July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Stepped Medication Use, Associated Symptoms, and Treatment Failure among Participants in the Medication Arm of the Collaborative Initial Glaucoma Treatment Study
Author Affiliations & Notes
  • David C Musch
    Ophthalmology & Visual Sciences, Univ of Michigan-Kellogg Eye Ctr, Ann Arbor, Michigan, United States
    Epidemiology, University of Michigan, Ann Arbor, Michigan, United States
  • Leslie M Niziol
    Ophthalmology & Visual Sciences, Univ of Michigan-Kellogg Eye Ctr, Ann Arbor, Michigan, United States
  • Brenda W Gillespie
    Biostatistics, University of Michigan, Ann Arbor, Michigan, United States
  • Paul R Lichter
    Ophthalmology & Visual Sciences, Univ of Michigan-Kellogg Eye Ctr, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   David Musch, Glaukos (R), InnFocus (R); Leslie Niziol, None; Brenda Gillespie, None; Paul Lichter, None
  • Footnotes
    Support  NIH Grant EY025719
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 1999. doi:
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      David C Musch, Leslie M Niziol, Brenda W Gillespie, Paul R Lichter; Stepped Medication Use, Associated Symptoms, and Treatment Failure among Participants in the Medication Arm of the Collaborative Initial Glaucoma Treatment Study. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1999.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To describe medication use, treatment failure, and the relationship between medications (number and type) and local eye symptoms/visual function problems in glaucoma patients randomized to the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS).

Methods : 607 newly-diagnosed, open-angle glaucoma patients participated in the CIGTS, of which 307 (51%) were randomized to receive topical medication to treat their glaucoma. Participants were followed at 3 months and every 6 months post-randomization for up to 10 years. Follow-up visits included collection of clinical measures [intraocular pressure (IOP) and visual field (VF)] and a patient-reported Symptom and Health Problem Checklist (SHPC). In the event of intervention failure (failure to meet target IOP and/or progressive VF loss), a stepped treatment regimen was applied. For the medication arm, steps included addition of medication, argon laser trabeculoplasty (ALT), and cross-over to trabeculectomy. Descriptive statistics were used to characterize medication use over time. Kaplan-Meier analysis was used to estimate the probabilities of adding medication and crossover to trabeculectomy. The relationship between symptoms and number and type of medication will also be reported.

Results : All 307 participants in the medication arm were placed on a single topical medication at baseline. By 3 months (n=288 with clinical data), 56% remained on a single medication, 35% were on 2 medications, 8% were on 3+ medications, and 1% had an ALT. After censoring for dropout, ALT, or trabeculectomy, the probability of adding medication was 0.40, 0.56, 0.67, 0.82, and 0.87 at 3, 6, 12, 36, and 60 months, respectively. Over the course of follow-up, 96 participants received ALT and 40 went on to trabeculectomy. The probability of trabeculectomy increased from 0.04 at 1 year to 0.15 at 9 years. At 3 months (n=280 with SHPC data), 81% of participants reported ≥1 ocular symptom/problem. All 18 symptoms/problems were observed, but the most frequently reported symptoms were eye irritation (43%) and difficulty with light/dark transitions (40%).

Conclusions : CIGTS participants randomized to a single medication to treat their glaucoma frequently needed additional medication early in follow-up. Most participants (81%) reported eye symptoms/problems at 3 months.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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