Treatment expectations in glaucoma: what matters most to patients?

Abstract

Background/Objectives Recent clinical trials in glaucoma have used patient-reported outcome measures (PROMs) of health-related quality of life to evaluate interventions. However, existing PROMs may not be sufficiently sensitive to capture changes in health status. This study aims to determine what really matters to patients by directly exploring their treatment expectations and preferences. Subjects/Methods We conducted a qualitative study using one-to-one semi-structured interviews to elicit patients’ preferences. Participants were recruited from two NHS clinics serving urban, suburban and rural populations in the UK. To be relevant across glaucoma patients under NHS care, participants were sampled to include a full range of demographic profiles, disease severities and treatment histories. Interview transcripts were evaluated using thematic analysis until no new themes emerged (saturation). Saturation was established when 25 participants with ocular hypertension, mild, moderate and advanced glaucoma had been interviewed. Results Themes identified were: Patients’ experiences of living with glaucoma, patients’ experiences of having glaucoma treatment, most important outcomes to patients, and COVID-related concerns. Participants specifically expressed their most important concerns, which were (i) disease-related outcomes (intraocular pressure control, maintaining vision, and being independent); and (ii) treatment-related outcomes (treatment that does not change, drop-freedom, and one-time treatment). Both disease-related and treatment-related experiences were covered prominently in interviews with patients across the spectrum of glaucoma severity. Conclusions Outcomes related both to the disease and its treatment are important to patients with different severities of glaucoma. To accurately evaluate quality of life in glaucoma, PROMs may need to assess both disease-related and treatment-related outcomes.

Priorities for health outcomes in glaucoma in an ethnically diverse UK cohort: an observational study

“… 44 Second, patients were asked to make choices between health priorities, all of which had been identified as important in a previous study. 34 It may have been difficult for some patients to choose between these priorities because of ambivalence. However, choice consistency as measured by variance was excellent ( figure 2B ), suggesting that the majority of patients were clear about what really mattered most to them.…”

“…Our previous work identified outcomes related to disease and treatment that were important to patients who have glaucoma. 34 These outcomes were control of intraocular pressure (eye pressure), maintaining vision, being independent, having a one-time treatment, drop freedom (freedom from using eye drops to control eye pressure) and having a treatment that does not change. We decided to consider one additional outcome related to treatment, namely avoiding side effects of eye drops, because this outcome was coded most frequently across the previous study and was thus potentially important.…”

Rates of visual field change and functional progression in glaucoma following trabecular microbypass implantation of iStent technologies: a meta-analysis

“…6 However, the ultimate goal of glaucoma management is not to lower IOP, but to preserve patients' functional vision and quality of life. 7 While IOP is an important factor in glaucoma management, the World Glaucoma Association consensus group and others have been calling for a shift in the focus of glaucoma clinical trials towards biomarkers that better represent disease stability, such as structural, functional or even composite endpoints, in order to improve decision-making in glaucoma. 8 9 Commonly used MIGS devices include iStent technologies (Glaukos, Aliso Viejo, California, USA), which are microscale biocompatible microbypass stents designed for ab interno implantation through the trabecular meshwork.…”