***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background / aims To determine if  eyelid closure  ( ELC ) after topical prostagl and in instillation provides greater intraocular pressure ( IOP ) reduction than prostagl and in instillation without ELC . Methods Patients receiving chronic bilateral prostagl and in monotherapy were enrolled in this study . The study intervention , ELC , was r and omly assigned to one eye , while the fellow eye served as control . ELC was performed for either 1 min or 3 min . After a 1-day washout , the IOP was measured in a masked fashion at baseline , 1 h and 24 h , and at a final visit that took place 7–14 days after enrolment . All visits were scheduled during the morning , and every individual patient 's visits occurred at similar times during the day . The main outcome was difference between intervention eye and control eye in IOP-lowering from baseline . Results 51 patients meeting eligibility criteria were enrolled : 25 were r and omised to ELC for 1 min and 26 to ELC for 3 min in the intervention eye . The pooled IOP-lowering difference ( 95 % CI , p value ) in intervention versus control eyes was 0.24 mm Hg ( −0.5 to 0.9 , p=0.50 ) , 0.24 mm Hg ( −0.7 to 1.2 , p=0.61 ) and 0.24 mm Hg ( −0.7 to 1.2 , p=0.61 ) in the overall group , 1 min ELC subgroup and 3 min ELC subgroup , respectively . The effect of ELC did not change significantly across visits . Conclusions ELC did not provide significant additional IOP reduction compared with no ELC in patients using chronic prostagl and in monotherapy . Trial Registration http:// clinical BACKGROUND Treatments for open-angle glaucoma aim to prevent vision loss through lowering of intraocular pressure , but to our knowledge no placebo-controlled trials have assessed visual function preservation , and the observation periods of previous ( unmasked ) trials have typically been at least 5 years . We assessed vision preservation in patients given latanoprost  compared with those given  placebo . METHODS In this r and omised , triple-masked , placebo-controlled trial , we enrolled patients with newly diagnosed open-angle glaucoma at ten UK centres ( tertiary referral centres , teaching hospitals , and district general hospitals ) . Eligible patients were r and omly allocated ( 1:1 ) with a website-generated r and omisation schedule , stratified by centre and with a permuted block design , to receive either latanoprost 0·005 % ( intervention group ) or placebo ( control group ) eye drops . Drops were administered from identical bottles , once a day , to both eyes . The primary outcome was time to visual field deterioration within 24 months . Analyses were done in all individuals with follow-up data . The Data and Safety Monitoring Committee ( DSMC ) recommended stopping the trial on Jan 6 , 2011 ( last patient visit July , 2011 ) , after an interim analysis , and suggested a change in primary outcome from the difference in proportions of patients with incident progression between groups to time to visual field deterioration within 24 months . This trial is registered , number IS RCT N96423140 . FINDINGS We enrolled 516 individuals between Dec 1 , 2006 , and March 16 , 2010 . Baseline mean intraocular pressure  was 19·6 mm Hg ( SD 4·6 ) in 258 patients in the latanoprost group and 20·1 mm Hg ( 4·8 ) in 258 controls . At 24 months , mean reduction in intraocular pressure was 3·8 mm Hg ( 4·0 ) in 231 patients assessed in the latanoprost group and 0·9 mm Hg ( 3·8 ) in 230 patients assessed in the placebo group . Visual field preservation was significantly longer in the latanoprost group than in the placebo group : adjusted hazard ratio ( HR ) 0·44 ( 95 % CI 0·28 - 0·69 ; p=0·0003 ) . We noted 18 serious adverse events , none attributable to the study drug . INTERPRETATION This is the first r and omised placebo-controlled trial to show preservation of the visual field with an intraocular-pressure-lowering drug in patients with open-angle glaucoma . The study design enabled significant differences in vision to be assessed in a relatively short observation period . FUNDING Pfizer , UK National Institute for Health Research Biomedical Research Centre Purpose To measure the impact of the Xal-Ease ® delivery device on ease of eyedrop administration and on treatment compliance and satisfaction . Methods This prospect i ve , multicenter , r and omized , comparative , crossover study was conducted at 43 sites in France . Eligible subjects were > 18 years of age , were diagnosed with primary open-angle glaucoma or ocular hypertension , had been treated with latanoprost or fixed-combination latanoprost/timolol for ≥3 months prior to enrollment , and did not require a therapy change . Subjects used either Xal-Ease or the dropper bottle for 4 weeks and then switched to the alternate delivery method for the next 4 weeks . Subjects completed question naires after 1 and 4 weeks in each treatment period . Results In all , 211 subjects were enrolled , 107 to the Xal-Ease/dropper bottle group and 104 to the dropper bottle/Xal-Ease group . Baseline demographic and ocular characteristics were similar . Use of Xal-Ease made it significantly less likely that the subject would need someone to help with drop instillation ( 6.9 % vs 18.1 % , respectively ; p<0.001 ) and reduced the problem of the tip of the bottle touching the eye ( 3.2 % vs 35.6 % , respectively ; p<0.001 ) . Reported compliance rates were very high and similar across groups during both treatment periods . After 1 month of use during both treatment periods , more than 70 % of subjects reported global satisfaction with Xal-Ease to their physicians . No adverse events associated with the use of Xal-Ease were noted . Conclusions Xal-Ease generally makes administration of latanoprost or fixed-combination latanoprost/timolol easier compared with the dropper bottle A prospect i ve collaborative study was conducted in five centers during a 13-year period to identify factors that influence the development of  visual-field defects ( GVFDs ) of open angle glaucoma . In 5,000 subjects ,  GVFDs  developed in only 1.7 % of eyes . Statistical analysis of 26 factors at first examination identified five that were significantly related to the development of GVFDs -- outflow facility , age , applanation pressure , cup-disc ratio , and pressure change after water drinking . Their absolute initial value , and not its change with time , was the important predictor . Multivariate analysis showed their collective predictive power to be undesirably poor , indicating that other factors must play an important role in the development of GVFDs . Mortality-table analysis indicated that during a period of five years , 98.54 % of eyes with initial pressure less than 20 mm Hg continued to be free from GVFDs as compared with 93.34 % of those with pressure of 20 mm Hg or greater We assessed the effect of  nasolacrimal occlusion on the therapeutic index of the adrenoreceptor agonists in healthy volunteers and patients with glaucoma . Nasolacrimal occlusion did not significantly alter the response to 2 % epinephrine or to 0.1 % dipivefrin in healthy subjects , suggesting that both 2 % epinephrine and 0.1 % dipivefrin are at the top of the dose-response curve . When 0.5 % epinephrine with nasolacrimal occlusion was tested in patients with glaucoma , effects were noticeable at four and eight hours ( P less than .05 ) , but not at 12 hours . For 2 % epinephrine , there was no significant difference at any measurement time . Epinephrine ( 1 % ) with and without nasolacrimal occlusion gave results similar to those of 2 % epinephrine , suggesting that 1 % epinephrine is also at the top of the dose-response curve . Nasolacrimal occlusion did not increase the ocular hypotensive effect of either of these concentrations . Because dipivefrin , the most widely used formulation in this class , is a prodrug of epinephrine that has a corneal penetration approximately 17 times that of epinephrine , 0.05 % dipivefrin , every 12 hours , might be an adequate dosage for maximal effect . Although nasolacrimal occlusion did not alter the drug effect of 0.1 % dipivefrin , preventing as much drug as possible from reaching the systemic circulation is desirable PURPOSE To investigate the impact of an intervention program to improve adherence with topical , once daily therapy for glaucoma . DESIGN R and omized controlled clinical trial . PARTICIPANTS Sixty-six patients with glaucoma being treated with a prostagl and in analog in 1 or both eyes at the Scheie Eye Institute or Wilmer Eye Institute between November 2006 and June 2007 . METHODS In an observational study , participants who took 75 % or fewer doses ( as measured using the travoprost Dosing Aid [ DA ] ) during an initial 3-month