Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication : a randomized controlled trial

Importance Approximately one-third of patients with peripheral artery disease experience intermittent claudication, with consequent loss of quality of life. Objective To determine the efficacy of ramipril for improving walking ability, patient-perceived walking performance, and quality of life in patients with claudication. Design, Setting, and Patients Randomized, double-blind, placebo-controlled trial conducted among 212 patients with peripheral artery disease (mean age, 65.5 [SD, 6.2] years), initiated in May 2008 and completed in August 2011 and conducted at 3 hospitals in Australia. Intervention Patients were randomized to receive 10 mg/d of ramipril (n = 106) or matching placebo (n = 106) for 24 weeks. Main Outcome Measures Maximum and pain-free walking times were recorded during a standard treadmill test. The Walking Impairment Questionnaire (WIQ) and Short-Form 36 Health Survey (SF-36) were used to assess walking ability and quality of life, respectively. Results At 6 months, relative to placebo, ramipril was associated with a 75-second (95% CI, 60-89 seconds) increase in mean pain-free walking time (P < .001) and a 255-second (95% CI, 215-295 seconds) increase in maximum walking time (P < .001). Relative to placebo, ramipril improved the WIQ median distance score by 13.8 (Hodges-Lehmann 95% CI, 12.2-15.5), speed score by 13.3 (95% CI, 11.9-15.2), and stair climbing score by 25.2 (95% CI, 25.1-29.4) (P < .001 for all). The overall SF-36 median Physical Component Summary score improved by 8.2 (Hodges-Lehmann 95% CI, 3.6-11.4; P = .02) in the ramipril group relative to placebo. Ramipril did not affect the overall SF-36 median Mental Component Summary score. Conclusions and Relevance Among patients with intermittent claudication, 24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo. This was associated with a significant increase in the physical functioning component of the SF-36 score. Trial Registration clinicaltrials.gov Identifier: NCT00681226

International contact lens prescribing in 2009

This is the eighth consecutive year that we have presented data from a survey of international contact lens prescribing in Contact Lens Spectrum. In this article we report on an assessment of 25,801 fits across 28 contact lens markets located in North America, Europe, the Middle East, Asia, and Africa. As in previous years, we opted for a prospective approach to this work. Up to 1,000 survey forms were randomly disseminated in each market to contact lens practitioners (ophthalmologists, optometrists, and/or opticians depending on the market), and information about the first 10 patients prescribed with lenses after receipt of paper or electronic survey forms was anonymously recorded.

RGP lenses 2010 : the last decade and the next decade

The results of the annual survey on international contact lens fits have become available again, which presents a great opportunity to distill the RGP lens data to see what the status of RGP lenses is today as well as to revisit the last decade of RGP lens fitting and to look ahead to the next decade.

International contact lens prescribing in 2010

For the past nine years, we have described the current state of contact lens fitting worldwide in Contact Lens Spectrum. This year, we report on 24,642 lens fits in 27 markets. As in all previous years, coordinators in each market distributed up to 1,000 paper or electronic survey forms to contact lens practitioners who, in turn, collected information about their next 10 fits. Data were processed and checked in the survey administrative offices in Manchester, United Kingdom and in Waterloo, Canada.

Globalisation of CL prescribing : the UK perspective

Globalisation is a concept that templates onto many aspects of the commercial world, and the contact lens field is no exception. The major international companies have worldwide distribution networks and supply lenses of the same product names and replacement frequencies to all nations, with a few minor adjustments for marketing and regulatory reasons. Small and mediumsized companies, often producing more specialist lenses, are also active in markets across the world.

Evolution or revolution?

Cosmetic tinted soft lenses, which were prescribed in 4-8 per cent of soft lens fits between 1997-2001, have declined in use and since 2003 have accounted for less than 2 per cent of soft lens fits. In general, there has been a slow but steady increase in the rate of prescribing for presbyopia.

The science behind the “stain”

It has been almost fi ve years since I fi rst published the article entitled “Much Ado About Staining” in Review of Optometry, which explored what we really knew in 2006 about the relationship between “corneal staining” and contact lens multipurpose solutions (MPS). This was published just prior to the controversial “staining grid.” While the Grid showed MPS-associated hyperfl uorescence under the slitlamp at two hours, it did not explain the “what” or “why” behind it; even so, many proponents of the Grid continue to suggest that it shows us which solution/lens combinations are “biocompatible” and which are not. New evidence suggests that the preservative-associated transient hyperfl uorescence (or PATH) observed at two hours after lens insertion is a benign phenomenon due to an interaction between fl uorescein, MPS preservatives, and corneal cell membranes. The misinterpretation of PATH as “real” corneal staining, like that observed in pathological conditions, may be due in part to the fact that there is not a lot of teaching regarding the true properties of fl uorescein and what is actually occurring when we see either PATH or corneal staining. To discuss the science of fl uorescein, corneal staining, and PATH, I have asked some of the preeminent research experts in the study of fl uorescence spectroscopy and corneal staining from around the world to share their new research and personal opinions on these topics...

Trends in Australian contact lens prescribing 2011

The 12th annual survey of Australian contact lens prescribing was conducted between January and April 2011, employing the same format as in previous years. About 3,000 optometrist members of Optometrists Association Australia were sent an e-mail message with a link to a downloadable questionnaire, and a request that this be accessed, printed and completed to provide details of the first 10 patients fitted with contact lenses after receipt of the questionnaire.

The science of compliance

A survey conducted in Australia and the Asian region of the way in which contact lens wearers use and maintain their lenses reveals disturbingly low levels of compliance with recommended practice. Key problem areas are identified, and a plea is made for practitioners to help reverse this trend.

International contact lens prescribing in 2011

This is the 11th annual report of contact lens prescribing trends that we have prepared for Contact Lens Spectrum. Each year, we capture current modes of contact lens practice by asking practitioners in each market (optometrists, opticians or ophthalmologists, as appropriate) to provide information about the first 10 lens fits undertaken after receiving our paper or electronic survey form. In 2011, we captured information about 22,362 fits in 29 countries.

Contact lens prescribing : USA vs the world

Along with other facets of commericialization, the contact lens market has become globalized during the past 30 years. The major international companies have worldwide distribution networks and supply lenses of the same product names and replacement frequencies to all nations, with a few minor adjustments for marketing and regulatory reasons. Small and medium-sized companies, often producing more specialized lenses, are also active in markets across the world.