Influence of Cost of Care and Adherence in Glaucoma Management: An Update

Abstract

e costs for glaucoma care are rising worldwide. e main reason is the increase of life expectancy and the increasing variety of diagnostic tests and therapeutically options by implants and devices. How can we influence the increase in costs? Does a relationship exist between the rising costs and the behavior of patients especially in regard to adherence of patients to the prescribed therapy? Are there ways to improve adherence? e costs of a disease can be estimated by adding the direct costs and the indirect costs deriving from the disease. Many studies have been looking at the direct costs, for example, the costs of diagnostic tests and treatment modalities. Unfortunately, not many studies investigated the indirect costs, i.e., costs related to the need of a person to accompany the patient during his or her outpatient visits or the costs deriving from loss of work capacity because of the disease itself or the outpatient visits. Adherence or the synonym compliance has been discussed since many years, and it seems that it remains a major problem in the management of many chronic diseases. Despite all efforts to improve adherence, the adherence rate in chronic diseases such as glaucoma or arterial hypertension remains considerably low. One of the main factors in improving adherence is raising patient's awareness of the disease by providing general understanding of their disease. Other important factors are simplified therapeutic regimens, e.g., fixed combination drops, sustained drug release techniques, or new glaucoma surgical procedures with a more favorable risk profile.

Novel Osmoprotective DOPC-DMPC Liposomes Loaded with Antihypertensive Drugs as Potential Strategy for Glaucoma Treatment

“…The liposomes were freeze-dried after preparation. Subsequently they were dissolved in methanol, centrifuged and filtered, and the yield was calculated (1). The percentage of drug lost during the manufacturing process was calculated as the difference between the yield obtained and 100%.…”

“…Due to the special arrangement of these axons in the optic nerve head, the patient begins to lose peripheral vision, gradually turning into tube-shaped vision and finally leading to total blindness. Glaucoma is one of the main causes of blindness in the world and it is estimated that in 2040 there will be more than 111.8 million affected [ 1 , 2 ]. One of the main modifiable risk factors in glaucoma is the increase in intraocular pressure (IOP), the use of topical antihypertensive drugs being the first line of treatment in those cases [ 3 ].…”

Anterior segment imaging in minimally invasive glaucoma surgery – A systematic review

“…However, minimally invasive glaucoma surgery (MIGS) has emerged in recent years as a group of newer surgical options for glaucoma and has been described as having an ab interno, micro-incisional approach; minimal trauma to target tissue with negligible disruption of normal anatomy and physiology; at least modest efficacy; a good safety profile; and rapid recovery, with minimal impact on patient's quality of life (Saheb & Ahmed 2012). MIGS has grown steadily in popularity due to its IOP-lowering efficacy and superior safety profile compared with traditional glaucoma surgeries (Minckler et al 2005;Minckler et al 2006;Francis et al 2008;Gedde et al 2012;Jordan et al 2013;Fea et al 2014;Iordanous et al 2014;Voskanyan et al 2014;Arriola-Villalobos et al 2016;Tan & Au 2016;Ansari 2017;Chen & Sng 2017;Kerr et al 2017;Rahmatnejad et al 2017;Ahmed et al 2018;Fingeret & Dickerson 2018;Popovic et al 2018;Hassan et al 2019;Hernstadt et al 2019;Le et al 2019;Sng et al 2019;Bartelt-Hofer & Flessa 2020;Cubuk & Unsal 2020;Hong et al 2020;Ioannidis et al 2020;Kansal et al 2020;Meier-Gibbons & Toteberg-Harms 2020;Newman-Casey et al 2020). It has ignited a paradigm shift in the surgical approach to glaucoma treatment, filling in the potential treatment gap between surgery and the conservative options of medications and laser therapy.…”

Topical Treatment of Elevated Intraocular Pressure in Patients with Graves’ Orbitopathy

“…In the treatment of the elevated IOP in GO patients, routine topical hypotensive therapy can be successfully applied as for all patients with glaucoma or ocular hypertension [ 17 ]; the ideal choice of hypotensive drug seems to be important. Due to GO resulting in inflammation of the ocular surface, the ideal hypotensive drug should combine the best intraocular pressure-lowering effect with the best tolerance to ensure the patient’s compliance [ 18 , 19 , 20 ].…”