period were r and omized into 2 groups . The intervention group watched an educational video , review ed current barriers to drop-taking and possible solutions with a study coordinator , received regular phone call reminders , and had audible and visible reminders activated on their DA devices . The control group was told to take drops as prescribed and received no additional intervention . MAIN OUTCOME MEASURES Change in drop use adherence as determined by the DA device . RESULTS In the 3-month observation period before r and omization , intervention group patients had used a mean of 54+/-17 % of scheduled doses , and this increased to 73+/-22 % during the following 3-month period ( P<0.001 , n = 35 ) . The control mean adherence rate of 46+/-23 % at baseline was statistically unchanged during the follow-up observation period ( 51+/-30 % , P = 0.16 , n = 31 ) . In a multivariate analysis , intervention , baseline compliance rate of < 50 % , and white ethnicity were predictors of improved adherence during the 3 months of intervention . The intraocular pressure ( IOP ) of the intervention and control groups did not change between months 3 and 6 after intervention ( P = 0.96 , 0.34 , respectively ) , and there was no correlation of IOP change with adherence rate change between both groups ( Pearson correlation r = 0.06 , P = 0.51 ) . CONCLUSIONS A multifaceted intervention significantly increased adherence with glaucoma medications . Those with improved adherence were in the intervention group , had very low adherence rates at baseline , and were white . IOP did not correlate with adherence . Further research is needed to determine which components of this intervention were most effective Nasolacrimal occlusion ( NLO ) and eyelid closure are simple techniques that not only increase the ocular bioavailability of topically applied ocular drugs but also reduce the probability of adverse systemic effects . Each serves to improve the therapeutic index . Subsequent to the application of 0.5 % timolol maleate , the effects of NLO and eyelid closure were compared with the effects of no procedures . In this experiment , systemic drug absorption in normal volunteers was reduced more than 60 % . Measurements were made by radioimmunoassay of timolol in blood plasma . In addition , the diminution of fluorescein in the anterior chamber was observed for three hours following direct application to the lower cul-de-sac . Results indicate a lower fluorescein concentration and a shorter duration of fluorescence in the absence of either experimental technique . Both NLO and eyelid closure seem to be safe , simple , and effective procedures that could minimize dosage requirements , as well as side effects The purpose of this study was to assess whether nasolacrimal occlusion improves the therapeutic index of various antiglaucoma medications . Use of nasolacrimal occlusion result ed in better efficacy and safer usage . Nasolacrimal occlusion used with 2 % pilocarpine , 1.5 % carbachol , 0.25 % timolol maleate , or 1 % epinephrine every 12 hours gave the maximal response for these drugs . Applying 0.25 % timolol and 1.5 % carbachol every 12 hours gave the maximal response for this combination . Nasolacrimal occlusion did not alter the effect of 0.1 % dipivefrin , and since the corneal penetration of this prodrug is 17 times that of epinephrine , 0.05 % dipivefrin every 12 hours might be an adequate dosage for maximal effect . Our findings suggest that most of the commercially used antiglaucoma agents can achieve the same maximal effect with lower concentrations and less frequent administration ( never exceeding every 12 hours ) . Nasolacrimal occlusion should markedly decrease systemic absorption and side effects following topical treatment Plasma timolol levels were measured in our timolol-treated glaucoma patients employing three protocol s : ( 1 ) measurements in ten patients over age 60 on chronic timolol therapy  before , one hour , and three hours after receiving one drop of 0.5 % timolol , ( 2 ) measurements in nine adult patients , with and without punctal occlusion , and ( 3 ) r and om measurement of plasma timolol in children on chronic timolol therapy while under general anesthesia . In the ten patients over age 
    Output:
    
It is unclear what , if any , effects instillation techniques have on topical medical therapy for glaucoma