Individualised treatment for glaucoma patients

Individualisation of a glaucoma patient’s management begins at diagnosis

Roibeard O’hEineachain

Posted: Monday, March 27, 2017

Professor Ingrida Januleviciene MD

Individualised treatment of glaucoma requires attention not only to the clinical parameters of the disease but also to the effect the intervention has on a patient’s day-to-day quality of life, said Professor Ingrida Januleviciene, MD, PhD, Lithuanian University of Health Sciences, Kaunas, Lithuania.
“A better understanding of patient reported quality of life can improve patient-physician interaction and thus improve treatment adherence,” she told a Glaucoma Day session at the XXXIV Congress of the ESCRS in Copenhagen.
The goal of glaucoma treatment is to maintain the patient’s visual function and related quality-of-life at a sustainable cost, she said. And while numerous studies have demonstrated that IOP-lowering can slow progression, not all treatments are equal for all patients.

Individualisation of a glaucoma patient’s management begins at diagnosis

Lifelong management
Individualisation of a glaucoma patient’s management begins at diagnosis, Dr Januleviciene said. In the case of a patient with a low risk for progression, measurements which are taken at baseline should be repeated every two years. On the other hand, a patient diagnosed with more advanced disease should be tested again at three months follow-up and then four further times over the following two years.
Setting the target IOP depends on several factors. For example in early disease the target may be higher but where there’s glaucoma damage a lower target IOP should be set. The degree of intervention should also take into account such factors as rate of progression, particularly in relation to life expectancy, the untreated IOP level and additional factors risk factors for progression, especially advanced age.
Patients lost to treatment
Treatment failure has been noted in numerous studies, but a certain proportion of that failure is down poor adherence on the part of the patient. That, in turn, results in part from a failure in communication between the physician and patient.
Studies show that approximately 50% of patients with glaucoma cannot take medication as prescribed, 41% of patients fail to undergo subsequent eye examinations after screening positive for glaucomatous disease, and 50% to 59% of patients with glaucoma diagnoses are unwilling to use follow-up eye services.
Among the factors reducing patient satisfaction with their therapy are the topical and systemic side effects of the drops and the difficulty in administering the medication and the complex regimen. Alternatives for alleviating such problems include fixed combination preparations and preservative-free drops.
“By customising treatment options based on the individual patient profile you may optimise the long-term prognosis,” Dr Januleviciene added.

Professor Ingrida Januleviciene Lithuanian University of health science, Kaunas, Lithuania