A review of glaucoma treatment in Scotland 1994–2004

Nation-Wide Analysis of Glaucoma Medication Prescription in Fiscal Year of 2019 in Japan

To report the updated prescription trend of antiglaucoma medications, the dose-based prescription of a glaucoma medication in Japan in the fiscal year 2019 was aggregated by using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open data. Of the 100 most frequently prescribed topical medications for outpatients from out-hospital pharmacies, 32 glaucoma medications were identified. This year, 150.8 million ml of glaucoma medications prescribed accounted for 12.3% of the total prescription dose (1.3 billion ml). The dose was the largest with prostaglandin FP2α agonist (PGF2α), followed by the fixed-dose combination (FDC) of β-blocker and carbonic anhydrase inhibitor (β + CAI) and α2-agonist. Prescription doses peaked at 75−79 years old for all medication classes, except for prostaglandin EP2 agonist of that peaked 10 years younger age class than other medications. The prescription dose was larger in women (55.3%) than men (44.7%), single medication formulation (71.2%) than FDC (28.8%), and brand-name (85.2%) than generic (14.8%). By multivariate analysis, prescription doses were affected by roles of the sex (p = 0.0066) and brand-name or generic (p = 0.032), but not by single medication formulation or FDC (p = 0.67); age was the most remarkable parameter for the difference in prescription dose (p < 0.0001). Dose-based anti-glaucoma medication prescription was analyzed using the government-provided most recent database on a national scale. The results provide the up-to-date real-world glaucoma medication prescriptions where the country has the highest aging rate in the world.

Changing Trends in Glaucoma Surgery Over the Past 5 Years in China

PURPOSE

To analyze the trends of glaucoma surgery procedures over the past 5 years among hospitals across major provinces in China.

MATERIALS AND METHODS

This was a retrospective observational study based on medical records. We obtained the annual numbers of commonly performed glaucoma incisional surgeries from 57 hospitals of 30 provincial regions in the Chinese Glaucoma Study Consortium (CGSC) from January 2015 to September 2019. The trend of glaucoma surgery was analyzed by Cochrane-Armitage trend test.

RESULTS

Trabeculectomy, cataract extraction combined with goniosynechialysis, cataract extraction combined with trabeculectomy, and surgical peripheral iridotomy (SPI) were the top 4 surgical procedures percentages of which have the most substantial change over the course of 2015 to 2019 (all Ptrend <0.001). Numbers of trabeculectomies decreased significantly from 47.59% in 2015 to 31.21% in 2019; cataract extraction combined with goniosynechialysis increased from 12.12% to 28.48%; cataract extraction combined with trabeculectomy increased from 13.11% to 15.97%; and SPI decreased from 9.03% to 6.34%. The proportion of internal drainage surgery increased from 24.31% in 2015 to 39.29% in 2019 while external drainage surgery decreased from 69.20% to 54.64% (All Ptrend <0.001). The microinvasive glaucoma surgeries including AB-interno Canaloplasty, gonioscopy-assisted transluminal trabeculotomy, and Trabectome, increased from 0.62% to 1.40% (Ptrend<0.001). Across all study hospitals, the trends were similar, except for the Tibet Autonomous Region Eye Center, where SPI and trabeculectomy remained the most common anti-glaucoma surgeries.

CONCLUSION

In the past 5 years, we observed substantial reduction in trabeculectomy, and increase in combination cataract-glaucoma procedures across major hospitals in China. The proportion of internal drainage surgery increased, while external drainage surgery decreased significantly. Detailed understanding of shifting trends in glaucoma surgeries can facilitate better health care resource allocation and training of glaucoma subspecialists in China.

The future is old - Patients with topical ocular hypotensive treatment in the Nordic region between 2008 and 2017 with projections for 2040

PURPOSE

The primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the Nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the Nordic region.

METHODS

A retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the Nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections.

RESULTS

The total number of patients with ocular hypotensive treatment in the Nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (DDD) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the Nordic countries, Finland had almost twice as many DDD per patient and day in 2017 (2.1) compared with Iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the Nordic region decreased from 96 million to 87 million Euro (-9%). In 2040, the number of patients with ocular hypotensive treatment in the Nordic region is estimated to 633 000 individuals (+51% compared with 2017).

