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Glaucoma Learning Zone
Declaration of sponsorship Novartis Pharma AG

Treating glaucoma

Declaration of sponsorship Novartis Pharma AG
Read time: 60 mins
Last updated:9th Jun 2022
Published:9th Jun 2022

Refresh your knowledge of glaucoma treatment options and considerations.

  • Learn about the unmet needs in glaucoma treatment from an expert
  • Explore the pharmacological, surgical and emerging treatment options for glaucoma
  • Watch patient case study videos for insights into tailoring treatment for individual patients

Unmet needs for treating glaucoma

In this video, Professor Anthony King discusses the unmet needs for treating glaucoma. As part of the discussion, he explains why regular monitoring is important, and how a risk-of-progression prediction model could be of benefit when determining the optimal treatment strategy for a patient.

Glaucoma remains undertreated globally1

Most people with glaucoma are undiagnosed and not receiving treatment. This is largely attributed to glaucoma being essentially asymptomatic until later stages of the disease. Prevalence surveys demonstrate that1:

  • in high-income countries, <50% of all detected glaucoma was diagnosed previously
  • in low-income and middle-income countries, >90% of people with glaucoma are not receiving care
  • up to 35% of people diagnosed with glaucoma in low-income and middle-income countries are already blind

Burton and colleagues conducted an umbrella review of systematic reviews to gain a deeper understanding of the impact of eye conditions, vision impairment and ophthalmic interventions on quality of life. While all reviews indicated poor quality of life outcomes associated with eye disease and vision loss, 75% of ophthalmic interventions had a positive impact on quality of life1. These findings highlight the importance and the opportunity of treatment to improve outcomes for glaucoma patients. Treatment challenges in glaucoma are illustrated in Figure 1.

Glaucoma_T3_Fig_1.png

Figure 1. The unmet needs in glaucoma treatment1-7.

Glaucoma treatment challenges

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Glaucoma treatment options

In this video, Professor King discusses recommended treatment options for glaucoma. Pharmacological, laser and surgical options are explored, along with the importance of determining a target intraocular pressure that is tailored to the individual patient.

On average, people with glaucoma are treated for 20 years14

Lowering intraocular pressure (IOP) is the only proven way to preserve visual function6,15. Topical medications or laser trabeculoplasty may be used as initial treatment for most forms of open angle glaucoma, with surgery a consideration for those patients with advanced visual field loss at presentation6. In people with ocular hypertension or with glaucoma in the absence of high IOP or severe damage, multiple IOP measurements may be worth considering before beginning IOP-lowering therapy6.

Target IOP for glaucoma

Determining target IOP

The aim of glaucoma therapeutic management is to lower the IOP of each eye to reduce the rate of visual field deterioration enough to maintain the patient’s quality of life. Therefore, it is important to set a target IOP as a treatment goal at diagnosis. The target IOP is the upper limit of the IOP that the healthcare professional considers is in alignment with this therapeutic aim6.

Because there is no singular target IOP level appropriate per patient, it needs to be determined for every eye of every patient – typically as a specific pressure level or percentage reduction. In newly diagnosed patients this would include consideration of the patient’s age, baseline IOP and the stage of their disease6.

When determining the individual target IOP, consider the factors outlined in Figure 2.

Glaucoma_T3_Fig_2.png

Figure 2. Factors to consider when determining the appropriate target IOP (Adapted6). *Family history, patient preference, adverse consequences of treatment, status of the other eye and central corneal thickness should also be considered. IOP, intraocular pressure.

Table 1 outlines target IOPs that may be sufficient/required at various stages of glaucoma.

Table 1. Suggested target IOPs for each stage of glaucoma6,16. IOP, intraocular pressure.

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Considerations for glaucoma patient management

In this video about managing patients with glaucoma, Professor King discusses treatment guidelines, the importance of tailoring treatment for the individual, and treatment goals from a patient’s perspective.

Figure 3 highlights key considerations for patient management.

Glaucoma_T3_Fig_3.png

Figure 3. Considerations for patient management1,6. IOP, intraocular pressure.

Eye care in primary care settings

In many countries, general primary healthcare staff assess, treat and refer people who experience issues with their vision. While training manuals and other supports have been developed to enable the delivery of primary eye care by primary healthcare staff, experiences are mixed because of knowledge and skill gaps, lack of equipment and lack of ongoing support. In some low and/or middle-income countries, mid-level ophthalmic personnel are permanently based in primary healthcare facilities. For example, in The Gambia ophthalmic nurses work in large district health centres, bridging primary health care with secondary services1.

In middle-resource and high-resource settings, specialised personnel typically provide primary eye care. Within community settings of high-income countries, primary eye care is commonly provided by optometrists, eye health specialists or ophthalmologists in the public and private sector, with access to sophisticated diagnostic equipment1.

These differences in eye care delivery within primary care highlight the challenges and opportunities to deliver higher quality eye care to people within the primary care setting.

Tailoring glaucoma treatment to the patient

When managing people with or at risk of glaucoma, their wellbeing and quality of life are of primary importance. Wellbeing and quality of life are impacted by visual function, costs and side effects of treatments, and the psychological impacts of having a progressive sight-threatening condition. Quality of life is largely determined by binocular visual function or the visual function of the best eye, while progression rates of each eye (separately) help determine treatment. Target intraocular pressure (IOP), follow-up frequency and treatment intensity should be balanced against the risk of loss of quality of life due to glaucoma6.

It is therefore important that glaucoma treatment is tailored to the patient on the basis of their individual needs, personal preferences, general health status and the rate of progression.

The following patient-specific features may influence glaucoma management6:

  • IOP at baseline and IOP reduction achieved
  • Family history
  • Severity
  • Diagnosis and type
  • Life expectancy and comorbidities

Patient information needs in glaucoma

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