Treatment Modifications Prevalent in Patients with Open-Angle Glaucoma

Gail Schwartz, MD

Findings from a new study demonstrated high rates of treatment modifications in patients with primary open-angle glaucoma.

A team led by Gail Schwartz, MD, of Wilmer Eye Institute, Johns Hopkins University, assessed treatment patterns and ophthalmology visits in patients with at least 2 diagnoses of open-angle glaucoma ≥7 days apart and within a year. Treatments included in the analysis were topical therapy, laser trabeculoplasty, and surgical procedures.

Data was evaluated using the US healthcare insurance claims database.

Patients had their first diagnosis in 2010, with at least 30 months prior to study enrollment with no open-angle glaucoma diagnosis or related medication use (with the exception of ocular hypertension diagnosis). Furthermore, treatment patterns were evaluated over the course of 48 months.

The investigators had assessed a total of 6172 patient claims, and divided them into 4 cohorts based on initial therapy following first diagnosis:

• Drug monotherapy
• Combination drug therapy
• Glaucoma procedure
• No claims for treatment

They had defined treatment modification as an addition to or change in drug therapy or procedure.

Overall, up to 83% of patients were initiated on either drug (69.5%) or procedure (13.5%). The most common therapies were topical prostaglandin analogs (56.4%) and laser trabeculoplasty (13.8%).

Throughout the 48 months following treatment initiation, 58.3% of the 3620 patients who began with drug monotherapy required no treatment modification.

However, 43.8% of everyone who were initiated on a drug or procedure experienced a treatment modification from the first treatment. As many as 67.1% of those who required modification required further modification to a third treatment.

The investigators also noted a decline in ophthalmology visits over time regardless of first treatment. The most notable decrease, however, was in the untreated and first-treatment procedure cohorts.

“The high rates of 2 or 3 treatment modifications over the 4-year period suggest an unmet need for glaucoma therapies with durable and predictable actions,” they concluded.

In 2019, the US Food and Drug Administration (FDA) had approved Rocktalan, an eye drop administered once daily, for alleviation of intraocular pressure (IOP) in patients with open-angle glaucoma.

A fixed-dose combination of latanoprost and netarsudil, Rocklatan has been shown in 2 phase 3 studies to reduce IOP by nearly 1/3 in more than 60% of patients.

Bimatoprost implant 10 mcg (Durysta), is another therapeutic option approved by the FDA this year. This implant was the first of its kind approved for lowering IOP in open-angle glaucoma patients.

Thus, the recent additions in treatment options for open-angle glaucoma highlights this great need for addressing the severe therapeutic shortcomings noted by the investigators. 

The study, "Characteristics and Treatment Patterns of Newly Diagnosed Open-Angle Glaucoma Patients in the US: An Administrative Database Analysis," was published online in ScienceDirect.