Medical Outcomes of Glaucoma Therapy from a Nationwide Representative Survey

Objective: To evaluate the medical outcomes of patients treated for primary open angle glaucoma (POAG) or ocular hypertension.

Patients and methods: Sixty-eight ophthalmologists selected at random from a national professional list in France were asked to report on disease progression in consecutive patients who they saw in their clinics and who had either POAG, normal tension glaucoma/ocular hypertension, and who were aged >18 years of age. Data on sociodemographics, general and ocular comorbidities, glaucoma risk factors, visual acuity (VA), optic nerve head (ONH) clinical data, and visual fields were collected. Disease progression was defined as a deterioration of ONH and/or visual field since initial diagnosis. Changes in treatment were also monitored. A treatment change was defined as adding a new drug or changing any of the current treatments. Time to treatment failure was compared using the Wilcoxon test applied to survival curves.

Results: Of 127 patients who were evaluated, 12 developed a disease progression after diagnosis (average follow-up 2.4 years). No statistically significant difference in the known confounding factors of disease progression was found between patients with or without disease progression. At 32 months, 2.6% of the patients with no changes in treatment had a DP, compared with 22.6% with one change in treatment and 46.2% with two or more changes in treatment (p < 0.03). Patients who experienced adverse effects (p < 0.008) and those who said they were unhappy with their treatment (p < 0.03) more often experienced disease progression.

Conclusion: An estimated 9.4% of a representative sample of patients with POAG or ocular hypertension experienced disease progression within 2.5 years of initial diagnosis. Patients with disease progression had more changes in treatment and adverse events; they were also more likely to have complained about being unhappy with their treatment.