CONCLUSIONS

The study revealed an increased use of glaucoma medications in the Nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypotensive treatment is estimated to have increased with an additional 50% due to a growing number of ageing individuals. This will lead to higher costs, not only for medications but also for diagnosing, monitoring and other aspects of glaucoma care.

Trends and Usage Patterns of Minimally Invasive Glaucoma Surgery in the United States: IRIS® Registry Analysis 2013-2018

PURPOSE

Understanding trends and patterns in the use of minimally invasive glaucoma surgery (MIGS) and patient profiles undergoing each procedure is important given their relative expense and unknown long-term safety and effectiveness.

DESIGN

Retrospective analysis.

PARTICIPANTS

Minimally invasive glaucoma surgeries and standard glaucoma surgeries recorded in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry.

METHODS

We used the data from IRIS Registry between 2013 and 2018 (inclusive) to measure the annual number of MIGS and standard surgical techniques (trabeculectomy or glaucoma drainage device [GDD] placement) performed in the United States, stratified by demographic characteristics. Secondary analyses of concurrent surgeries and of subsequent surgeries for MIGS and standard surgical technique also were conducted.

MAIN OUTCOME MEASURES

Trends and sociodemographic characteristics of MIGS use in the United States.

RESULTS

Two hundred three thousand three hundred thirty-two eyes and 232 537 unique procedures had associated, documented International Statistical Classification of Diseases and Related Health Problems (ICD), Ninth or Tenth Revision, codes for glaucoma and were included in final analyses. Among eyes with documented glaucoma diagnoses, a substantial increase in annual MIGS procedures occurred over the study period (from 7586 in 2013 to 39 677) and a smaller decrease in standard glaucoma procedures (from 16 215 to 13 701). The proportion of iStent procedures almost tripled during the study period (from 14% to 40%), and by 2017 accounted for almost half (43.7%) of all glaucoma surgeries in the United States. Twenty-one thousand twenty-five of all eyes (10.3%) underwent multiple procedures: 7638 (36.3%) on the same day and 13 387 (63.7%) on subsequent days. Endocyclophotocoagulation and iStent placement were the most common concurrent procedures (55.4% of all concurrent procedures). Trabeculectomy and GDD placement were most commonly followed by another standard glaucoma surgery, but when followed by sequential MIGS, endocyclophotocoagulation and goniotomy were the most common procedures performed (33.0% and 21.9%, respectively).

CONCLUSIONS

A significant increase in MIGS use occurred over the recent 6-year period, despite limited evidence of their long-term safety or effectiveness, highlighting the need for trials comparing safety and outcomes of novel MIGS versus traditional surgical treatments for glaucoma.

Use of Topical Intraocular Pressure-lowering Medications in the US Population: Results From the NHANES Study 1999 to 2014

PRECIS

We found no evidence of an increase in the number of Americans using topical intraocular pressure (IOP) medication or a number of drops used per patient from 1999 to 2014, although there were significant changes in the class of medications used.

PURPOSE

The purpose of this study was to determine changes in topical IOP-lowering medication use in the United States from 1999 to 2014.

MATERIALS AND METHODS

A series of 8 nationally representative, weighted cross-sectional surveys of United States residents were performed every 2 years from 1999 to 2014. On 2-year cycles, professional interviewers performed in-home interviews of a representative sample of the nation as part of the National Health and Nutrition Examination Survey study. Participants were asked, "In the past month, have you used or taken medication for which a prescription is needed?" Adults over age 40 who responded to this question were included in the analysis. The primary outcome was number of US adults using topical IOP-lowering medication. Secondary outcomes included the number and types of medications used.

RESULTS

There was no change in the number of adults using topical IOP-lowering medications over the time period studied (P=0.74) with 1.4% (95% confidence interval: 0.9%-1.8%) of US residents on IOP-lowering medications in 1999 to 2000 and 1.4% of US residents (95% confidence interval: 1.1%-1.8%) on topical medications in 2013 to 2014. There was no change in the number of medications per patient over the period of the study (P=0.14). There was a significant increase in the use of prostaglandin analogs and combination medications and a decrease in the use of β-blockers (all P<0.01).

