK between 1991 and 1993. A Summit UV200 excimer laser was used. Patients were divided into two groups-low myopia: preoperative Ͻ6.00 diopters (D) (range: Ϫ1.50 to Ϫ5.75 D) (n=19); and high myopia: preoperative у6.00 D (range: Ϫ6.00 to Ϫ13.00 D) (n=12). Long-term postoperative follow-up was every 2 years up to 14 years. Refraction, visual acuity, corneal status, and intraocular pressure (IOP) were evaluated. At 14 years, corneal topography and endothelial cell count were performed. RESULTS: At last follow-up, manifest refraction spherical equivalent (MRSE) for the low myopia group was Ϫ0.17Ϯ0.8, uncorrected visual acuity (UCVA) logMAR was Ϫ0.06Ϯ0.55, and best spectacle-corrected visual acuity (BSCVA) logMAR was 0.00Ϯ1.00. The high myopia group had a fi nal MRSE of Ϫ0.67Ϯ1.4, UCVA log-MAR Ϫ0.11Ϯ0.55, and BSCVA logMAR Ϫ0.03Ϯ1.00. At 14 years, BSCVA for most eyes was at least equal to preoperative BSCVA. In both groups, haze increased between 3 and 6 months, then declined in the fi rst year. A temporary increase of IOP was seen in 4 eyes. Complications were minor haze (2 eyes), transient anisocoria (9 eyes), and intraepithelial hemosiderin deposits (4 eyes). No abnormalities in endothelial cell count or morphology, astigmatism, or ectasia were noted. Three patients reported night vision disturbance, but the majority of patients were satisfi ed with the outcome based on subjective questionnaire (low myopia group: 84%; high myopia group: 75%).