Topical Therapies for Glaucoma and Ocular Hypertension: An Update on Current Practice

Considerations in developing model-based economic evaluations of glaucoma treatment

PURPOSE

To facilitate future glaucoma model development and to provide guidance for decision-makers evaluating them, we provide an overview of an innovative glaucoma model and highlight important modeling considerations.

CONSIDERATIONS

The considerations that were addressed include: disease outcome that is both relevant and meaningful to current clinical practice; diversity in treatment options and practices; incorporation of therapy discontinuation; and consideration of the variability in patient response to treatment.

MODEL SCOPE

A state-transition, Monte Carlo simulation model was developed to simulate the management and treatment of patients with glaucoma and/or ocular hypertension. The model examines strategies involving sequential use of up to 6 pharmacologic interventions. Transitions are based on the monthly probability that a patient is no longer "successfully maintained" on therapy, which can be a consequence of lack of intraocular pressure control, adverse events, lack of compliance, or lack of persistence. Outputs of the model include months on each treatment, frequency of therapy switches, days of intraocular pressure control, frequency of ophthalmologist visits, frequency of surgery, and glaucoma-related costs. The model allows the user to specify country-specific treatment strategies, survival on therapy, surgical rates, practice patterns, and costs.

CONCEPT APPLICATION

The model presented offers insights into accommodating patient and clinician variability through the use of persistence distributions. It will facilitate future glaucoma model development and provide insight for decision-makers who must evaluate model-based analyses of the economic value of glaucoma interventions.

Prise en charge de l’hypertonie oculaire et du glaucome chronique à angle ouvert par les ophtalmologistes français : rôle de la pression intra-oculaire cible

PURPOSE

A low level of intraocular pressure (IOP) can reduce or even stop the progression of glaucoma. It is essential to limit conversion from ocular hypertension (OHT) to glaucoma. The IOP value that protects the visual field and the optic nerve is called target IOP. This study analyzes how French ophthalmologists determine the target IOP level.

MATERIAL AND METHODS

The main objective of this prospective, multicenter national survey was to analyze the management of OHT or glaucoma patients and to evaluate the importance of target IOP in the therapeutic strategy.

RESULTS

A total of 972 ophthalmologists included 11.177 patients from May 2002 to March 2004. In 68.7% of cases, the practitioner determined the target IOP level using the following methods: a target of 15 mmHg or 17 mmHg or a reduction of the IOP level in percentage (EGS guidelines). This mean target IOP ranged from 14.3 to 17.3 mmHg.

DISCUSSION

The estimation of target IOP is used by the majority of French ophthalmologists.

CONCLUSION

This study shows that the determination of target IOP is becoming increasingly important in the therapeutic decision and follow-up in the routine practice of French ophthalmologists.