CONCLUSIONS

In contrast to the increase in glaucoma medication use seen in several other developed nations, use in the United States remained stable from 1999 to 2014. This may be due to differential use of other procedures. Future studies of IOP-lowering medications incorporating the effect of new agents and minimally invasive surgeries are warranted.

Prescribing Trends of Topical Glaucoma Medications in Australia From 2001 to 2017

PRECIS

As new glaucoma treatments arise, including minimally invasive glaucoma surgeries and new classes of glaucoma medications, it is important to examine the prescription trends of current topical glaucoma medications and how they may change.

PURPOSE

To determine the prescribing trends of topical glaucoma medications in Australia from 2001 to 2017.

METHODS AND ANALYSIS

Pharmaceutical Benefits Scheme (PBS) item numbers were used to determine glaucoma medication prescribing rates from 2001 to 2017. All data were adjusted for population (/100,000) as per the Australian Bureau of Statistics (ABS) population data.

RESULTS

Overall prescription rates for glaucoma medications ranged between 67,904 and 86,936 per 100,000 from 2001 to 2017. An upward trend was noted from 2001 to 2015, with the exception of a notable decline in 2013 by 14.7%, before then increasing by 13.7% in 2014. After 2015, prescribing rates were seen to decrease over the subsequent years in the study period. Latanoprost remained the most prescribed medication and prostaglandin the most prescribed class. Prescribing rates of single-agent beta-blockers were noted to decrease during the 17-year period, particularly with the introduction of combination agents, which note an upward trend. Brinzolamide/brimonidine has increased by 50.0% from 2016 to 2017.

CONCLUSIONS

Total rates of prescriptions have remained relatively stable from 2001 to 2017. The number of medications prescribed when considering combination agents separately was seen to be increasing from 2001 to 2015. From 2015 to 2017, a downward trend was noted in the number of medications prescribed. Prostaglandins remain the most prescribed class throughout the study period.

Prescribing Trends in a Glaucoma Clinic and Adherence to EGS Guidelines: A Retrospective, Non-Interventional, Single-Center UK Study

INTRODUCTION

The purpose of this study was to determine prescribing trends in a specialist glaucoma clinic in the UK. Specifically, the aims were to determine which drugs were prescribed as first-, second-, and third-line treatment, the persistence of first-, second-, and third-line treatment regimens, and the proportion of treatment decisions conforming to the European Glaucoma Society (EGS) guidelines.

METHODS

A retrospective, non-interventional, single-center, case-note review was performed on a cohort of consecutive patients presenting to a specialist glaucoma clinic for follow-up. Inclusion criteria for the study were (1) a diagnosis of primary open-angle glaucoma or ocular hypertension, (2) glaucoma management entirely within the unit, and (3) minimum of 2 years of follow-up.

RESULTS

A total of 114 case notes met the inclusion criteria. Mean age was 71 years (range 40-95 years). Mean length of follow-up was 56 months (range 24-180 months). Prostaglandin analogues (PGA) were the most popular first-line treatment in 73% of patients. As second-line treatment, PGA were again the predominant class, prescribed in 87% of cases, whereas beta-blockers (BB) were prescribed in 70% of cases. Carbonic anhydrase inhibitors (CAI) and alpha-2 agonists (AA) were more popular in third-line regimens. Second-line treatment was introduced at a mean of 28.0 months after first-line treatment (range 1-120 months, 95% CI 22.1-33.9 months). Third-line treatment was introduced at a mean of 22.9 months after second-line treatment (range 1-96 months, 95% CI 17.1-28.8 months). Breaches to EGS guidelines were most common for third-line treatment and included duplication of drug classes.

DISCUSSION

There was a clear hierarchy of PGA as first-line, BB as second-line, while CAI and AA were considered third-line choices. First-line choices were generally in line with EGS guidelines. There was a tendency to breach guidelines by escalating treatment in dual steps rather than single steps (especially in third-line treatment). Combination drops were popular. In third-line treatment there was an increased incidence of prescribing errors. This data is important in terms of informing patients of the expected treatment course, to remind clinicians about best practice, and also to guide comparisons of cost-effectiveness with other treatment modalities.

