Different strategies and cost-effectiveness in the treatment of primary open angle glaucoma

Ting, Naomi Sj; Yim, James F. Li; Ng, Jia Yu

doi:10.2147/ceor.s30697

Cited by 18 publications

(14 citation statements)

References 49 publications

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“…The usefulness of SLT and its possible cost-efficient character [ 12 , 48 ] thus relies upon its repeatability. Hong et al [ 39 ] published one of the first studies on repeat SLT.…”

Section: Reviewmentioning

confidence: 99%

“…More complex dosing regimens, as common in glaucoma, result in poorer adherence [ 4 , 8 , 9 , 11 ]. Administering topical medications is often problematic for elderly patients who need assistance to administer the drops or miss the eye and waste expensive medication [ 12 ]. Not properly using the prescribed drops is a major cause of visual loss in patients with glaucoma [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Long-term follow-up showed that after a few years, 68–95 % of patients returned to a higher IOP. Retreatment with ALT was found to be ineffective [ 12 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Where does selective laser trabeculoplasty stand now? A review

Keyser

Belder

et al. 2016

Eye and Vis

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BackgroundChronic treatment of glaucoma can present a challenge in patients who lack the means and/or the discipline to use daily glaucoma medication. We wondered if selective laser trabeculoplasty (SLT) could be a useful alternative.MethodsInclusion criteria: controlled trials comparing efficacy of SLT in adult patients with any form of open angle glaucoma or ocular hypertension and case reports on side effects of SLT. Two recent meta-analyses identified eight randomized clinical trials (RCTs) comparing the effect of SLT with medication (prostaglandin analogs) and with argon laser trabeculoplasty (ALT). We took these eight RCTs as reference base and calculated their success rates where they were not given. Other articles were added to elaborate on technique and side effects.ResultsMean intraocular pressure (IOP) reduction after SLT was 3.8–8.0 mmHg after 6 months to 1 year. Mean success rate of SLT at 6 months to 1 year is 55–82 %. Higher IOP before laser predicts a higher IOP-lowering effect. In terms of mean IOP reduction, reduction in number of medications and treatment success, the effect of SLT was found to show no clinically relevant difference from that of contemporary medication (prostaglandin analogs) and from ALT.ConclusionsThe evidence indicates that SLT is an efficacious primary or adjunctive therapy for treating glaucoma.

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“…The usefulness of SLT and its possible cost-efficient character [ 12 , 48 ] thus relies upon its repeatability. Hong et al [ 39 ] published one of the first studies on repeat SLT.…”

Section: Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Where does selective laser trabeculoplasty stand now? A review

Keyser

Belder

et al. 2016

Eye and Vis

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“…[15] reported that cost of nonpenetrating deep sclerotomy cost between US $305.25 to US $ 390.09 depending on the severity of glaucoma. Thus, these procedures are as or more cost effective than other options in primary open angle glaucoma seen in the study by Ting NS et al [16] …”

Section: Resultsmentioning

confidence: 93%

Comparative Analysis of Penetrating and Non-Penetrating Glaucoma Surgery in Primary Open Angle Glaucoma

