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Anne L Coleman, Wang Degang, Li Guo, Hitesh Chandwani; Subsequent medical management of open-angle glaucoma patients treated with laser trabeculoplasty. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5613.
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To evaluate long-term patterns of medical (Rx) management in open-angle glaucoma (OAG) patients treated with laser trabeculoplasty (LT). For comparison, a cohort of patients managed with Rx therapy alone was also assessed.
Retrospective analysis of adjudicated insurance claims (medical and pharmacy) from the Truven Health MarketScan® Commercial and Medicare Supplemental databases between Jan 1, 2007 to Dec 31, 2014. Patients aged 18 years or older were included if they had ≥2 medical claims with OAG ICD-9-CM codes within 12 months (≥1 week apart) with prior treatment with prostaglandin analog monotherapy only . Index date for the LT cohort was the date of the first LT claim. The index date for the comparison Rx cohort was the date of the second medication class claim (add-on or switch). All patients were required to be continuously enrolled for 12 months pre- and 48 months post-index date. The outcome of interest was the cumulative number of topical medication classes post-index.
After applying selection criteria, there were N=2,376 in the LT cohort, and N=2,783 in the Rx cohort. The 2 cohorts were similar in age (mean±SD: 67.8±12.2 vs 67.5±12.6 years, p=0.38 for LT and Rx cohorts) and gender (47.2% vs 46.0%, - male in the LT and Rx cohorts, p=0.36). At three months post-index, 60% of LT-treated patients were also prescribed at least 1 topical glaucoma medication (Table 1). At 1 and 4 years post-index, 18.6% and 36.5% of LT- treated patients were using 2+ glaucoma medications. Only 22.9% of LT-treated patients were receiving no additional topical glaucoma medications at Year 1, and this number decreased to 16.1% by 4 years post-LT. Rates of receipt of additional medication classes post-index were higher for the Rx cohort compared with the LT cohort (Table 1).
In this population of prior-PGA treated patients, our findings are consistent with LT being an adjunctive therapy rather than an alternative to topical medications for glaucoma treatment. A sizeable proportion of LT-treated patients required multiple (2+) medications for ongoing disease management, albeit a smaller proportion than in the Rx cohort. This may be a significant limitation to the use of LT for glaucoma patients, since in patients with poor adherence they may still need to use drops if they have the LT procedure.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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