Glaucoma treatment trends: a review

Glaucoma is one of the most common causes of blindness worldwide, and its prevalence is increasing. The aim of the present review is to describe the current medical and surgical treatment trends in the management of open-angle glaucoma. There has been an increase in the availability of glaucoma medications and the use of laser trabeculoplasty over the past decade, with a subsequent decrease in invasive incisional surgery. In addition, a new class of glaucoma procedures, termed microinvasive glaucoma surgery, has emerged, which aims to fill the gap between conservative medical management and more invasive surgery.

Glaucoma prescribing trends in England 2000 to 2012

PURPOSE

In 2009, the National Institute for Clinical Excellence (NICE) published guidance on the treatment of ocular hypertension and glaucoma. The aim of the present study was to describe the impact this guidance had on glaucoma prescribing and to describe recent prescribing trends in England.

METHOD

Prescribing cost analysis data held by NHS Business Authority for the years 2000-2012 was analysed.

RESULTS

The number of prescriptions dispensed increased by 67% from 4.76 million in 2000 to 7.96 million in 2012. Over the same time period, drug costs increased by 88% from £55.2 million to £103.7 million. Prescriptions for prostaglandin analogues increased fourfold, while there was a threefold decrease in the use of beta-blockers. The most commonly prescribed glaucoma medication was latanoprost. The introduction of generic latanoprost in 2012 more than halved the cost associated with this medication. NICE guidance appeared to have had no effect on the total number of prescriptions or the classes of medications prescribed.

CONCLUSION

The introduction of the NICE guidelines did not change glaucoma prescribing practice, although it is not clear whether this represents non-adherence to the guidelines or whether the guidelines embodied pre-existing practice.

Glaucoma costs in Denmark in treatment naive patients

PURPOSE

To describe the costs and providers of glaucoma treatment in Denmark.

METHODS

Analyses were based on National Register data. Glaucoma/OHT patients were identified by their first prescription for glaucoma medication (ATC-codes) in the Danish Register of Medicinal Product Statistics 2002-2007. Patients had used no glaucoma medication for 6 months. Data for 2007 were sampled cross-sectionally for a budgetary analysis of glaucoma (ICD10 code) medication and services consumed in the primary and secondary health care services. Patients were categorized according to their number of treatment changes.

RESULTS

The Danish annual incidence rate of glaucoma was estimated at 1.2 per 1000 adult persons. Thirty-seven per cent of patients (men 44%, mean age 68 years; women 56%, mean age 71 years) persisted with their initial treatment regimen, 21% had changed to a second regimen, and 43% had experienced ≥ 3 regimens. Treatment costs increased with the number of sequential regimens. Annual glaucoma costs (health care sector perspective) were €305 for patients under their initial regimen, increasing to €740 with ≥ 3 regimens. Drug costs accounted for 57% of total cost.

CONCLUSIONS

Drugs represented the major cost of glaucoma, and those costs increased, obviously, with the number of treatment changes.

Use of glaucoma medications: state of the science and directions for observational research

PURPOSE

To summarize observational studies that focus on the use of glaucoma medications and to identify gaps in knowledge to guide future investigation.

DESIGN

Literature study.

METHODS

We searched the electronic databases MEDLINE, EMBASE, and PubMed for English language articles published through December 2009 using the search terms physician's practice patterns, drug prescriptions, pharmaceutical services, medication adherence, ophthalmology, glaucoma, and ophthalmic solutions. We categorized studies by areas of focus and extracted and summarized key features: study population, data sources, and main findings.

RESULTS

We identified 2224 articles by the search. Fifty-five described glaucoma medication use using large databases. Predominant areas of focus were: trends in prescription choices (n = 13); adherence, persistence, or both (n = 31); rational use of medications (n = 9); and policy-related issues (n = 2). Over the last decade, use of β-blockers and miotics has decreased substantially, whereas new agents, particularly prostaglandin analogs, have become more popular. Nonadherence was an issue in more than 25% of patients. A significant proportion of patients with comorbidities, contraindications, or both had received topical β-blockers.

CONCLUSIONS

To date, most studies have focused on adherence to glaucoma medications and changes in treatment choices. Major gaps in knowledge include prescribing patterns by prescriber specialty (ophthalmologists, primary care physicians, and optometrists), medication-related problems, and subsequent adverse health outcomes. Well-designed longitudinal observational studies addressing these gaps are warranted to improve patient safety.