Pendke¹,

Bhalgat²

2016

jemds

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OBJECTIVESPurpose analysis of safety and efficacy of Non-Penetrating Glaucoma Surgery (NPGS) for control and maintenance of intraocular pressure as compared to penetrating glaucoma surgery in Primary Open Angle Glaucoma (POAG) patients. DESIGNA hospital based randomized study. Participants 70, eyes of 70 POAG patients, 35 of which underwent NPGS and the remaining underwent Trabeculectomy surgery. MATERIALSNPGS and trabeculectomy was performed by standard surgical procedures after recording routine preoperative data. Patients were divided into 2 groups depending on the procedure they underwent. All patients were followed up after 1 week, 1 month, 3 months, 6 months and 12 months. Post-operative success was defined as IOP <21 mmHg at 1 month in absence of additional antiglaucoma medication or other treatment. RESULTSA significant reduction in intraocular pressure was observed post-surgery in both groups, changing from a preoperative mean of 31.09±7.37 mmHg and 29.26±7.10 mmHg to a postoperative mean of 15±3.06 mmHg and 14.85±4.22 mmHg respectively (P<0.001) at 12 months for trabeculectomy patients. It was seen that there was approximately constant reduction in all ranges of IOP, while for NPGS patient's best control in IOP was seen between at preoperative IOP between 21 to 30 mmHg. There was a significant difference in complications between two groups and the NPGS group had significantly less number of complications than the trabeculectomy group (p<0.05). However, the trabeculectomy group had a significantly lesser failure rate as compared to the NPGS group (p<0.05). CONCLUSIONTrabeculectomy though more effective for higher preoperative IOP, range is associated with greater risk of complications and hence for IOP range between 21 to 30 mmHg, NPGS would be the surgery of choice due to its equivalent efficacy and much greater safety standards.

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“…Preservatives inherent in these medications are known to cause corneal erosion, conjunctival injection and superficial punctate keratitis in some patients. 10,11 As therapeutic intervals increase over months to years the efficacy of anti-glaucoma drops may wane and their cost can become prohibitive to treatment. 12 Selective laser trabeculoplasty (SLT) is capable of producing the same 20-30% reduction in intraocular pressure (IOP) as medication.…”

Section: Introductionmentioning

confidence: 99%

Combined iStent® Inject Trabecular Micro-Bypass and Phacoemulsification in Australian Patients with Open-Angle Glaucoma

Salby¹,

Skalicky²

2020

OPTH

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Purpose: This retrospective audit aimed to evaluate the impact of combined iStent ® Inject (iSI) and phacoemulsification on medication number in Australians with open-angle glaucoma. Secondary outcomes included intraocular pressure (IOP), best-corrected visual acuity, refraction and visual fields. Patients and Methods: Patients with glaucoma that received combined iSI and phacoemulsification by the same surgeon between 1 February 2016 and 1 February 2018 were audited for postoperative medication number, pressures after 1 day, 1 week, 4 weeks and 6, 12, 18 and 24 months, visual acuity, refraction and visual fields. These parameters were compared to baseline levels and with those from a separate cohort of patients without glaucoma that received standalone phacoemulsification. Results: Forty-one patients (63 eyes) received the combined procedure. Thirty-four patients (59 eyes) received standalone phacoemulsification. Four weeks after receiving combined iSI and phacoemulsification the mean medication number was significantly reduced by 1.3 (p < 0.001) for those on medication at baseline and by 0.5 (p = 0.002) overall. Mean IOP was significantly reduced from baseline after 6 months (-16%; p = 0.012; n = 35) and 12 months (-29%; p = 0.004; n = 16). Patients receiving standalone phacoemulsification had short-term reductions in IOP at 4 weeks (-8%; p < 0.001; n = 57) and 6 months (-16%; p < 0.001; n = 32). These patients without glaucoma had lower pressures overall compared to those with glaucoma that received the combined procedure (p = 0.019). There were no differences in final visual acuity or refractive outcomes between groups. Conclusion: This audit suggests that iSI and phacoemulsification are at least as effective in controlling IOP as medical therapy. It may have an important role in reducing the medication burden in Australians with cataract and glaucoma. This study is one of the first to confirm refractive stability in concomitant iSI and phacoemulsification.

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Different strategies and cost-effectiveness in the treatment of primary open angle glaucoma

Cited by 18 publications

References 49 publications

Where does selective laser trabeculoplasty stand now? A review

Where does selective laser trabeculoplasty stand now? A review

Comparative Analysis of Penetrating and Non-Penetrating Glaucoma Surgery in Primary Open Angle Glaucoma

<p>Combined iStent<sup>®</sup> <em>Inject</em> Trabecular Micro-Bypass and Phacoemulsification in Australian Patients with Open-Angle Glaucoma</p>

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