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Yongsoo Kim, Judit Banhazi, Alexandra Durus, Laura Rodriguez Torres, Adam Gondos, Daniel Viriato, Vladimir Bezlyak, Naomi Boxall, Tim Wintermantel, Alexandros Sagkriotis, Douglas A Hubatsch; Treatment Pathways of Primary Open Angle Glaucoma prior to Laser Surgery: Real World Evidence from UK Ophthalmology Clinics. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6109. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Treatment for primary open angle glaucoma (POAG) may begin with pharmacologic therapies or laser trabeculoplasty (LT) with the aim to reduce intraocular pressure and slow disease progression. The purpose of this retrospective, observational analysis was to identify real world treatment pathways in POAG before first LT.
Data from Medisoft, an established real-world evidence platform of 6 UK ophthalmology centers using electronic medical records system were used to describe treatment pathways preceding first LT. The patient-eyes included had a diagnosis of POAG, a minimum follow-up of 12 months, and were identified from 2006 to 2017. The treatment pathways explored were defined as: those with laser surgery as first intervention (P1), trajectories recommended by publications and clinical guidelines as well as FDC as first line, which was commonly observed in clinical practice (P2) and other trajectories not meeting P1 or P2 (P3).
The dataset included 2323 surgical eyes, of which 1746 (75.2%) received LT and were analyzed. Of all LT eyes, 559 (32.0%) received LT as first-line treatment (P1) while 1187 (68.0%) received pharmacologic treatment before LT (P2 and P3). Of all eyes with pharmacologic treatment prior to LT, 620 (52.2%) received treatment according to P2 trajectories, of which the most common were monotherapy (439, 71.0%) or fixed-dose combination (90, 15.0%) followed by LT. The most common monotherapy within P2 was PGA (339, 54.7%) and the most common fixed-dose combination was PGA with BB (65, 10.5%). In the remaining P2 trajectories, 91 (14.7%) eyes were treated with PGA monotherapy, followed by PGA-based combination therapies. Of all eyes receiving LT, 567 (32.5%) were treated according to P3.
The real-world data show that the majority of eyes received pharmacologic treatment before undergoing LT and one-third of the eyes underwent LT without prior pharmacologic treatment. These results suggest that LT is used early in the glaucoma treatment pathway, either as initial intervention or after one line of treatment, often consisting of monotherapy or fixed-dose combination. The results show that in the real world, treatment pathways are manifold and more heterogeneous than suggested by clinical guidelines.
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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