March 2020

GLAUCOMA

Research Highlight
Independent living is a key outcome of glaucoma treatment for patients


by Vanessa Caceres Contributing Writer

Glaucoma specialists have a clear idea of the outcomes they would like to see in patients with medical or surgical treatment, but how do those outcomes match what patients want?
Patients are more focused on the ability to maintain an independent lifestyle, according to the results of focus group interviews led by U.K. researchers published in the British Journal of Ophthlamology.1
While IOP reduction is the usual measure of treatment success among ophthalmologists and in clinical trials in glaucoma, it’s unclear if this translates into improvements valued by patients, according to the researchers. The researchers also pointed out differing perceptions that patients may have of medical vs. surgical treatment, with the latter usually viewed as a last resort.
Researchers invited patients at the Glaucoma Service of Nottingham University Hospital, Nottingham, U.K., to take part in one of seven focus group sessions led by two researchers. There was a total of 45 participants (ages 52–90 years). Patients in three of the groups had had medical treatment only, while patients in the other four groups had previous surgical treatment. Surgical treatment was not specified, although trabeculectomy was mentioned. Patients had an overall solid understanding of IOP, visual acuity, and visual fields. Most of the patients were content with their glaucoma treatments and control of the disease.

Insights from the participants

Researchers found several themes from the focus group sessions:
• Both medical and surgical patients said they preferred using eye drops for as long as needed to avoid surgery.
• Many patients relied heavily on guidance from their physicians regarding glaucoma surgery. Patients were willing to try newer surgical treatments, if their physician said they were beneficial.
• Many patients expressed anxiety about having surgery; they were most afraid of losing eyesight and the fact that efficacy wasn’t guaranteed.
• Although patients understood and appreciated IOP control, many said that IOP reduction on its own was not a meaningful treatment outcome. They were more concerned about maintaining enough sight to live independently and pursue life’s activities.
• Patients liked the idea of fewer drops after surgery, but they felt that should be weighed against surgery’s uncertainties.
• Some patients said they were willing to accept less improvement from surgery, if that improvement was guaranteed rather than uncertain.
Tailoring patients’ treatments to suit their lifestyle requirements would have a positive impact on the perception of glaucoma treatment outcomes, the researchers said. They also said discussing surgery at an early stage of treatment could help bridge the misconception that surgery is a last resort.

Expert thoughts on the findings

Ian Saldanha, PhD, said that while the field has known for awhile that patients greatly value outcomes related to visual field, such as the ability to drive, it is interesting that patients in this study were insightful about distinctions between visual acuity and visual field. He also noted that efforts in questionnaire development for patient-important outcomes, specifically for MIGS devices, are underway.2
Howard Krauss, MD, sees a contrast between a focus among glaucoma leaders in the field to “maintain every retinal ganglion cell” often touted at meetings vs. maintaining functional vision throughout the patient’s life. “We should certainly be more concerned about preserving the adequacy of visual function than saving every retinal ganglion cell,” he said.
The biggest lesson that Dr. Krauss sees based on this study is the need to devote more adequate time to serve each patient’s individual needs. “All treatment options should be offered to patients with evidence-based outcomes analysis of risks and benefits, with the ‘benefits’ being translated to visual function outcomes rather than outcomes of statistically significant quantitative changes in perimetric or OCT analyses,” he said.
Rafael Salazar II, MHS, who has focused on patient-centered outcomes in his clinical and research work, found it notable how much patients rely on advice from their physicians. “I always tell professionals that I work with or students that I teach that the impact clinicians can have on a patient’s decision and expectations about treatment is enormous,” he said.

About the sources

Howard Krauss, MD
Director of ophthalmology
Pacific Neuroscience Institute at
Providence St. Joseph Health
Santa Monica, California

Rafael Salazar II, MHS
President and CEO
Rehab U Practice Solutions
Augusta, Georgia

Ian Saldanha, PhD
Assistant professor
Brown University
Providence, Rhode Island

References

1. Kulkarni BB, et al. Exploring patients’ expectations and preferences of glaucoma surgery outcomes to facilitate healthcare delivery and inform future glaucoma research. Br J Ophthalmol. 2019;103:1850–1855.
2. Li T, et al. Patient-reported outcomes measures and patient preferences for minimally invasive glaucoma surgical devices. Eye. 2020;34:205–210.

Relevant disclosures

Krauss
: None
Salazar: None
Saldanha: None

Contact

Krauss
: hkrauss@pacificneuro.org
Salazar: rafi@rehabupracticesolutions.com
Saldanha: ian_saldanha@brown.edu

Independent living is a key outcome of glaucoma treatment for patients Independent living is a key outcome of glaucoma treatment for patients
Ophthalmology News - EyeWorld Magazine
283 110
220 137
,
2020-03-03T08:03:05Z
True, 3