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C. K. Vorwerk, U. Thelen, F. Kimmich, P. Buchholz; Treatment of Glaucoma Patients With Insufficient Intraocular Pressure Control: A Survey of German Ophthalmologists in Private Practice. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5446.
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Medical management of intraocular pressure (IOP) is the primary treatment strategy for glaucoma, but is of limited success for many patients. We conducted a survey of difficult-to-treat patients with ocular hypertension (OH) and glaucoma in Germany. A standardized questionnaire was used to evaluate if the new findings from different epidemiological studies (AGIS, OHTS, EMGT, etc.) related to diagnosis, therapy and follow-up of patients with OH, primary open-angle glaucoma (POAG) and other types of glaucoma are already established in glaucoma practice.
A questionnaire was given to ophthalmologists in private practice in Germany and data including treatment difficulty, target IOP, number and type of medications used, 2 most recent IOP readings, and optic nerve head and visual field observations were collected from patients who exhibited unsatisfactory progress with IOP-lowering pharmacotherapy.
Of the 853 patients analyzed, POAG was the diagnosis for 67.1%. Target IOP levels had been determined for 95.5% of patients, and not achieving the target pressure was identified as a treatment difficulty for 81.0% of patients. Of patients on monotherapy, β-blockers were prescribed most often (42.3%). For all diagnoses, 53.3% of patients were treated with 2 or more agents as either fixed or non-fixed combinations. The non-fixed combination of a prostaglandin and CAI was the most frequently prescribed dual therapy (19.2%). Mean actual (treated) IOP for all patients was 20.3 ± 4.3 mmHg, mean target IOP was 16.6 ± 2.3mmHg. Actual (treated) IOP values followed a normal distribution (maximum: 20 mmHg). The most frequent target IOP value chosen by the participants of the survey was 18 mmHg (358 eyes). Disease severity was influencing the choice of target IOP: mean target IOP for patients with OH (n = 110) was 18.5 ± 2.0 mmHg whereas the mean target IOP for patients with glaucomatous optic nerve head and visual field damage (n = 437) was 16.4 ± 2.4 mmHg. Non-compliance was identified as a cause of unsatisfactory IOP-lowering in 26.8% of all patients.
Treatment alterations are necessary to achieve sufficient IOP control in some patients, and more aggressive therapies including fixed-combination preparations may improve efficacy and compliance.
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